Refracture of a malunited clavicle: angular deformity as an under-recognized biomechanical risk factor
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20260531Keywords:
Clavicle fracture, Malunion, Refracture, Angulation, BiomechanicsAbstract
Angular deformity in clavicle fractures is often considered acceptable in adults when displacement and significant shortening are absent. However, altered biomechanics resulting from angular malunion may predispose to refracture. We report a 40-year-old male with a previously malunited clavicle fracture treated non-operatively who sustained a refracture following minor trauma. After failure of conservative management, open reduction and internal fixation with a clavicular reconstruction plate was performed. This case highlights angular malunion as an under-recognized biomechanical risk factor for clavicle refracture in adults and suggests that angular deformity should be considered during initial fracture assessment.
Metrics
References
Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2007;89(1):1-10. DOI: https://doi.org/10.2106/JBJS.F.00020
McKee MD, Whelan DB, Schemitsch EH, Michael D. Operative versus nonoperative care of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2012;94(8):675-84. DOI: https://doi.org/10.2106/JBJS.J.01364
Xu J, Xu L, Xu W, Yudong G, Jianguang X. Operative versus nonoperative treatment of midshaft clavicular fractures. J Shoulder Elbow Surg. 2014;23(2):173-81. DOI: https://doi.org/10.1016/j.jse.2013.06.025
Masnovi ME, Mehlman CT, Eismann EA, Douglas AM. Pediatric refracture rates after angulated clavicle fractures. J Orthop Trauma. 2014;28(11):648-52. DOI: https://doi.org/10.1097/BOT.0000000000000135
Chalmers PN, Van Thiel GS, Ferry ST. Is skin tenting secondary to displaced clavicle fracture more than a theoretical risk? Am J Orthop. 2015;44:E414-6.
De Giorgi S, Notarnicola A, Tafuri S, Giuseppe S, Lorenzo M, Biagio M. Conservative treatment of clavicle fractures. BMC Res Notes. 2011;4:333. DOI: https://doi.org/10.1186/1756-0500-4-333
McKee MD, Pedersen EM, Jones C, David JGS, Hans JK, Emil HS, et al. Deficits following nonoperative treatment of displaced clavicle fractures. J Bone Joint Surg Am. 2006;88(1):35-40. DOI: https://doi.org/10.2106/00004623-200601000-00005
Sankarankutty M, Turner BW. Fractures of the clavicle. Injury. 1975;7(2):101-6. DOI: https://doi.org/10.1016/0020-1383(75)90006-6
Ledger M, Leeks N, Ackland T, Wang A. Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg. 2005;14(4):349-54. DOI: https://doi.org/10.1016/j.jse.2004.09.011
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment. J Bone Joint Surg Am. 2004;86(7):1359-65. DOI: https://doi.org/10.2106/00004623-200407000-00002
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third clavicle fractures gives poor
results. J Shoulder Elbow Surg. 1997;6(9):428-33. DOI: https://doi.org/10.1016/S1058-2746(97)90080-X
Mathieu PA, Marcheix PS, Hummel V, Denis V, Christian M. Anatomical study of the clavicle. Surg Radiol Anat. 2014;36(1):11-5. DOI: https://doi.org/10.1007/s00276-013-1140-2