Nonunion Of The Clavicle - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes nonunion of the clavicle, its etiology, signs and symptoms, diagnostic tests, and treatment options.
What is non-union?
Nonunion means that a bony union will not occur without help.
Surgery is usually required for union of the bone.
Impending nonunion could occur, meaning the fracture will not heal without help.
Established nonunion could occur, meaning a good amount of time has passed (usually about 4 months) and the fracture did not heal.
Timing of surgery is debatable, most of the clavicle fractures will heal without surgery.
Conservative treatment has about an 85% success rate.
The rate of nonunion is about 15%.
Nonunion may be difficult to diagnose due to superimposition of the ends of the clavicle which gives the false impression of healing.
CT scan may be needed for the diagnosis of nonunion in clavicle fractures.
There are no orthogonal views (such as AP and lateral x-rays).
One view of the clavicle alone may not give an idea about the status of the fractures clavicle healing.
Risk factors of nonunion:
- Female
- Advanced age
- Displacement of the fracture
- Communication of the fracture
- Overlapping of the fracture (more than 2 cm)
- Fracture in the lateral third of the clavicle
- Smoking
Treatment:
- If the nonunion is painless, then leave it alone.
- If the nonunion is painful, then the patient will require surgical treatment of the nonunion.
- The typical patient will have painful range of motion.
- Patient may also have thoracic outlet syndrome or brachial plexus compression.
- Surgical treatment of the clavicle nonunion has about a 90%- 95% good to excellent result.
There are 3 types of nonunion of the clavicle:
1- Atrophic
2- Hydrotrophic
3- Nonunion with shortening: compare both sides of the shoulder with the same radiographic view.
Tactics of treatment:
For the nonunion to heal, you will need vascularity and stability of the nonunion.
The vascularity will come from a bone graft:
• Local bone graft
• Iliac crest bone graft
Stability: the stability will come from a stable fixation, usually done with superior anatomic plate with at least three cortical screws on each side.
Sometimes as interfragmentary lag screw is used, then a neutralization plate is used.
Types of nonunion explained:
1- Atrophic:
- Will need bone graft and plate fixation.
- The bony ends are cleaned, prepared and roughened.
- Sometimes the medullary canal is entered.
2- Hypertrophic:
- Will need stability.
- Usually stability is obtained by a plate.
- May trim the extra hypertrophic bone graft and use it locally.
3- Nonunion with shortening:
- Compare the length of both clavicles preoperatively by having one film that shows both clavicles.
- Check the amount of shortening and overlap between the bony ends.
- If the shortening is more than the overlap, then you will probably need to have a bicortical or tricortical interposition graft if the shortening is more than 10 mm.
- Need to fill this gap to restore the length and probably will need a strong graft.
4- Patient had plate fixation/ stabilization with failure of fixation and nonunion
- Rule out infection
- Get CRP and sedimentation rate
- Check the clinical appearance of the wound
- Try to get intraoperative culture
- Adequately debride the bone
- May need 1 of 2 approaches:
• Debride now, then close the wound and fix the fracture later, operation is done in 2 stages.
• Deride now, then plate and cancellous bone graft now, operation is done in 1 stage.
Both approaches are a judgment call of the surgeon depending on the appearance of the wound, the clinical experience of the surgeon as well as the circumstances of the patient.
• Bone morphogenetic proteins (BMPs)
- I do not use it in this area near the chest because the fluid may travel and may be unpredictable.
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[@oldgeezerproductions]

I am 77 years old and a male. Five weeks ago I was practicing slow speed maneuvers on my motorcycle when the engine quit and I was slammed hard on my left side. My clavicle broke at a rather low angle, but with only minor compressional displacement. The first three days were quite painful, especially at night when trying to sleep (I had to raid my emergency drug stash for three pills). I abandoned the sling after the first couple of days because I could hold my arm painlessly without it and getting it on and off caused me pain. Of course, sleeping on my back was necessary for the first few weeks. In this five week period, I did nothing special except to use my left arm up to the point it started to be painful. Today, the only thing that reminds me that I broke the left clavicle is a rather large lump where the break was. I have full motion of the left arm without pain. I attribute my quick recovery and healing to the fact that I take Vitamin D2 and K3 and calcium supplements and have so for years. I'm sure the low angle shearing break was fortuitous. Everyone will be relieved to know that my motorcycle was unhurt. 😁

[@mohammedhend7575]

رائع د. نبيل زادك الله علما ونفع بك

[@shanmugamsayeekrishnan9101]

Thanks for the valuable informations.

[@johnpiggott4101]

Excellent presentation, professor. Thank you for explaining things in such an accessible way.

