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Clavicular Nonunion and Malunion: Evaluation and Surgical Management

Massachusetts General Hospital, Boston.

Nonunions and malunions of the clavicle are uncommon but can be disabling. Pain, limitation of shoulder mobility, or local compression of the brachial plexus can produce profound functional impairment. Nonunions usually are associated with more severe fractures, open injuries, or failures of operative treatment. Reconstructive procedures are focused on gaining union and restoring clavicular anatomy-most often achieved with plates and screws and autogenous bone graft. Salvage procedures include excision of a bony prominence, partial or total clavicular resection, and resection of the first rib. While most patients with a malunited clavicular fracture are asymptomatic, osteotomy and correction of the deformity should be considered when there is associated functional or neurovascular impairment.