Failed Fixation of Clavicle Fracture

Clavicle fractures are common injuries. Many non-displaced clavicle fractures are successfully treated non-operatively, while displaced and shortened fractures are often treated with surgery. Fixation methods include plate osteosynthesis as the primary mode and also intramedullary fixation. Several factors contribute to the mechanical burden imparted to the implants used in primary fixation, which may ultimately lead to failed fixation. These include the deforming forces on the clavicle, including the weight of the arm and muscular attachments, and the degree of multiplanar motion the clavicle undergoes with shoulder motion. Historical plate designs were typically thin and malleable lending to fatigue failure; modern plating designs tend to be stronger and are often pre-contoured lending to more fatigue resistance and ease of plate application. Failure of fixation, when it occurs, can be related to any combination of these factors. Bilateral radiographs and computed tomography (CT) scans of the clavicle can aid in the diagnosis of failed fixation and can aid in surgical planning for revision surgery. A thorough pre-operative plan and an inventory of the necessary equipment enable a successful revision surgery. Revision surgery can be performed with various options of plate types, plate locations, plate quantities, bone graft (structural or non-structural), and augmentation with suture and tendon allografts as needed depending on the fracture morphology, fracture location, and biological needs.