Malunion occurs when the clavicle has united in a shortened or severely angulated position. Nonunion occurs when there is no bony union of the clavicle after 6 months of sustaining the fracture regardless of undergoing surgery or not. Various reasons can lead to these two problems. These include fracture factors such as: comminution or an initial open fracture. Patient factors such as: smoking, non compliance or immunosuppression. Technical factors that can play a role include: too short a plate, rigid fixation not obtained or plate/screw failure. A malunion / nonunion can lead to chronic pain and abnormal biomechanics of the shoulder girdle.
Procedure duration: This is dependent on what is required to address the problem. Theatre time can range anything from 45minutes to 120 minutes. Removal of hardware can be time consuming. Harvesting of autogenous bone graft from the iliac crest in non union cases can add also add additional time
Post operative rehabilitation: A sling should be worn for 4-6 weeks to allow bony union. Rehabilitation with a physiotherapist is also indicated.
