Joe is a 29 year-old male who had successful surgery to treat an old, malunited clavicle fracture that was causing pain and disrupting activity. He had noticed that his shoulder just didn’t sit right and that he had a large lump over the malunion site.

Joe injured his clavicle during a fall in 2013, sustaining a displaced fracture in the middle of the bone shaft. This was initially treated non-operatively with a sling, and the bone healed in a displaced position. Healing in this way is known as a malunion and can be seen in the x-ray image below.

Over the following 7 years the malunited fracture caused difficulties for Joe; he experienced an aching pain, had trouble with overhead movements and activities, and was aware of the abnormal and asymmetrical position of his shoulder. As a young and active patient, Joe was eager to find a treatment that allowed him to achieve full functionality of his shoulder.

After seeing Joe, I arranged a 3D CT scan to visualise the bone and a CT angiogram to assess the location of the blood vessels surrounding the injury.

These images show clearly the deformity and shortening of the clavicle, and allow careful planning for a surgical procedure. After discussing his options with me, Joe decided to proceed with an operation to correct the malunited fracture. The first step of the operation was to re-break the clavicle at the site of the old fracture, allowing the bone to be brought out to its normal length. A plate and screws were inserted to hold the bone in its correct, anatomical position. A local bone graft was then used after collecting bone around the old fracture site to encourage healing of the old fracture ends.

X-rays taken after the operation showed good positioning of the clavicle, with normal length and alignment, as well as signs of bone healing. After 3 weeks of resting the arm in a sling, Joe’s shoulder function and range of movement was much improved, and he was able to return to many activities that had been difficult and painful before the operation.

During the surgery I made two separate cuts in the bone, allowing it to be repositioned and brought out to its correct length. The position of the cuts (or Osteotomy sites) were determined from his original fracture and from the 3D model. The newly aligned clavicle was held in place with a plate and screws, and excess bone was used as graft to stabilise the position and encourage healing of the bone. X-rays taken during and after the operation showed that the clavicle was back in its anatomical position.