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Iliac crest bone graft was not used to augment the fixation
20%
38/193
Infection
26%
50/193
Inadequate strength of the plate
25%
49/193
Use of superior plating rather than anterior plating
12%
24/193
Inadequate medial screw fixation
14%
27/193
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In this patient, the hardware was intact for 5 months without any evidence of loosening prior to the catastrophic failure. This suggests that the primary cause of nonunion was poor biology rather than insufficient fixation. Biologic compromise can be caused by either infection, poor blood supply, or lack of osteogenic induction cells. Iliac crest bone graft has been used by some for any nonunion of the clavicle, but two studies have shown that bone graft is not necessary to achieve union. Rigid fixation is all that is required. Infection will still complicate any fixation technique. The radiographs show unicortical screw fixation medially, but the construct did not loosen; therefore, it is not the cause of failure.
1.3
(87)
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