Novel method to treat sterno-clavicular joint instability and medial clavicle fracture symptomatic nonunion

Background

Stabilization of the medial clavicle is traditionally associated with relatively high complication and failure rate. This is a retrospective, case series study to assess outcome of a novel two-stage surgical treatment of sterno-clavicular joint instability or symptomatic medial clavicle fracture non-union.

Methods

Between 1997 and 2007, 9 consecutive patients with an average age of 35 years were treated by a staged surgical treatment, six with sterno-clavicular joint instability, and three with symptomatic medial clavicle nonunion. The first stage involved fixation of the medial clavicle and mid-clavicle osteotomy to offload the fixation and a second stage, at an average of four months, to remove the medial clavicle fixation and fix the mid-clavicle osteotomy with a plate. Average follow-up was 41 months (range, 7-127).

Results

All sterno-clavicular joints were satisfactorily stabilized and all fracture non-unions united. There was no complication from the medial clavicular hardware. The average Constant score was 75 (average Constant score for the unaffected shoulder was 86) and the average quick DASH score was 14.96. All patients were very satisfied with the treatment and outcome.

Conclusion

We cautiously recommend this method to experienced surgeons. A larger number of patients is required to endorse wider generalization of the results.

Keywords: Sterno-clavicular joint, medial clavicle fracture, instability, non-union, osteotomy, Constant score