Fractures of the Clavicle (original) (raw)

Abstract

Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union, and the functional outcomes are good after nonoperative treatment. ä Nonoperative treatment of displaced shaft fractures may be associated with a higher rate of nonunion and functional deficits than previously reported. However, it remains difficult to predict which patients will have these complications. ä Since a satisfactory functional outcome may be obtained after operative treatment of a clavicular nonunion or malunion, there is currently considerable debate about the benefits of primary operative treatment of these injuries. ä Displaced lateral-end fractures have a higher risk of nonunion after nonoperative treatment than do shaft fractures. However, nonunion is difficult to predict and may be asymptomatic in elderly individuals. The results of operative treatment are more unpredictable than they are for shaft fractures.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (182)

  1. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classifi- cation. J Bone Joint Surg Br. 1998;80:476-84.
  2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994;300:127-32.
  3. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002;11:452-6.
  4. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury. 2000;31:353-8.
  5. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articu- lation. J Bone Joint Surg Am. 1967;49:774-84.
  6. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br. 1988;70:461-4.
  7. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res. 1968;58:43-50.
  8. Craig EV. Fractures of the clavicle. In: Rockwood CA Jr, Matsen FA 3rd, editors. The shoulder. Philadelphia: WB Saunders; 1990. p 367-412.
  9. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86:1359-65.
  10. Lewonowski K, Bassett GS. Complete posterior sternoclavicular epiphyseal separation. A case report and review of the literature. Clin Orthop Relat Res. 1992;281:84-8.
  11. Brinker MR, Simon RG. Pseudo-dislocation of the sternoclavicular joint. J Or- thop Trauma. 1999;13:222-5.
  12. Eskola A. Sternoclavicular dislocation. A plea for open treatment. Acta Orthop Scand. 1986;57:227-8.
  13. Hanby CK, Pasque CB, Sullivan JA. Medial clavicle physis fracture with pos- terior displacement and vascular compromise: the value of three-dimensional computed tomography and duplex ultrasound. Orthopedics. 2003;26:81-4.
  14. Jougon JB, Lepront DJ, Dromer CE. Posterior dislocation of the sternoclavicular joint leading to mediastinal compression. Ann Thorac Surg. 1996;61:711-3.
  15. Barbier O, Malghem J, Delaere O, Vande Berg B, Rombouts JJ. Injury to the brachial plexus by a fragment of bone after fracture of the clavicle. J Bone Joint Surg Br. 1997;79:534-6.
  16. Chen CE, Liu HC. Delayed brachial plexus neurapraxia complicating malunion of the clavicle. Am J Orthop. 2000;29:321-2.
  17. Yates DW. Complications of fractures of the clavicle. Injury. 1976;7:189-93.
  18. Lusskin R, Weiss CA, Winer J. The role of the subclavius muscle in the sub- clavian vein syndrome (costoclavicular syndrome) following fracture of the clavicle. A case report with a review of the pathophysiology of the costoclavicular space. Clin Orthop Relat Res. 1967;54:75-83.
  19. Penn I. The vascular complications of fractures of the clavicle. J Trauma. 1964;4:819-31.
  20. Sharr JR, Mohammed KD. Optimizing the radiographic technique in clavicular fractures. J Shoulder Elbow Surg. 2003;12:170-2.
  21. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;58:29-42.
  22. Dugdale TW, Fulkerson JP. Pneumothorax complicating a closed fracture of the clavicle. A case report. Clin Orthop Relat Res. 1987;221:212-4.
  23. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7:99-106.
  24. Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure- of-eight bandage versus a simple sling. Acta Orthop Scand. 1987;58:71-4.
  25. Eskola A, Vainionpää S, Myllynen P, Pätiälä H, Rokkanen P. Outcome of clavicular fracture in 89 patients. Arch Orthop Trauma Surg. 1986;105:337-8.
  26. Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006-11.
