ORIF of clavicle nonunion

Osteosynthesis of clavicular pseudoarthrosis is a surgical procedure used to treat a clavicle fracture that has failed to heal within the expected period and has progressed to pseudoarthrosis.

The aim of the procedure is to restore bone continuity and stabilize the clavicular fragments, creating the conditions necessary for bone healing and recovery of upper-limb function.

Depending on the location and characteristics of the pseudoarthrosis, as well as the condition of the bone tissue, the physician may use osteosynthesis materials such as plates and screws. In some cases, the procedure may include the use of a bone graft or another bone substitute material.

The surgical technique and fixation materials are selected individually, taking into account the specific clinical case and the results of imaging studies.

Indications

• clavicular pseudoarthrosis following a fracture;
• failure of bone healing within the expected period;
• persistent pain in the clavicular region associated with non-union;
• abnormal mobility at the fracture site;
• deformity or shortening of the clavicle associated with pseudoarthrosis;
• impaired upper-limb function caused by pseudoarthrosis;
• cases in which surgical treatment is recommended by an orthopedic trauma surgeon.

Procedure

Before the procedure, the patient is evaluated by an orthopedic trauma surgeon. The results of imaging studies and the patient’s general health are assessed, after which the physician determines the surgical technique and the required type of fixation.

The procedure is performed under anesthesia, with the type of anesthesia determined by the anesthesiologist according to the specifics of the procedure and the patient’s health status.

During surgery, a surgical approach to the clavicle is performed, and the pseudoarthrosis site is prepared to restore contact between the bone fragments. The fragments are repositioned and stabilized using osteosynthesis materials, usually plates and screws.

Depending on the clinical situation, a bone graft or bone substitute material may be used to promote bone healing.

At the end of the procedure, the surgical wound is closed and a dressing is applied. The duration of the procedure and hospital stay depend on the complexity of the case and the patient’s condition.

Limitations

• Bone healing after surgery takes time and may vary depending on the patient’s age, bone quality, type of pseudoarthrosis and adherence to postoperative recommendations.
• The procedure does not guarantee bone healing in all cases.
• Movement and physical activity may need to be restricted until bone healing occurs.
• A gradual return to usual activities is recommended according to the physician’s instructions and the results of follow-up imaging studies.
• In some cases, additional treatment or repeat surgery may be required if bone healing is not achieved.

Contraindications

Contraindications to the procedure are determined individually by the physician and may include:

• active infection at the surgical site;
• acute or decompensated conditions that increase anesthetic or surgical risk;
• severe uncorrected coagulation disorders;
• temporary inability to safely perform the procedure;
• other contraindications identified during the preoperative assessment.

The decision to perform the procedure is made after assessing the potential benefits and risks of treatment.

Advantages

• restoration of the mechanical stability of the clavicle;
• realignment and fixation of the bone fragments;
• creation of favorable conditions for bone healing;
• possibility of correcting deformity associated with pseudoarthrosis;
• reduction of abnormal mobility and, where indicated, pain relief;
• possibility of gradual recovery of upper-limb function.