Name of the Procedure:

Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion

Summary

This surgical procedure involves cutting and realigning the clavicle (collarbone) to correct improper healing (nonunion or malunion) of a previous fracture. The procedure may involve internal fixation and bone grafting to aid in proper bone healing.

Purpose

This procedure addresses nonunion (failure of the bone to heal) or malunion (improper healing) of a clavicle fracture. The goal is to restore normal bone alignment and function, alleviate pain, and improve shoulder mobility.

Indications

• Persistent pain at the site of a clavicle fracture
• Difficulty or pain with shoulder movement
• Visible deformity or shortening of the clavicle
• X-ray or imaging studies confirming nonunion or malunion
• Patients who have failed conservative treatment approaches

Preparation

• Patients may need to fast for a certain period before the surgery.
• Certain medications, particularly blood thinners, may need to be adjusted or stopped.
• Preoperative imaging tests such as X-rays or CT scans are often required.
• A physical examination and medical history review will be conducted.

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made over the clavicle.
3. The bone is cut (osteotomy) to correct alignment.
4. Bone graft material, often taken from the patient’s own body or a donor, is placed at the site.
5. Internal fixation devices like plates, screws, or pins may be used to stabilize the bone.
6. The incision is closed with sutures and covered with a sterile dressing.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The surgery is usually performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to nerves or blood vessels
• Anesthesia-related complications
• Failure of the bone to heal properly even after surgery
• Pain or discomfort at the graft site

Benefits

• Improved bone alignment and function
• Reduction in pain
• Enhanced shoulder mobility
• Stable and durable bone healing

Recovery

• Pain management with prescribed medications
• Wearing a sling or brace to immobilize the area
• Physical therapy to regain strength and mobility
• Initial recovery can take several weeks, with complete healing often taking several months
• Follow-up appointments to monitor healing progress

Alternatives

• Non-surgical treatments like physical therapy and bracing
• Platelet-rich plasma (PRP) injections
• Electrical bone stimulation
• Pros: Less invasive, lower immediate risk
• Cons: May not be effective for severe cases of nonunion or malunion

Patient Experience

• The patient will be under general anesthesia during the procedure, so no pain is felt.
• Postoperative discomfort is managed with pain medication.
• There may be some swelling and bruising around the surgical site.
• Physical therapy and gradual return to activity are essential for full recovery.