  27. Sankarankutty M, Turner BW. Fractures of the clavicle. Injury. 1975;7:101-6.
  28. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma. 1998;12:572-6.
  29. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1-10.
  30. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am. 2003;85:790-7.
  31. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, Wild LM, Potter J. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88:35-40.
  32. Lester CW. The treatment of fractures of the clavicle. Ann Surg. 1929;89:600-6.
  33. Hoofwijk AG, van der Werken C. [Conservative treatment of clavicular frac- tures].
  34. Z Unfallchir Versicherungsmed Berufskr. 1988;81:151-6. German.
  35. Mullick S. Treatment of mid-clavicular fractures. Lancet. 1967;289:499.
  36. Wilkins RM, Johnston RM. Ununited fractures of the clavicle. J Bone Joint Surg Am. 1983;65:773-8.
  37. Böstman O, Manninen M, Pihlajamäki H. Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma. 1997;43:778-83.
  38. Wick M, Müller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121:207-11.
  39. Zenni EJ Jr, Krieg JK, Rosen MJ. Open reduction and internal fixation of clav- icular fractures. J Bone Joint Surg Am. 1981;63:147-51.
  40. Bradbury N, Hutchinson J, Hahn D, Colton CL. Clavicular nonunion. 31/32 healed after plate fixation and bone grafting. Acta Orthop Scand. 1996;67:367-70.
  41. Davids PH, Luitse JS, Strating RP, van der Hart CP. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization. J Trauma. 1996;40:985-6.
  42. Ebraheim NA, Mekhail AO, Darwich M. Open reduction and internal fixation with bone grafting of clavicular nonunion. J Trauma. 1997;42:701-4.
  43. Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management. J Bone Joint Surg Am. 1987;69:753-60.
  44. Manske DJ, Szabo RM. The operative treatment of mid-shaft clavicular non- unions. J Bone Joint Surg Am. 1985;67:1367-71.
  45. Mullaji AB, Jupiter JB. Low-contact dynamic compression plating of the clavi- cle. Injury. 1994;25:41-5.
  46. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997;79:537-9.
  47. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.
  48. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [cor- rected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602-8. Erratum in: Am J Ind Med. 1996;30:372.
  49. Jenkins PJ, Huntley JS, Robinson CM. Primary fixation of displaced clavicle fractures: unanswered questions. 2007 Mar 27. http://www.ejbjs.org/cgi/elet- ters/89/1/1#3652. Accessed 2008 Oct 31.
  50. Potter JM, Jones C, Wild LM, Schemitsch EH, McKee MD. Does delay matter? The restoration of objectively measured shoulder strength and patient-oriented outcome after immediate fixation versus delayed reconstruction of displaced mid- shaft fractures of the clavicle. J Shoulder Elbow Surg. 2007;16:514-8.
  51. Chu CM, Wang SJ, Lin LC. Fixation of mid-third clavicular fractures with Knowles pins: 78 patients followed for 2-7 years. Acta Orthop Scand. 2002;73:134-9.
  52. Coupe BD, Wimhurst JA, Indar R, Calder DA, Patel AD. A new approach for plate fixation of midshaft clavicular fractures. Injury. 2005;36:1166-71.
  53. Geckeler EO. Fractures of the clavicle in adults; Kirschner wire fixation (Murray method). Am J Surg. 1951;81:333-5.
  54. Grassi FA, Tajana MS, D'Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma. 2001;50:1096-100.
  55. Jubel A, Andermahr J, Schiffer G, Tsironis K, Rehm KE. Elastic stable intra- medullary nailing of midclavicular fractures with a titanium nail. Clin Orthop Relat Res. 2003;408:279-85.
  56. Kettler M, Schieker M, Braunstein V, König M, Mutschler W. Flexible intra- medullary nailing for stabilization of displaced midshaft clavicle fractures: tech- nique and results in 87 patients. Acta Orthop. 2007;78:424-9.
