Clavicle fractures may not heal correctly for a variety of reasons ranging from chronic disease, diabetes, anemia, hypothyroidism, age, smoking and poor nutrition to improper early activity and infection. A nonunion indicates a lack of fracture healing while a malunion is healing of the fracture in improper alignment. Without intervention, most nonunions and some malunions will continue to cause pain and physical limitations. Surgery to stimulate, stabilize and bone graft the fracture is sometimes necessary to promote proper fracture healing in acceptable alignment.
Surgery consists of making a small open incision over the clavicle, taking down the extra scar tissue, “freshening up” the ends of the non-united bones, repositioning the fracture fragments, bone grafting and stabilizing the fracture in proper alignment with plates and screws. After fracture healing, these fixation devices may be removed if needed. During surgery, X-ray is used to ensure that all fragments are appropriately aligned.You may return to unlimited activities when there is no pain and full shoulder range of motion, muscle strength and endurance, and the fracture is healed. This usually requires three months following a midshaft clavicle ORIF. Dr. Chudik will clear patients to resume all activities.
Nonunion of clavicular fracture with incomplete healing, over three months post-injury
Contraindications to Surgery
- Infection
- Shoulder stiffness
- Patients with poor general health (not advised to proceed with surgery)