Session VIII - Reconstruction

Sat., 10/11/03 Reconstruction, Paper #50, 10:21 AM

*Patient-Oriented Outcome after Open Reduction and Internal Fixation of Clavicular Shaft Nonunion: The Effect of Time to Repair

Neeti Singh; Emil H. Schemitsch, MD; Alison J. McConnell, BSc; Michael D. McKee, MD, FRCS; St. Michael's Hospital, Toronto, Ontario, Canada (a-University of Toronto Scholarship Fund)

Purpose: By using modern patient-oriented limb-specific outcome measures, we sought to determine the effect of time to repair on patient satisfaction after surgical fixation of nonunion of the clavicular shaft.

Methods: We identified 38 patients, 23 men and 15 women with a mean age of 43 years (range, 18 to 71 years), who had undergone open reduction internal fixation of a nonunion of the clavicular shaft. The mean duration of nonunion was 1.8 years with a range from 4 months to 31 years. All patients underwent fixation with a plate, and 64% of patients also underwent iliac crest bone grafting. Two nonunions required revision surgery for healing: 36 (95%) healed after the index procedure. We assessed patient outcome with standard history and physical examination, radiographs, and the DASH and SF-36 outcome instruments.

Results: The mean DASH score (0 = perfect, 100 = complete disability, "normal" = 10) was 12.5 (range, 0 to 58), indicating good restoration of upper extremity function with mild residual disability. SF-36 scores were within the normal control range. There was no significant difference in DASH or SF-36 scores between those fixed "early" (<6 months) and those repaired "late" (>6 months), P = 0.30, P = 0.78, respectively.

Discussion: Previous reports of clavicular nonunion repair have concentrated on radiographic or surgeon-based criteria. The results of our study showed that successful clavicular nonunion repair effectively restores upper extremity function and general health status to near-normal levels. These results can be used to counsel patients, to prognosticate, and to compare with other upper extremity conditions or procedures.

Conclusion: As measured by the DASH and SF-36 instruments, patient satisfaction was high after clavicular nonunion repair with only minor degrees of residual disability. Time to repair did not have a significant effect on outcome.

* If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options and e-consultant or employee.