  57. Mueller M, Burger C, Florczyk A, Striepens N, Rangger C. Elastic stable intra- medullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years. Acta Orthop. 2007;78:421-3.
  58. Neviaser RJ, Neviaser JS, Neviaser TJ, Neviaser JS. A simple technique for internal fixation of the clavicle. A long term evaluation. Clin Orthop Relat Res. 1975;109:103-7.
  59. Ngarmukos C, Parkpian V, Patradul A. Fixation of fractures of the midshaft of the clavicle with Kirschner wires. Results in 108 patients. J Bone Joint Surg Br. 1998;80:106-8.
  60. Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280-4.
  61. Meier C, Grueninger P, Platz A. Elastic stable intramedullary nailing for mid- clavicular fractures in athletes: indications, technical pitfalls and early results. Acta Orthop Belg. 2006;72:269-75.
  62. Lee YS, Lin CC, Huang CR, Chen CN, Liao WY. Operative treatment of mid- clavicular fractures in 62 elderly patients: Knowles pin versus plate. Orthopedics. 2007;30:959-64.
  63. Ali Khan MA, Lucas HK. Plating of fractures of the middle third of the clavicle. Injury. 1978;9:263-7.
  64. Poigenfürst J, Rappold G, Fischer W. Plating of fresh clavicular fractures: results of 122 operations. Injury. 1992;23:237-41.
  65. Faithfull DK, Lam P. Dispelling the fears of plating midclavicular fractures. J Shoulder Elbow Surg. 1993;2:314-6.
  66. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior- inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006;20:680-6.
  67. Shen WJ, Liu TJ, Shen YS. Plate fixation of fresh displaced midshaft clavicle fractures. Injury. 1999;30:497-500.
  68. Russo R, Visconti V, Lorini S, Lombardi LV. Displaced comminuted midshaft clavicle fractures: use of Mennen plate fixation system. J Trauma. 2007;63:951-4.
  69. Kabak S, Halici M, Tuncel M, Avsarogullari L, Karaoglu S. Treatment of mid- clavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques. J Shoulder Elbow Surg. 2004;13:396-403.
  70. Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biome- chanical study. J Shoulder Elbow Surg. 2002;11:457-62.
  71. Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A. Biome- chanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma. 2008;22:241-7.
  72. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the applicability of precontoured plates. J Bone Joint Surg Am. 2007;89:2260-5.
  73. Kuner EH, Schlickewei W, Mydla F. [Surgical therapy of clavicular fractures, indications, technic, results].
  74. Hefte Unfallheilkd. 1982;160:76-83. German.
  75. Bronz G, Heim D, Pusterla C, Heim U. [Osteosynthesis of the clavicle (author's transl)].
  76. Unfallheilkunde. 1981;84:319-25. German.
  77. Freeland A. Unstable adult midclavicular fracture. Orthopedics. 1990;13:1279-81.
  78. Andermahr J, Jubel A, Elsner A, Johann J, Prokop A, Rehm KE, Koebke J. Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures. Clin Anat. 2007;20:48-56.
  79. Thumroj E, Kosuwon W, Kamanarong K. Anatomic safe zone of pin insertion point for distal clavicle fixation. J Med Assoc Thai. 2005;88:1551-6.
  80. Golish SR, Oliviero JA, Francke EI, Miller MD. A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg. 2008;3:28.
  81. Strauss EJ, Egol KA, France MA, Koval KJ, Zuckerman JD. Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:280-4.
  82. Ring D, Holovacs T. Brachial plexus palsy after intramedullary fixation of a clavicular fracture. A report of three cases. J Bone Joint Surg Am. 2005;87:1834-7.
  83. Schuind F, Pay-Pay E, Andrianne Y, Donkerwolcke M, Rasquin C, Burny F. External fixation of the clavicle for fracture or non-union in adults. J Bone Joint Surg Am. 1988;70:692-5.
  84. Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72:1262-7.