[@zencontroller]

I had the front wheel of a bike come off and consequently dislocated my clavicle when i was 11 years old. I have had nothing but problems getting this operated on in the UK with GP's trying to hinder my progress to have the op, simply to protect their reputation as I'm now 43 so have waited 32yrs for the OP. I had my op cancelled mysteriously 8yrs ago.

[@swaroopkumar2963]

Excellent

[@aqadder5229]

thanks fore giving the information

[@PrashantKumar-iy4wj]

thank you very much for clavicle fixation information

[@danuparit586]

sir same facter hand AC joint no operation

[@FirexLyrics]

What is recovery time after nonunion clavicle fracture bonegraft surgery

[@steveeb9567]

No mention of the scenario where the clavicle is shattered into many pieces. What then ?

[@deblifestylevlog.493]

I am watching your video more time your video is awesome sir.love for india

[@williamclifford1431]

Thank you doctor,I'm going in Thursday for plate fixation on the middle third of the clavicle(non-union).From the presentation I know beforehand it will be an atrophic /iliac surgery. I have been waiting three years to get this seen to(covid disrupted everything)but finally hopefully this will give me some relief and so in turn be able to sleep properly again. Thanks again, 🙏

[@ironmantooltime]

Why were you waiting three years, uk??

[@johnpiggott4101]

Thank you, professor, you explained that very well and in terms most people understand. I learned much more from you than I did from my osteo, who was rather dismissive.

[@williamclifford1431]

Cancellations and my own stubbornness.

[@FirexLyrics]

Please suggest me healing time of bone after this surgery

[@geojor]

thank you Dr.

[@karenthornton7014]

Hi i have just completed surgery of a failed fixation I had 8 months ago, the metal plate broke last week and when the xrayed it the original fracture hadn't healed so the plate gave way! The surgeon did a bone graft from my pelvis and has repaired it using the plate how you have described in this video. I hope it works this time!. If you look at my picture I bet you can guess how I broke it in the first instance!! Thank you for this video it has helped me understand what is going on with my break

[@jacksonlotha8832]

I have broken my collar bone in a mv accident and the right one is a little shorter than the left one is is possible to have a surgery after 6 months

[@ankurjain8943]

Hi Clifton! I just read your comment here. How are you doing now? I broke my clavicle over 9 weeks ago and had a surgery and it's most likely going into a non union. I am also considering a graft surgery- in case it does go into a non union. Would you like to share your experience? Thank you!

[@jyh0705]

Any updates from anyone? I have a nonunion of 17 mm in my clavicle. And surgeons have told me theres no surgery

[@FirexLyrics]

Same happen with me please advice me recovery time and outcome can I work hard because my works heavy objects lifting

[@karenthornton7014]

@@FirexLyrics hi it’s been fine since re operating and the bone graft has worked! I am back to full strength riding my horse again and I lift heavy weights too

[@Travel199T6]

Helpful

[@FirexLyrics]

Is nonunion clavicle with bonegraft can it heal completely

[@chrissymeri4957]

I broke my collar bone in a car accident years ago. I was dumb and didn't wear my sling very much. I also had a 9 month old baby at the time and wasn't supposed to carry her. But I did. It still sticks out pretty far and looks weird, 6 years later. I never did go to the doctor to get it checked out after my accident. But I have severe (what I think might be) sciatica pain on my left side. Which is the side I broke my collar bone. My whole left side of my body feels messed up and in pain all the time. Is this something that can happen?

[@ajaykumarchourasia4357]

Go to visit dr. First

[@AbdulAziz-tk1fh]

What if the clavial bone is a bit curved and not joined? Can mobment be done later? Please reply..❤❤❤

[@neepasandeep1280]

thank u

[@pavanvarmajampana5807]

It has been 2 years from now.... I have collarbone fracture at the age 22 ... I have nonunion shortening clavicle fracture.... I decrease my shoulder size with other hand compared and muscle tooo .... So... Please kind me provide collarbone exercises... to strech my neck strip and muscle tooo ... Plzzz DOCTOR 🙏🙏🙏.When u r free give me time to solve my problem 🙏

[@bruceverlinkop3172]

I broke my collar bone . I have non union. Please dr help me

[@FirexLyrics]

My surgery done with bone graft how long recovery time and functional outcome

[@gopivarun90]

3months

[@ivi7792]

I have nonunion in the lateral side of the bone (near the shoulder) does the same information presented on this video apply on that too?

[@fritz_von_steiner5544]

You should look for advice from a surgeon! Good luck!

[@SouvikBiswas420]

Can clavicle nonunion be painless?

[@Thecodexnoir]

Yes. And it can also become painful out of seemingly nowhere later in life.

