Clavicular Refracture at the Site of Angular Malunion in Young Athletes.

OBJECTIVE: The treatment of midshaft clavicle fractures has, in the last 2 decades, shifted markedly towards operative management. Prospective trials have defined accepted clinical and radiographic indications for the surgical management of clavicle fractures. This report documents 3 cases of clinically united angular malunion of the midshaft clavicle in young athletes that subsequently refractured to highlight angular deformity in the absence of displacement as a potential indication for surgical fixation.

DESIGN: Case series.

SETTING: A level 1 trauma centre.

PATIENTS/PARTICIPANTS: Three young athletic patients with angular malunion of the midshaft clavicle who experienced refracture, requiring surgical fixation.

INTERVENTION: Surgical fixation of midshaft clavicle fracture, as treatment for refracture after angular malunion.

RESULTS: All 3 patients required subsequent surgical fixation of their midshaft clavicle fracture, correcting the angular malunion and restoring shoulder function.

CONCLUSIONS: Midshaft clavicular fractures that malunite with significant angulation in the absence of displacement represent a risk for subsequent refracture. For this reason, angular deformity should be considered as a potential indication for surgical fixation in acute clavicular fractures.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.