Midshaft Clavicle Malunion with an Atypical Posterior Apex Deformity

Ross Leighton

doi:10.32474/osmoaj.2018.01.000110

Abstract

We are presenting this pattern of a rare variant of a clavicle malunion with an apex posterior-inferior deformity. This occurred in an elite major junior hockey player during his draft season. This illustrates that such a deformity will most likely result in shoulder weakness, altered shoulder mechanics and may cause brachial plexus neurological findings. In addition, this can cause associated sterno-clavicular deformity which can lead to sternoclavicular joint subluxation secondary to the increased strain placed on the sternoclavicular joint from an apex posterior inferior malunited clavicle. Deformity of > 20 degrees in any direction interferes with normal motion and normal cortical strength even in a young patient.

Highlights

Symptomatic malunion is less frequently observed (4) since the significant shift to operative treatment for displaced shortened mid shaft clavicle fractures
Patient’s report weakness of the involved shoulder with rapid fatigability plus an increased deformity comes with an increased risk of recurrent fractures
Neurological symptoms and signs are more likely to occur in inferior malunited clavicle, with an inferior-posterior deformity

Summary

Introduction

Symptomatic malunion is less frequently observed (4) since the significant shift to operative treatment for displaced shortened mid shaft clavicle fractures. Symptomatic patients are typically those with marked displacement and significant shortening at the fracture site. Not commonly described in the literature, clavicle malunion usually has a very consistent deformity pattern. As illustrated by McKee et al, the patient usually presents with a complex three dimensional deformity with shortening, an anterior apex at the fracture site and associated joint pain around the shoulder or sternum (6). Angulations are more acute the closer the break is to these pivot points. This has had associated significant alteration in normal clavico-scapular motion.

Conclusion

Operative Procedure

Findings

Discussion