[@kgaius8692]

I broke mine 5 weeks ago.. I don't feel any pain again but I feel it's a non-union 😰😥😢

[@akashchandran9926]

@@kgaius8692 is it healed or not

[@kgaius8692]

@@akashchandran9926 I don't know.. Never went back for the X-ray.. But I can do everything with the hand now without pain

[@GSingh-rp1jn]

@@kgaius8692 mine also broke right side collar bone in middle area. Doctor advised to surgery but I denied. Can it naturally heal

[@BL-rb7jm]

I'm in my sixties I had a car accident and I broke my collarbone. I couldn't sleep laying down I sat up in a chair for 2 months. I had a sling but nobody gave me a bag brace or an brace that was shaped like the letter eight. I started Physiotherapy and that's been five months now and I'm still doing physiotherapy twice a week I have to do certain exercises at home and I'm sleeping on my back which I don't like I'm sleeping finally on my right side with a pillow under my left arm because it's the left side that I broke my collarbone. I filled this bone that is sticking out. What is happening is that it didn't heal properly. The surgeon took an x-ray a week after the car accident and he told me I had a broken collarbone then I had to come back a month later and they told me that the collarbone was healed on schedule and then I when have another x-ray a month ago and he says that the bone hasn't forms yet but it's still where the cartilage is around the bone he says that it could take a year to heal and I asked him should I have surgery and he said that would be up to me depending on the pain but I'm just wondering whether it will make things worse or get better. I don't want to go in and have one operation after another and I heard that there's a lot of difficulties such as punctured lung infection and blood clots in the legs but tell me am I going to be living with this pain in my shoulder the rest of my life I mean I didn't want to end my life in the last 20 years or whatever I've got left in constant pain I mean that's not nice the stupid idiot that went to the red light T-Bone me the car flipped and landed on the driver side it would happen to be me who ends up getting all the pain and suffering and my passenger sitting in the back seat on the passenger side had nothing happened to him. And he's 81 years old I kept asking how he was and he kept saying I'm fine I'm fine and he still fine no broken bones and nothing and I'm the one that suffered and still suffering. So I don't know what to do here I don't know if the pain will ever go away after the operation or whether it will go away if I give it time I hate drugs I hate anything that interferes with natural healing or anything like that but I had to take morphine I don't take it anymore because I'm trying to avoid that but at one time I couldn't even move my body in a sitting position without screaming in pain I'm grateful for that but I noticed that my back gets inflamed and I have to do exercises to strengthen the muscles in my back. Tell me please that's some of this will get better and better with time even if it's just five years I'm just hoping it just gets better I want to continue my life I can't do my gardening I can't go swimming and I was always a very active individual in fact I used to be in the Olympics training when I was young it's just depressing

[@steveeb9567]

There are no easy answers. So many variables. I would seek multiple opinions. There's no guaranty that surgery will make it better. Things to think about: as you age the body doesn't heal as well (modelling), bone density(osteopenia) common in older women, skill of the surgeon, what are the chances surgery doesn't work or makes it worse. Good luck.

[@BL-rb7jm]

@@steveeb9567 Thank you for being very honest I discovered that the bone wasn't even joined so here I have a bone that sticks out when I lay on my side it feels kind of weird but I've recently heard of one woman that had her collarbone joined with a plate and screws and it came out and I'm saying to myself wow that's terrible and not like me who's in my sixties she's in her early forties. So I have to live with this and it was due to a car accident Somebody went through a red light as I was legally and cautiously Crossing through an intersection it's not nice to go through life thinking that when you age you have a retirement of good health and I basically did this accident has really put me in a different state of life but I cope and that's all I can do where so many things in the world are going on and crazy I tried to keep focus on happy things around me thank you very much for replying

[@roshanstepit]

My non union is not painful at all. should i leave it alone

[@rockygraciano891]

How did you end up healing mine is not painful

[@deblifestylevlog.493]

Good decision

[@sta.magdalenasorsogon2351]

I have non union, not allowed to carry 4kilograms

[@aeroraj]

Have your fracture healed? My case 2months old non union should leave it or need any treatment

[@Thecodexnoir]

Not always... if you have shortening just get it fixed now before it turns into the pain that it almost always does later in life... and then getting surgery is even worse. I should’ve gotten mine fixed a loooong time ago but I didn’t know any better back then. Better late than never and better to go through some rough healing now than to just let it become more painful day by day. That’s what I’m looking at right now anyway... and yes I tried physical therapy. Sometimes that’s not enough.

[@dimasrangga2518]

thumbs Up

[@kimberlyforbes2150]

hip

[@dimasrangga2518]

:-)

[@sunnyllso]

Hindi bhi rakho

[@nataliaacosta7788]

Alguien que me lo explique en español XD🤣😭

[@skaran86]

R u mad or what

[@karthikhegde9752]

😳😵

[@lifehope1447]

Excellent