Associated Factors of Nonunion Following Conservative Management of Distal Clavicle Fractures

Chul-Hyung Kang; Jae Hoon Jung; Hee-Uk Ye; Chul-Hyun Cho

doi:10.4055/jkoa.2015.50.2.137

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Kang, Jung, Ye, and Cho: Associated Factors of Nonunion Following Conservative Management of Distal Clavicle Fractures

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(2): 137-142.

Published online: 30 April 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.2.137

Associated Factors of Nonunion Following Conservative Management of Distal Clavicle Fractures

Chul-Hyung Kang, M.D., Jae Hoon Jung, M.D., Hee-Uk Ye, M.D., Chul-Hyun Cho, M.D., Ph.D.

Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Chul-Hyun Cho, M.D., Ph.D. Department of Orthopedic Surgery, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-7729, FAX: +82-53-250-7205, oscho5362@dsmc.or.kr

Received 7 April 2014 Revised 2 June 2014 Accepted 8 January 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate radiological and clinical outcomes and to analyze factors associated with nonunion after conservative management in patients with distal clavicle fracture.

Materials and Methods

We analyzed 29 cases. Neer type, coracoclavicular distance (CCD), initial displacement, comminution, union, and presence of bony union were evaluated by plain radiographs. Clinical outcomes according to University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and subjective shoulder value (SSV) scores were assessed.

Results

Six cases (20.7%) had developed nonunion. Three cases had asymptomatic nonunion. Mean UCLA, ASES, and SSV scores were 30.9, 88.3, and 87.0 in the union group and 26.7, 76.2, and 70.8 in the nonunion group. Although the nonunion group had inferior clinical outcome compared to the union group, there was no significant difference between the two groups. Older age and more CCD showed correlation with nonunion (p=0.047, p=0.007).

Conclusion

Conservative management of distal clavicle fractures provided satisfactory clinical outcomes. The rate of symptomatic nonunion was 10.4%. Occurrence of nonunion showed correlation with older age and more CCD.

Keywords: distal clavicle fracture, conservative management, nonunion, associated factor

Figures and Tables

Figure 1

A 59-year-old man with a right distal clavicle fracture was treated nonoperatively. (A) Initial anteroposterior and oblique radiographs show a Neer type I fracture. (B) Radiographs at 43 months after initial trauma show nonunion. The patient had a normal activity level without pain.

Figure 2

A 62-year-old woman with a left distal clavicle fracture was treated nonoperatively. (A) Initial anteroposterior and oblique radiographs show a Neer type IIB fracture. (B) Radiographs at 7.5 years after initial trauma show nonunion. The patient had a normal activity level without pain.

Figure 3

A 73-year-old woman with a right distal clavicle fracture was treated nonoperatively. (A) Initial anteroposterior and oblique radiographs show a Neer type IIB fracture. (B) Radiographs at 7.9 years after initial trauma show union. The patient had a normal activity level without pain.

Table 1

Demographic Data

Values are presented as mean±standard deviation or number.

^*Statistically significant.

Table 2

Radiologic Parameters

Values are presented as mean±standard deviation or number only.

^*Statistically significant.

Table 3

Comparison of Clinical Outcome between Two Groups

Values are presented as mean±standard deviation. UCLA, University of California at Los Angeles; ASES, American Shoulder and Elbow Surgeons; SSV, subjective shoulder value.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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