Modification of the Ilizarov external fixator for aseptic hypertrophic nonunion of the clavicle - An option for treatment

Objective: To assess the results of treatment of aseptic hypertrophic nonunion of the clavicle by external fixation using a modified Ilizarov apparatus. Design: Prospective study. Setting: A consecutive series of 12 patients from 2 specialized orthopaedic institutions, treated by the 3 senior authors. Patients: Twelve patients (5 females) with a mean age of 38.7 +/- 12.4 (range, 18-50) years with an aseptic hypertrophic nonunion of the clavicle were treated operatively during the period 1994 to 1998. Ten patients had previously been treated nonoperatively, whereas 2 had been treated surgically" the treatment in all had failed. All patients had pain with shoulder stiffness. Intervention: Patients were treated using the Ilizarov external fixation technique. The operation was performed under general anesthesia and an Ilizarov external fixator was applied percutaneously under fluoroscopic control, without a skin incision or bone grafting. The patients were then monitored clinically and radiologically for 24 to 96 (mean, 45.4) months. Main Outcome Measurements: Radiologic evaluation and clinical assessment by the Constant numerical score. Results: The mean Constant preoperative score was 30.4 +/- 9 (range, 18-44). Healing of the nonunion occurred in all patients treated by the Ilizarov technique. Nine patients had pain relief and gained unlimited range of motion, whereas 3 patients had mild pain during elevation of the arm. A mean period of 75.4 (range, 50-95) days was needed for gradual bone reduction and union. The mean Constant outcome score was 68.8 +/- 14.7 (range, 46-85). Complications: 2 patients had superficial pin infections that cleared with local therapy and antibiotics, and 1 patient had a reoperation for a nonunion after a fall onto the floor. Conclusions: Ilizarov fixation seems to be an effective method in the treatment of aseptic hypertrophic clavicle nominions, even in patients where previous surgery has failed.