Cic edizioni internazionali
Clinical Cases in mineral and bone metabolism

The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?

Case report, 372 - 378
doi: 10.11138/ccmbm/2017.14.3.372
Tag this article
Abstract
Enhanced HTML Full text PDF
Introduction. The nonunion rate has been reported between 0.1% and 15%. There are also several predisposing factors for the onset of complications: general factors connected with the patient and specific factors related to the fracture site. The purpose of our study is to review the etiology of nonunion of the clavicle in its atrophic form and investigate the outcomes of the revision treatment in a single step.
Materials and methods. Retrospective study on 71 patients suffering from nonunions due to the following treatments: conservative in 13 patients; plate fixation in 12; closed reduction and fixation with K-wire in 24; open reduction and fixation with K-wire. All patients were operated on in beach chair position and classic approach to the clavicle by incising the previous surgical scar. The clinical and radiographic criteria for evaluating the outcomes were: the Short Form (12) Health Survey (SF-12), the Constant Shoulder Score (CSS) and the Disability Disabilities of the Arm, Shoulder and Score (DASH) and radiographic Union Score (RUS) for bone healing. The evaluation endpoint was set at 12 months.
Results. Blood and culture tests showed 22 infected nonunions and 49 atrophic or oligoatrophic. In only 10 cases, before surgery, the inflammatory markers were positive. The isolated microorganisms were resistant to common antibiotics. In 70 out of 71 cases, plates and screws on the upper side and fibula allogenic splints at the bottom, associated with cancellous bone grafts taken from the patients’ iliac crests, were implanted. In one case, however, it was decided to implant the plate on the front edge of the clavicle and the fibula allogeneic splint on the posterior margin, also associated with a cancellous bone graft taken from the patient’s iliac crest. The radiographic bone healing was observed in 107.8 (range 82-160) days for the aseptic nonunions, while in 118.4 (range 82-203) days for the septic ones. The non-healing case was a serious failure that led to asubtotal excision of the clavicle.
Conclusions. The importance of classification and study of nonunions are essential to achieve positive outcomes.
The guiding principle of our work is that aseptic nonunions heal in the operating room, while infected nonunions can be challenged and defeated on the operating table. Restoring the correct length of the clavicle interconnection between the sternum and the shoulder cingulum is indispensable to avoid functional deficits of the upper limb. The fibula splint and the tricorticale bone graft have both mechanical and strong biological values to quickly heal the nonunion.The return to pre-injury quality of life has to be our main goal.

Vol. XIV (No. 3) 2017 October - December

  1. From the Editor-in-Chief
    Brandi M.L.
    doi: 10.11138/ccmbm/2017.14.3.279
  2. The effect of strontium chloride on human periodontal ligament stem cells
    Romagnoli C., Zonefrati R., Galli G., Aldinucci A., Nuti N., Martelli F.S., Tonelli P., Tanini A., Brandi M.L.
    doi: 10.11138/ccmbm/2017.14.3.283
  3. Lower limbs heterometry correction in patients with osteoporosis and increased risk of falls
    Pratelli E., Alito A., Zanella C., Busi L., Mangone G., Scarselli M., Pasquetti P.
    doi: 10.11138/ccmbm/2017.14.3.294
  4. Grafting and fixation of proximal humeral aseptic non union: a prospective case series
    Rollo G., Rotini R., Pichierri P., Giaracuni M., Stasi A., Macchiarola L., Bisaccia M., Meccariello L.
    doi: 10.11138/ccmbm/2017.14.3.298
  5. Effect of combined treatment with focused mechanoacoustic vibration and pharmacological therapy on bone mineral density and muscle strength in post-menopausal women
    Saggini R., Ancona E., Carmignano S.M., Supplizi M., Barassi G., Bellomo R.G.
    doi: 10.11138/ccmbm/2017.14.3.305
  6. Hypothyrodism as a risk factor of periodontitis and its relation with vitamin D deficiency: mini-review of literature and a case report
    Yussif N.M., El-Mahdi F.M., Wagih R.
    doi: 10.11138/ccmbm/2017.14.3.312
  7. Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature
    Toro G., Moretti A., Toro G., Tirelli A., Calabrò G., Toro A., Iolascon G.
    doi: 10.11138/ccmbm/2017.14.3.317
  8. Atypical femur fractures: a distinctive tract of adult hypophosphatasia
    Marini F., Brandi M.L.
    doi: 10.11138/ccmbm/2017.14.3.324
  9. Pitfalls in interpreting interventional studies for osteoporosis
    Shafi Kuchay M., Bansal B., Mithal A.
    doi: 10.11138/ccmbm/2017.14.3.329
  10. Secondary aneurysmal bone cyst in McCune-Albright syndrome
    Tournis S., Balanika A., Megaloikonomos P.D., Mavrogenis A.F.
    doi: 10.11138/ccmbm/2017.14.3.332
  11. Actual reason for bone fractures in the case of a patient followed-up with the osteogenesis imperfecta: Gaucher’s Disease
    Demirci U., Çizmecioglu A., Aydogdu I.
    doi: 10.11138/ccmbm/2017.14.3.336
  12. Calcitriol-mediated hypercalcemia secondary to granulomatous disease caused by soft-tissue filler injection: a case report
    Noreña J.A., Niño C.D., Gallego S., Builes-Barrera C.A., Castro D.C., Román-González A., Jimenez C.
    doi: 10.11138/ccmbm/2017.14.3.340
  13. Adult-onset hypophosphatasia diagnosed following bilateral atypical femoral fractures in a 55-year-old woman
    Lawrence J.E., Saeed D., Bartlett J., Carrothers A.D.
    doi: 10.11138/ccmbm/2017.14.3.347
  14. Neonatal severe hyperparathyroidism secondary to a novel homozygous CASR gene mutation
    Ahmad N., Bahasan M., Abdulhadi Abdullah Al-Ghamdi B., Al-Enizi H.F., Al-Zahrani A.S.
    doi: 10.11138/ccmbm/2017.14.3.354
  15. Glomus tumor as a cause of oncogenic osteomalacia
    Dehghani M., Dabbaghmanesh M.H., Khalafi-Nezhad A., Riazmontazer N., Dehghanian A., Vojdani R., Sasani M.
    doi: 10.11138/ccmbm/2017.14.3.359
  16. Femur shaft fracture following osteoid osteoma radiofrequency ablation
    Mazzawi E., Militianu D., Eidelman M., Keren Y.
    doi: 10.11138/ccmbm/2017.14.3.363
  17. Subtrochanteric femoral stress fracture with features of atypical femoral fracture in patient with Paget’s disease: a case report
    Lee Y.-K., Kim H.S., Cho H.S., Koo K.-H.
    doi: 10.11138/ccmbm/2017.14.3.368
  18. The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?
    Rollo G., Pichierri P., Marsilio A., Filipponi M., Bisaccia M., Meccariello L.
    doi: 10.11138/ccmbm/2017.14.3.372
Last Viewed articles: la lista degli ultimi x visitati.
  1. The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?
    Rollo G., Pichierri P., Marsilio A., Filipponi M., Bisaccia M., Meccariello L.
    doi: 10.11138/ccmbm/2017.14.3.372
credits