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Published August 25, 2021

Sternoclavicular Joint Reconstruction for Medial Clavicle Fracture Nonunion

Background

Medial clavicle fracture-dislocations are a rare phenomenon. The management of medial clavicle fracture-dislocations often is complicated by unfamiliar anatomy and strong forces across the sternoclavicular joint, which may ultimately result in fixation failure. Medial clavicle nonunions resulting from failed fixation of medial clavicle fracture-dislocations are an even more challenging problem because of the already mentioned issues and subsequent bone loss.

Purpose

This video demonstrates a technique for the management of medial clavicle fracture nonunions after a failed open reduction and internal fixation. The technique includes excision of the medial fragment, reduction of the medial clavicle, and sternoclavicular reconstruction with the use of a gracilis tendon allograft.

Methods

An overview of the pathogenesis, diagnosis, and management of medial clavicle fracture nonunions is presented. A reconstruction technique with the use of gracilis allograft is shown. Particular attention is paid to graft passage and tensioning.

Results

The procedure was successfully performed, and the sternoclavicular joint remained reduced. The patient shown in this video was advanced through a standardized rehabilitation protocol. At 6 months postoperatively, the patient was cleared for return to full activity, including weight lifting and rock climbing.

Conclusion

Sternoclavicular reconstruction with the use of gracilis allograft is a reliable treatment option for patients with a medial clavicle nonunion and a sternoclavicular dislocation. Good results with restoration of sternoclavicular contour and function have been reported at 6 months postoperatively.