FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF ANATOMICAL PLATE FIXATION OSTEOSYNTHESIS WITH AUTOGENOUS BONE GRAFTING FOR MIDDLE THIRD CLAVICLE FRACTURE NONUNION

Background: Clavicle fracture is among the most frequent orthopaedic injuries, representing nearly 10% of all fractures, with the midshaft region most commonly affected. Although most cases respond well to conservative treatment, approximately 4–5% progress to nonunion, leading to persistent pain and functional limitation. Symptomatic clavicle fracture nonunion often necessitates surgical fixation using locking plate osteosynthesis, with or without biological augmentation, to restore anatomical alignment and achieve bony union. Objective: This study aimed to evaluate the clinical and functional outcomes of locking plate osteosynthesis combined with autologous iliac crest bone grafting (ICBG) in patients with midshaft clavicle fracture nonunion previously managed conservatively. Methods: A prospective interventional study was conducted on 23 patients (mean age: 29.6 ± 7.1 years) with midshaft clavicle fracture nonunion treated conservatively for over six months. Under general anaesthesia, a bi-cortical ICBG was harvested and placed at the nonunion site, followed by fixation with a 3.5 mm superior-anterior locking plate. Postoperatively, patients were immobilized for two weeks before gradual mobilization. The primary outcome was bone healing—defined by radiographic obliteration of the fracture line—while secondary outcomes included Disability of the Arm, Shoulder and Hand (DASH) and University of California Los Angeles (UCLA) Shoulder Scores. Results: All patients achieved radiographic union, yielding a bone healing rate of 100%. The mean time to union was 9.5 weeks (range: 8–11 weeks). Functional assessment demonstrated significant improvement, with the mean one-year DASH score reducing to 18 ± 2.0 from a preoperative mean of 25.7 ± 8.9 (p < 0.001), and the mean UCLA score reaching 31 ± 2.6. Reported complications included two superficial infections (8.7%), one plate breakage (4.3%), and one hypertrophic keloid scar (4.3%), with no neurovascular deficits. Conclusion: Locking plate osteosynthesis augmented with autologous ICBG provided excellent radiological and functional outcomes for midshaft clavicle fracture nonunion, offering reliable bone healing and minimal disability. This technique remains a practical and effective option in the surgical management of clavicle nonunion.