Clavicle non-union - Lucy Dennell 7/11/2002Background
Definition – At least 16/52 post injury or earlier if major displacement + absence of callus. “a fracture that is not going to unite without surgical intervention”
Incidence 2% (3-5%)
S+S pain , Neuro vascular compromise
Aetiology,
high energy,open#, closed # Rx surgically, separation of fragments by > 2cm,
refracture
Author
Davids PH et al,
Title
Operative treatment for delayed union and non union of midshaft clavicular factures: AO reconstruction plate fixation and early mobilisation
Reference
The Journal of Trauma: Injury, Infection and Critical Care 40(6) June
1996, 985-986
Summary
14 pts, mean # to surgery time was 24/12, immobilized w sling for 1/52 only then began early active motion. All united, one infection. All pts asymptomatic after 10 weeks
Critique
Really a case series over 15 years. AO recon plate easier to shape + lower profile, yet strong enough to with stand early active motion
Atrophic non union of the clavicle: Treatment by compression plate, lag screw fixation and bone graft.
Author
Wu CC et al,
Title
Treatment of Clavicular aseptic non union:Comparison of Plating and im nailing techniques
Reference
The Journal of Trauma: Injury, Infection and Critical Care 45(3) Sept 98; 512-6
Summary
29 pts, fu for min 1 year, median 3 years. 11 plated/18 im Steinmann pin or threaded Knowles pins. Both groups united by 4/12, plating 81.8% solid union, im 88.9%. Claim this as the only comparative study in the literature. Conclude that on clinical and theoretical grounds im nail superior than plating except in osteoporotic bone
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