Chronic Clavicular Malunion Treated with Corrective Osteotomy

Case Report

Austin J Orthopade & Rheumatol. 2016; 3(2): 1031.

Chronic Clavicular Malunion Treated with Corrective Osteotomy

Sally Corey, Shaw KA* and Terry Mueller

Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, USA

*Corresponding author: K. Aaron Shaw, Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Georgia, USA

Received: June 04, 2016; Accepted: July 20, 2016; Published: July 21, 2016


The standard of care for the majority of mid-shaft clavicle fractures is nonoperative management, especially in the pediatric and adolescent population. Although a degree of malunion can be expected in nearly every displaced midshaft clavicle fracture treated non-operatively, most are asymptomatic. Recent emphasis on patient-reported outcome measures reveal symptomatic clavicular malunions are more prevalent than previously believed. We report a case of a chronic clavicular malunion following multiple clavicular fractures sustained during childhood, treated with a corrective osteotomy nineteen years following injury.

Keywords: Clavicle fracture; Malunion; Corrective osteotomy


Clavicle fractures are common, representing approximately 5% of all fractures, the majority occurring in the mid-shaft region [1]. In adults, indications for operative intervention include shortening of >1.5cm, skin tenting, neurovascular compromise, and open fractures [2], although these remain controversial [3]. Most fractures treated operatively will have satisfactory results; however, one in four will require a reoperation [4]. In patients who do not receive initial operative intervention, some degree of malunion does occur and can become symptomatic [5]. Prevention of symptomatic malunion with surgical intervention remains a controversial topic [6].

In this article, we report the case of a chronic clavicular malunion following multiple clavicle fractures sustained in childhood, resulting in shoulder dysfunction, as well as a delibitating cosmetic deformity in adulthood. She underwent a corrective osteotomy with resultant improvement in shoulder function 19 years following the most recent injury. The patient provided consent for print and electronic publication of this case report.

Case Presentation

A 34-year-old right hand-dominant female was evaluated in the orthopaedic clinic for right shoulder pain and dysfunction. She reported a history of 5 fractures to the right clavicle since the age of 9, with the most recent occurring at the age of 15. These injuries resulted in a noticeable deformity about the shoulder and clavicle. She had been treated with non-operative management for all fractures, consisting of sling immobilization followed by progressive return to activity. The patient experienced persistent pain and right shoulder dysfunction which progressed throughout adulthood to the extent that she would not use her right upper extremity. Her shoulder pain was activity related, but absent with rest. She had no complaints of distal neurovascular aberration or thoracic outlet syndrome. She was particularly concerned with the cosmetic deformity of the shoulder and had sought care from multiple orthopaedic surgeons due to her shoulder dysfunction but was repeatedly counseled against surgical intervention.

On physical exam, there was an obvious deformity to her clavicle, with the shoulder held protracted. Asymmetry in the height of her shoulders is present with inferior displacement of the affected shoulder. The shoulder and clavicle was nontender and range of motion consisted of forward flexion to 150 degrees and abduction to 110 degrees. Radiographs of the clavicle and shoulder demonstrated a malunion of the right clavicle (Figure 1A). Bilateral views of the acromioclavicular joints showed 1.3 cm of shortening in comparison to the contralateral clavicle and Computed Tomography (CT) demonstrated 80 degrees of apex posterosuperior angulation (Figure 1B).