Malunion Of The Clavicle - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes malunion of the clavicle, explains the etiology and treatment of this condition and tells you all you need to know about it.
Regardless of a sling or figure 8 strap is used, the clavicle will heal.
The clavicle will heal despite the fracture displacement.
There will be deforming forces in the midshaft area of the clavicle.
Despite the presence of a bump, fracture displacement and deformity, healing of the fracture still occurs rapidly.
Healing occurs in about 85% of the cases; however the clavicle will not look aligned due to difficulty in reduction of the fracture.
It is hard to achieve reduction of the fracture without surgery.
Without surgical reduction, the fracture may end with some degree of malunion and possible of the clavicle.
The fragments will not line up with the distal fragment appearing to be downward and anteriorly rotated.
Shortening is clinically significant because it alter the dynamics of the muscles around the shoulder.
It also narrows the costoclavicular space.
The patient may complain of decreased shoulder strength and endurance if the patient had a displaced midshaft clavicle fracture that healed with more than healed with more than 2 cm of shortening.
What are the symptoms of clavicle malunion?
- Pain
- Easy fatigability
- Cosmetic problems (especially in females)
- Neurological dysfunction (possible involvement of the brachial plexus- especially the ulnar nerve)
- Patient may have thoracic outlet syndrome.
X-ray:
- Get x-ray of both shoulders: bilateral panoramic views to measure the shortening.
- Check the amount of overlap at the clavicle.
Treatment:
- Surgical treatment of the malunion may be successful in restoring the function and relieving the pain.
- Clavicle osteotomy is done in the plane of the healed fracture.
- The fracture is recreated with correction of the deformity and the length of the clavicle is restored.
- If an osteotomy is done with reduction of the clavicle to its preinjury position and this leaves a significant bone defect, then you will need a tricortical piece of bone at the osteotomy area.
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