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Abstract
The purpose of this study was to evaluate the clinical and radiological outcome following compression plate fixation in combination with autologous bone grafting, with and without additional application of recombinant human bone morphogenetic protein (rhBMP) for treatment of aseptic clavicle non-union. Between April 2004 and April 2015, 82 patients were treated for clavicle fracture and had developed aseptic clavicle non-union. Seventy-three out of 82 patients were available for follow-up at least one year after revision surgery; among them, 27 women and 46 men, with a median age of 49 (range, 19-86) years. Forty-five patients received compression plate osteosynthesis with autologous bone grafting, and 28 patients obtained compression plate fixation with autologous bone grafting and additional application of rhBMP-2 (3/28 patients) or rhBMP-7 (25/28 patients). Seventy out of 73 non-unions (96%) healed within 12months after revision surgery. Functional outcome according to the DASH Outcome Measure (with rhBMP, 33.16 ± 1.17 points; without rhBMP, 30.58 ± 2.12 points [mean ± SEM]; p = 0.81), non-union healing (p = 0.86), time interval between revision surgery and bone healing (p = 0.37), as well as post-operative complications, did not demonstrate relevant differences between the treatment groups and were not age-dependent. Functional and radiological results demonstrate that successful healing of aseptic clavicle non-union is dependent on radical resection of non-union tissue, restoration of length of the shoulder girdle and application of stable locking-plate osteosynthesis in combination with autologous bone grafting, but not dependent on application of additional rhBMP.
Highlights
About 5 % of all fractures in adults involve the clavicle, and most of them are located in the middle third of the shaft [1, 2]
Only a few case reports have assessed the additional application of recombinant human bone morphogenetic protein in the upper extremity [11, 12]
Eighty-two patients had been treated with clavicle fracture and had developed aseptic clavicle non-union (Fig. 1)
Summary
About 5 % of all fractures in adults involve the clavicle, and most of them are located in the middle third of the shaft [1, 2]. Recent literature reports an increased risk of symptomatic non-union for comminuted clavicle fractures following conservative as well as surgical treatment including plate osteosynthesis or intramedullary fixation using pins, screws, wires or nails [2]. Biological augmentation with autologous nonvascularised corticocancellous, cancellous or vascularised grafts, is an important option for successful treatment of non-union, despite increased donor site morbidity [9, 10]. In this context, only a few case reports have assessed the additional application of recombinant human bone morphogenetic protein (rhBMP) in the upper extremity [11, 12]
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