Clavicle Non-Union Surgery

⚙️What This Procedure Involves

An incision is made over the clavicle along Langer's lines. The non-union site is exposed and the fibrous tissue between the bone ends is excised. The bone ends are debrided to bleeding cancellous bone. Autologous bone graft (from the iliac crest or locally) is packed around the site. A pre-contoured locking plate is applied. Occasionally the non-union involves significant bone loss requiring a structural graft or shortening. The operation takes one to one and a half hours.

💡Why It May Be Recommended

Clavicle non-union causes pain, shoulder weakness, and difficulty with overhead activities. Risk factors include initial displacement, smoking, NSAID use, and inadequate immobilisation. Non-union is defined as no healing at six months with no radiographic progression.

⚖️Non-Operative Alternatives

Continued observation (some non-unions are painless and functional), bone stimulator (limited evidence), and acceptance with activity modification.

📋Preparing for Surgery

X-rays and CT to assess the non-union gap and bone quality. Blood tests to exclude metabolic causes (vitamin D, calcium, thyroid). Smoking cessation is mandatory.

✅Expected Benefits

Union rates with plate fixation and bone grafting exceed 90–95%. Pain relief and restoration of shoulder strength and endurance.

⚠️Common Risks

• Plate prominenceCommon

  The clavicle is subcutaneous — the plate is often palpable and may need removal.

• Graft donor site painCommon

  Iliac crest discomfort.

• NumbnessCommon

  Supraclavicular nerves may be damaged, causing numbness below the scar.

🔴Less Common but Serious Risks

• Persistent non-unionUncommon

  Despite grafting and fixation. Approximately 5%.

• Plate failureUncommon

  If union is delayed.

• PneumothoraxRare

  The lung apex lies directly deep to the clavicle. Very rare.

• Subclavian vessel injuryRare

  Very rare.

• Brachial plexus injuryRare

  Very rare.

• InfectionUncommon

  Wound infection.

💉Anaesthetic Considerations

General anaesthesia. Two surgical sites if iliac crest graft.

🏃Recovery and Rehabilitation

Sling for two to four weeks. Gentle shoulder exercises from one to two weeks. Progressive strengthening from six weeks. Return to sport at three to four months. Full recovery four to six months.

📅Follow-Up

X-rays at six weeks, three months, and six months.

❓Frequently Asked Questions