  85. Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand. 1993;64:87-91.
  86. Post M. Current concepts in the treatment of fractures of the clavicle. Clin Orthop Relat Res. 1989;245:89-101.
  87. Edwards DJ, Kavanagh TG, Flannery MC. Fractures of the distal clavicle: a case for fixation. Injury. 1992;23:44-6.
  88. Kavanagh TG, Sarkar SD. Complications of displaced fractures (Type II Neer) of the outer end of the clavicle [abstract].
  89. J Bone Joint Surg Br. 1985;67:492-3.
  90. Eskola A, Vainionpää S, Pätiälä H, Rokkanen P. Outcome of operative treat- ment in fresh lateral clavicular fracture. Ann Chir Gynaecol. 1987;76:167-9.
  91. Ghormley RK, Black JR, Cherry JH. Ununited fractures of the clavicle. Am J Surg. 1941;51:343-9.
  92. Neviaser JS. The treatment of fractures of the clavicle. Surg Clin North Am. 1963;43:1555-63.
  93. Kona J, Bosse MJ, Staeheli JW, Rosseau RL. Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma. 1990;4:115-20.
  94. Robinson CM, Cairns DA. Primary nonoperative treatment of displaced lateral fractures of the clavicle. J Bone Joint Surg Am. 2004;86:778-82.
  95. Deafenbaugh MK, Dugdale TW, Staeheli JW, Nielsen R. Nonoperative treat- ment of Neer type II distal clavicle fractures: a prospective study. Contemp Orthop. 1990;20:405-13.
  96. Rokito AS, Zuckerman JD, Shaari JM, Eisenberg DP, Cuomo F, Gallagher MA. A comparison of nonoperative and operative treatment of type II distal clavicle frac- tures. Bull Hosp Jt Dis. 2002-2003;61:32-9.
  97. Hessmann M, Kirchner R, Baumgaertel F, Gehling H, Gotzen L. Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavic- ular joint. Injury. 1996;27:47-52.
  98. Petersson CJ. Resection of the lateral end of the clavicle. A 3 to 30-year follow- up.
  99. Acta Orthop Scand. 1983;54:904-7.
  100. Ballmer FT, Gerber C. Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. J Bone Joint Surg Br. 1991;73:291-4.
  101. Fann CY, Chiu FY, Chuang TY, Chen CM, Chen TH. Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fractures. A prospective evaluation of 32 cases. J Trauma. 2004;56:1102-6.
  102. Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M. Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand. 2002;73:50-3.
  103. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg. 1997;6:380-2.
  104. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma. 2001;51:522-5.
  105. Levy O. Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. J Shoulder Elbow Surg. 2003;12:24-8.
  106. Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ. Coracoclavicular screw fixation for unstable distal clavicle fractures. Orthopedics. 2005;28:693-6.
  107. Meda PV, Machani B, Sinopidis C, Braithwaite I, Brownson P, Frostick SP. Clavicular hook plate for lateral end fractures: a prospective study. Injury. 2006;37:277-83.
  108. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using Wolter clavicular plates. J Nippon Med Sch. 2000;67:32-4.
  109. Neer CS 2nd. Fracture of the distal clavicle with detachment of the coraco- clavicular ligaments in adults. J Trauma. 1963;3:99-110.
  110. Webber MC, Haines JF. The treatment of lateral clavicle fractures. Injury. 2000;31:175-9.
  111. Yamaguchi H, Arakawa H, Kobayashi M. Results of the Bosworth method for unstable fractures of the distal clavicle. Int Orthop. 1998;22:366-8.
  112. Bezer M, Aydin N, Guven O. The treatment of distal clavicle fractures with coracoclavicular ligament disruption: a report of 10 cases. J Orthop Trauma. 2005;19:524-8.
  113. Chen CH, Chen WJ, Shih CH. Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. J Trauma. 2002;52:72-8.
  114. Flinkkilä T, Ristiniemi J, Lakovaara M, Hyvönen P, Leppilahti J. Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients. Acta Orthop. 2006;77:644-9.
