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J Shoulder Elbow Surg. 2018 Jan;27(1):29-35. doi: 10.1016/j.jse.2017.06.040. Epub 2017 Aug 24.

Adolescent clavicle nonunions: potential risk factors and surgical management.

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Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA. Electronic address:
Department of Orthopedics, Rady Children's Hospital, San Diego, CA, USA.
Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Sports Medicine Center, Texas Scottish Rite Hospital, Dallas, TX, USA.
Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
Department of Orthopedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Campbell Clinic Orthopaedics, Memphis, TN, USA.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Orthopedics, St. Luke's Clinic, Boise, ID, USA.



Clavicle nonunions in adolescent patients are exceedingly rare. The purpose of this study was to evaluate a series of clavicle nonunions from a pediatric multicenter study group to assess potential risk factors and treatment outcomes.


A retrospective review of all clavicle nonunions in patients younger than 19 years was performed at 9 pediatric hospitals between 2006 and 2016. Demographic and surgical data were documented. Radiographs were evaluated for initial fracture classification, displacement, shortening, angulation, and nonunion type. Clinical outcomes were evaluated, including rate of healing, time to union, return to sports, and complications. Risk factors for nonunion were assessed by comparing the study cohort with a separate cohort of age-matched patients with a diaphyseal clavicle fracture.


There were 25 nonunions (mean age, 14.5 years; range, 10.0-18.9 years) identified, all of which underwent surgical fixation. Most fractures were completely displaced (68%) initially, but 21% were partially displaced and 11% were nondisplaced. Bone grafting was performed in 24 of 25 cases, typically using the hypertrophic callus. Radiographic healing was achieved in 96% of cases. One patient (4%) required 2 additional procedures to achieve union. The primary risk factor for development of a nonunion was a previous history of an ipsilateral clavicle fracture.


Clavicle nonunions can occur in the adolescent population but are an uncommon clinical entity. The majority occur in male patients with displaced fractures, many of whom have sustained previous fractures of the same clavicle. High rates of union were achieved with plate fixation and the use of bone graft.


Clavicle; adolescent; clavicle fracture; clavicle refracture; nonunion; pediatric

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