Salvage Surgery for a Recalcitrant Clavicular Nonunion Using the Masquelet Technique: A Case Report

TL;DR

A man with a persistent clavicle fracture that didn't heal was successfully treated with a two-stage surgical technique called the Masquelet method.

Contribution

The paper presents a successful application of the Masquelet technique for a challenging case of clavicle nonunion.

Findings

The Masquelet technique achieved bone union and functional recovery in a patient with a long-standing clavicle nonunion.

A two-stage approach using a cement spacer and bone grafting led to successful reconstruction.

The patient remained pain-free and regained full shoulder function four and a half years after injury.

Abstract

A 47-year-old man sustained an injury in a motorcycle accident and was transported to our hospital by ambulance. Radiography and computed tomography revealed a midshaft fracture of the left clavicle with multiple fragments and displacement. One week after the injury, anterior plate fixation was performed at our hospital using a locking plate with suture stabilization of the bone fragments. However, the initial plate fixation surgery failed, resulting in nonunion and necessitating plate removal. One year and 10 months post-injury, reconstructive surgery for the nonunion was attempted using the double-plate fixation method, with bone grafting. However, the plates were removed due to breakage and bone graft resorption.

Three years and six months post-injury, the patient requested surgery due to persistent dull shoulder pain, shoulder droop, and difficulty performing tasks requiring shoulder elevation, caused by pain from fragment irritation. Salvage surgery was performed using the Masquelet technique. During the first-stage surgery, a 3 cm bone defect was filled with a cement spacer after refreshing and drilling the fragment ends. Clavicle length and alignment were reconstructed using locking plate fixation, guided by a two-dimensional template based on an actual-sized clavicle image. Six weeks later, in the second-stage surgery, cancellous bone chips and β-tricalcium phosphate chips were grafted into the induced membrane. Four years and six months post-injury, bone union was achieved, and the patient attained full functional recovery and remained pain-free. This case highlights the potential of the Masquelet technique as a treatment option for recalcitrant clavicle nonunion.

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