  115. Haidar SG, Krishnan KM, Deshmukh SC. Hook plate fixation for type II frac- tures of the lateral end of the clavicle. J Shoulder Elbow Surg. 2006;15:419-23.
  116. Jin CZ, Kim HK, Min BH. Surgical treatment for distal clavicle fracture as- sociated with coracoclavicular ligament rupture using a cannulated screw fixation technique. J Trauma. 2006;60:1358-61.
  117. Kashii M, Inui H, Yamamoto K. Surgical treatment of distal clavicle fractures using the clavicular hook plate. Clin Orthop Relat Res. 2006;447:158-64.
  118. Kalamaras M, Cutbush K, Robinson M. A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique. J Shoulder Elbow Surg. 2008;17:60-2.
  119. Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA. Treatment of distal clavicle fractures using an arthroscopic technique. J Shoulder Elbow Surg. 2008;17:395-8.
  120. Wang SJ, Wong CS. Transacromial extra-articular Knowles pin fixation treat- ment of acute type V acromioclavicular joint injuries. J Trauma. 2008;65:424-9.
  121. Bosworth BM. Acromioclavicular separation. New method of repair. Surg Gynecol Obstet. 1941;73:866-71.
  122. Poigenfürst J, Baumgarten-Hofmann U, Hofmann J. [Unstable fractures of the lateral end of the clavicle and principles of their treatment]. Unfallchirurgie. 1991;17:131-9. German.
  123. Faraj AA, Ketzer B. The use of a hook-plate in the management of acromio- clavicular injuries. Report of ten cases. Acta Orthop Belg. 2001;67:448-51.
  124. Nadarajah R, Mahaluxmivala J, Amin A, Goodier DW. Clavicular hook-plate: complications of retaining the implant. Injury. 2005;36:681-3.
  125. Qureshi F, Potter D. The use of the arthroscopic tightrope in shoulder injuries. 2005. http://www.opnews.com/articles/145/articles.php#3\. Accessed 2008 Nov 27.
  126. Nourissat G, Kakuda C, Dumontier C, Sautet A, Doursounian L. Arthroscopic stabilization of Neer type 2 fracture of the distal part of the clavicle. Arthroscopy. 2007;23:674.e1-4.
  127. Pujol N, Philippeau JM, Richou J, Lespagnol F, Graveleau N, Hardy P. Ar- throscopic treatment of distal clavicle fractures: a technical note. Knee Surg Sports Traumatol Arthrosc. 2008;16:884-6.
  128. Franck WM, Siassi RM, Hennig FF. Treatment of posterior epiphyseal disruption of the medial clavicle with a modified Balser plate. J Trauma. 2003;55:966-8.
  129. Brinker MR, Bartz RL, Reardon PR, Reardon MJ. A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation. J Orthop Trauma. 1997;11:378-81.
  130. Brinker MR, Edwards TB, O'Connor DP. Estimating the risk of nonunion fol- lowing nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2005;87:676-7.
  131. Der Tavitian J, Davison JN, Dias JJ. Clavicular fracture non-union surgical outcome and complications. Injury. 2002;33:135-43.
  132. Johnson EW Jr, Collins HR. Nonunion of the clavicle. Arch Surg. 1963;87:963-6.
  133. Kay SP, Eckardt JJ. Brachial plexus palsy secondary to clavicular nonunion. Case report and literature survey. Clin Orthop Relat Res. 1986;206:219-22.
  134. Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma. 2002;52:393-9.
  135. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg. 2004;13:479-86.
  136. Ballmer FT, Lambert SM, Hertel R. Decortication and plate osteosynthesis for nonunion of the clavicle. J Shoulder Elbow Surg. 1998;7:581-5.
