Clinical and radiographic outcomes of revision with autogenous “structured” bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study

Purpose To assess the efficacy of autogenous “structured” bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). Methods This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. Results The average time between primitive fracture and this operative treatment was 29 months (15–38 months). The average duration of surgery was 153 minutes (range, 115–230 min), and the average blood loss was 560 ml (range, 350–860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12–30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12–16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up ( P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up ( P < 0.01). Conclusions ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.