Extension osteotomy in malunited clavicular fractures

Most fractures of the clavicle heal well with nonoperative treatment. On rare occasions, malunited clavicular fractures are associated with a pattern of disability that includes not only pain but also functional or neurovascular impairment. In these cases, clavicular osteotomy and correction of the deformity should be considered. In four patients with a malunited fracture of the clavicle following nonoperative treatment, we performed a clavicular osteotomy for deformity. In all four patients the clavicular fracture healed with shortening associated with pain and ipsilateral glenohumeral dysfunction. The deformity was not associated with neurovascular dysfunction. In preoperative X-ray studies, the shortening of the malunited clavicle was between 0.9 and 2.2 cm in comparison to the contralateral clavicle. All patients underwent an extension osteotomy of the clavicle with interposition of an autogenous iliac crest bone graft. The follow-up was 1-4 years postoperatively. The functional outcome was evaluated using the Constant-Murley and the UCLA score. All patients had immediate pain relief following osteotomy and correction of the deformity. The shoulder function rapidly improved, and the functional outcome was good in three out of the four patients. If there is associated functional impairment in malunited clavicular fractures, extension osteotomy combined with autogenous bone grafting may produce predictably good results.