  137. Boehme D, Curtis RJ Jr, DeHaan JT, Kay SP, Young DC, Rockwood CA Jr. Non- union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am. 1991;73:1219-26.
  138. Boyer MI, Axelrod TS. Atrophic nonunion of the clavicle: treatment by com- pression plate, lag-screw fixation and bone graft. J Bone Joint Surg Br. 1997;79:301-3.
  139. Capicotto PN, Heiple KG, Wilbur JH. Midshaft clavicle nonunions treated with intramedullary Steinman pin fixation and onlay bone graft. J Orthop Trauma. 1994;8:88-93.
  140. Eskola A, Vainionpää S, Myllynen P, Pätiälä H, Rokkanen P. Surgery for un- united clavicular fracture. Acta Orthop Scand. 1986;57:366-7.
  141. Hoe-Hansen CE, Norlin R. Intramedullary cancellous screw fixation for non- union of midshaft clavicular fractures. Acta Orthop Scand. 2003;74:361-4.
  142. Karaharju E, Joukainen J, Peltonen J. Treatment of pseudarthrosis of the clavicle. Injury. 1982;13:400-3.
  143. Laursen MB, Døssing KV. Clavicular nonunions treated with compression plate fixation and cancellous bone grafting: the functional outcome. J Shoulder Elbow Surg. 1999;8:410-3.
  144. Marti RK, Nolte PA, Kerkhoffs GM, Besselaar PP, Schaap GR. Operative treatment of mid-shaft clavicular non-union. Int Orthop. 2003;27:131-5.
  145. O'Connor D, Kutty S, McCabe JP. Long-term functional outcome assessment of plate fixation and autogenous bone grafting for clavicular non-union. Injury. 2004;35:575-9.
  146. Olsen BS, Vaesel MT, Søjbjerg JO. Treatment of midshaft clavicular nonunion with plate fixation and autologous bone grafting. J Shoulder Elbow Surg. 1995;4:337-44.
  147. Pedersen M, Poulsen KA, Thomsen F, Kristiansen B. Operative treatment of clavicular nonunion. Acta Orthop Belg. 1994;60:303-6.
  148. Pyper JB. Non-union of fractures of the clavicle. Injury. 1978;9:268-70.
  149. Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques. J Trauma. 1998;45:512-6.
  150. Rosenberg N, Neumann L, Wallace AW. Functional outcome of surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures. J Shoulder Elbow Surg. 2007;16:510-3.
  151. Khan SA, Shamshery P, Gupta V, Trikha V, Varshney MK, Kumar A. Locking compression plate in long standing clavicular nonunions with poor bone stock. J Trauma. 2008;64:439-41.
  152. Nowak J, Rahme H, Holgersson M, Lindsjö U, Larsson S. A prospective comparison between external fixation and plates for treatment of midshaft non- unions of the clavicle. Ann Chir Gynaecol. 2001;90:280-5.
  153. Manske DJ, Szabo RM. The operative treatment of mid-shaft clavicular non- unions. J Bone Joint Surg Am. 1985;67:1367-71.
  154. Ring D, Jupiter JB, Sanders RA, Quintero J, Santoro VM, Ganz R, Marti RK. Complex nonunion of fractures of the femoral shaft treated by wave-plate osteo- synthesis. J Bone Joint Surg Br. 1997;79:289-94.
  155. Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK. Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg Br. 2000;82:867-71.
  156. Krishnan KG, Mucha D, Gupta R, Schackert G. Brachial plexus compression caused by recurrent clavicular nonunion and space-occupying pseudoarthrosis: definitive reconstruction using free vascularized bone flap-a series of eight cases. Neurosurgery. 2008;62(5 Suppl 2):ONS461-70.
  157. Erdmann D, Pu CM, Levin LS. Nonunion of the clavicle: a rare indication for vascularized free fibula transfer. Plast Reconstr Surg. 2004;114:1859-63.
