ISSN: 2706-8870
Volume 10, Number 3 (2025)
Year Launched: 2016
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How to treat a Midclavicular Nonunion: A Narrative Review

Volume 10, Issue 3, June 2025     |     PP. 83-99      |     PDF (715 K)    |     Pub. Date: October 24, 2025
DOI: 10.54647/cm321405    14 Downloads     176 Views  

Author(s)

Univ. Prof. PD Dr. med. Axel Jubel, Department of Trauma and Reconstructive Surgery, Eduardus Hospital Cologne, Custodisstr. 3-17, 50679 Cologne, Germany; Faculty of Medicine and Dentistry, Department of Medicine; Center for Clinical Medicine Danube Private University, 3500 Krems, Austria
Maximilian Knopf, Faculty of Medicine and Dentistry, Department of Medicine; Center for Clinical Medicine Danube Private University, 3500 Krems, Austria
Jil Marie Jubel, Department of Dermatology and Allergology, Venusberg-Campus 1, 53127 Bonn, Germany
Maximilian Appel, Department of Trauma and Reconstructive Surgery, Eduardus Hospital Cologne, Custodisstr. 3-17, 50679 Cologne, Germany
Moritz Antonie, Faculty of Medicine and Dentistry, Department of Medicine; Center for Clinical Medicine Danube Private University, 3500 Krems, Austria

Abstract
Introduction:For decades, clavicular fractures were considered to have an exceptionally low nonunion rate (1–3%), and conservative management was the standard of care. However, recent studies have demonstrated that nonunion after nonoperative treatment is significantly more frequent, with rates of 5–15%, representing a clinically challenging and socioeconomically relevant problem.Methods:This review summarizes current evidence on the definition, epidemiology, risk factors, diagnostics, classification, and therapeutic options for clavicular nonunion in adults. Data were compiled from key epidemiological studies, systematic reviews, and clinical series, focusing on both nonoperative and surgical treatment outcomes.Results:Nonunion rates after conservative treatment range from 15–24% for midshaft fractures, compared to 1–2% following surgery. Major risk factors include fracture displacement (>2 cm), multifragmentary fracture morphology, female sex, advanced age, nicotine use, metabolic comorbidities, and refracture after plate removal. Diagnosis is based on persistent pain, clinical instability, and radiological evidence, supported by CT when necessary. Classification distinguishes hypertrophic, oligotrophic, and atrophic types, reflecting mechanical versus biological causes. Treatment depends on symptomatology and vitality: hypertrophic nonunion typically responds to stable plate osteosynthesis, whereas atrophic nonunion requires additional autologous bone grafting, frequently harvested from the iliac crest. Alternative strategies include allografts, vascularized grafts for larger defects, and the Masquelet technique. Stable fixation with angle-stable plates, preferably in superior or antero-inferior position, yields healing rates >90%.Discussion/Conclusion:Successful management of clavicular nonunion requires accurate diagnosis, differentiation between mechanical and biological failure, and individualized surgical planning. Early surgical intervention in symptomatic cases improves outcomes. Combining stable fixation with biological augmentation ensures high union rates and good functional recovery.

Keywords
clavicle nonuniuon; collarbone nonunion; clavicle fracture, clavicle refracture

Cite this paper
Univ. Prof. PD Dr. med. Axel Jubel, Maximilian Knopf, Jil Marie Jubel, Maximilian Appel, Moritz Antonie, How to treat a Midclavicular Nonunion: A Narrative Review , SCIREA Journal of Clinical Medicine. Volume 10, Issue 3, June 2025 | PP. 83-99. 10.54647/cm321405

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