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Nonunion of the Clavicle

Nonunion of the Clavicle Abstract The clavicle is the bone in the body most frequently fractured, accounting for 5% to 10% of all fractures.1 Because of the difficulty of completely immobilizing fractures in this region, more than 200 different methods of treatment have been suggested. However, despite the apparent dissatisfaction with methods of fixation, nonunion is rare. Annersten in 19482 reviewed 350 cases and found the incidence of pseudarthrosis to be 1.3%. A review of the English-language literature reveals only three studies of 18 or 20 cases each and one of nine cases.3-6 It has been stated that nonunion is becoming more frequent,7 but it is not certain whether this is due to an increased severity of injuries (secondary to the increased trauma in accidents associated with higher speeds of vehicles), a complacent attitude about the initial treatment, or more frequent open reduction of fractures. Of the reports mentioned, one, by References 1. One patient had fracture of both clavicles. 2. Moore, T. O.: Internal Pin Fixation for Fracture of the Clavicle , Amer Surg 17:580-583 ( (July) ) 1951. 3. Powell, H. D. W.: Ununited Fractures of the Clavicle , Brit Med J 2:651-652 ( (Sept 20) ) 1952.Crossref 4. Berkheiser, E. J.: Old Ununited Clavicular Fractures in the Adult , Surg Gynec Obstet 64:1064-1072 ( (June) ) 1937. 5. Ghormley, R. K.; Black, J. R.; and Cherry, J. H.: Ununited Fractures of the Clavicle , Amer J Surg 51:343-349 ( (Feb) ) 1941.Crossref 6. Neer, C. S., II.: Nonunion of the Clavicle , JAMA 172:1006-1011 ( (March 5) ) 1960.Crossref 7. Sakellarides, H.: Pseudarthrosis of the Clavicle , J Bone Joint Surg 43A:130-138 ( (Jan) ) 1961. 8. Bateman, J. E.: " Fractures and Dislocations of the Shoulder Region ," in Shoulder and Environs , St. Louis: C. V. Mosby Company, 1955, pp 457-521. 9. Cave, E. F.: Fractures and Other Injuries , Chicago: The Year Book Medical Publishers, Inc., 1958, pp 254-263. 10. O'Donoghue, D. H.: " Injuries to the Shoulder Girdle ," in Reynolds, F. C.: The American Academy of Orthopaedic Surgeons: Instructional Course Lectures , St. Louis: C V. Mosby Company, 1960, vol 17, pp 392-406. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1963.01310180079013
Publisher site
See Article on Publisher Site

Abstract

Abstract The clavicle is the bone in the body most frequently fractured, accounting for 5% to 10% of all fractures.1 Because of the difficulty of completely immobilizing fractures in this region, more than 200 different methods of treatment have been suggested. However, despite the apparent dissatisfaction with methods of fixation, nonunion is rare. Annersten in 19482 reviewed 350 cases and found the incidence of pseudarthrosis to be 1.3%. A review of the English-language literature reveals only three studies of 18 or 20 cases each and one of nine cases.3-6 It has been stated that nonunion is becoming more frequent,7 but it is not certain whether this is due to an increased severity of injuries (secondary to the increased trauma in accidents associated with higher speeds of vehicles), a complacent attitude about the initial treatment, or more frequent open reduction of fractures. Of the reports mentioned, one, by References 1. One patient had fracture of both clavicles. 2. Moore, T. O.: Internal Pin Fixation for Fracture of the Clavicle , Amer Surg 17:580-583 ( (July) ) 1951. 3. Powell, H. D. W.: Ununited Fractures of the Clavicle , Brit Med J 2:651-652 ( (Sept 20) ) 1952.Crossref 4. Berkheiser, E. J.: Old Ununited Clavicular Fractures in the Adult , Surg Gynec Obstet 64:1064-1072 ( (June) ) 1937. 5. Ghormley, R. K.; Black, J. R.; and Cherry, J. H.: Ununited Fractures of the Clavicle , Amer J Surg 51:343-349 ( (Feb) ) 1941.Crossref 6. Neer, C. S., II.: Nonunion of the Clavicle , JAMA 172:1006-1011 ( (March 5) ) 1960.Crossref 7. Sakellarides, H.: Pseudarthrosis of the Clavicle , J Bone Joint Surg 43A:130-138 ( (Jan) ) 1961. 8. Bateman, J. E.: " Fractures and Dislocations of the Shoulder Region ," in Shoulder and Environs , St. Louis: C. V. Mosby Company, 1955, pp 457-521. 9. Cave, E. F.: Fractures and Other Injuries , Chicago: The Year Book Medical Publishers, Inc., 1958, pp 254-263. 10. O'Donoghue, D. H.: " Injuries to the Shoulder Girdle ," in Reynolds, F. C.: The American Academy of Orthopaedic Surgeons: Instructional Course Lectures , St. Louis: C V. Mosby Company, 1960, vol 17, pp 392-406.

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1963

References