  158. Momberger NG, Smith J, Coleman DA. Vascularized fibular grafts for salvage reconstruction of clavicle nonunion. J Shoulder Elbow Surg. 2000;9:389-94.
  159. Choudry UH, Bakri K, Moran SL, Karacor Z, Shin AY. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony non- unions. Ann Plast Surg. 2008;60:174-80.
  160. Fuchs B, Steinmann SP, Bishop AT. Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle. J Shoulder Elbow Surg. 2005;14:264-8.
  161. O'Rourke IC, Middleton RW.The place and efficacy of operative management of fractured clavicle. Injury. 1975;6:236-40.
  162. Papineau LJ. [Excision-graft with deliberately delayed closing in chronic osteomyelitis]. Nouv Presse Med. 1973;2:2753-5. French.
  163. Vidal J, Buscayret C, Connes H, Melka J, Orst G. Guidelines for treatment of open fractures and infected pseudarthroses by external fixation. Clin Orthop Relat Res. 1983;180:83-95.
  164. Edelson JG. The bony anatomy of clavicular malunions. J Shoulder Elbow Surg. 2003;12:173-8.
  165. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. Surgical technique. J Bone Joint Surg Am. 2004;86 Suppl 1:37-43.
  166. Chan KY, Jupiter JB, Leffert RD, Marti R. Clavicle malunion. J Shoulder Elbow Surg. 1999;8:287-90.
  167. Nordqvist A, Redlund-Johnell I, von Scheele A, Petersson CJ. Shortening of clavicle after fracture. Incidence and clinical significance, a 5-year follow-up of 85 patients. Acta Orthop Scand. 1997;68:349-51.
  168. Oroko PK, Buchan M, Winkler A, Kelly IG. Does shortening matter after cla- vicular fractures? Bull Hosp Jt Dis. 1999;58:6-8.
  169. Bosch U, Skutek M, Peters G, Tscherne H. Extension osteotomy in malunited clavicular fractures. J Shoulder Elbow Surg. 1998;7:402-5.
  170. Simpson NS, Jupiter JB. Clavicular nonunion and malunion: evaluation and surgical management. J Am Acad Orthop Surg. 1996;4:1-8.
  171. Wilkes RA, Halawa M. Scapular and clavicular osteotomy for malunion: case report. J Trauma. 1993;34:309.
  172. Bateman JE. Neurovascular syndromes related to the clavicle. Clin Orthop Relat Res. 1968;58:75-82.
  173. Connolly JF, Dehne R. Nonunion of the clavicle and thoracic outlet syndrome. J Trauma. 1989;29:1127-33.
  174. Howard FM, Shafer SJ. Injuries to the clavicle with neurovascular complica- tions. A study of fourteen cases. J Bone Joint Surg Am. 1965;47:1335-46.
  175. Kitsis CK, Marino AJ, Krikler SJ, Birch R. Late complications following cla- vicular fractures and their operative management. Injury. 2003;34:69-74.
  176. Bargar WL, Marcus RE, Ittleman FP. Late thoracic outlet syndrome secondary to pseudarthrosis of the clavicle. J Trauma. 1984;24:857-9.
  177. Fujita K, Matsuda K, Sakai Y, Sakai H, Mizuno K. Late thoracic outlet syn- drome secondary to malunion of the fractured clavicle: case report and review of the literature. J Trauma. 2001;50:332-5.
  178. Miller DS, Boswick JA Jr. Lesions of the brachial plexus associated with fractures of the clavicle. Clin Orthop Relat Res. 1969;64:144-9.
  179. Leffert RD. Thoracic outlet syndrome. In: Operative nerve repair and recon- struction. Gelberman RH, editor. Philadelphia: JB Lippincott; 1991. p 1177-95.
  180. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87:1446-55.
  181. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active com- pression test: a new and effective test for diagnosing labral tears and acromio- clavicular joint abnormality. Am J Sports Med. 1998;26:610-3.
  182. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972;54:1187-94.