Clavicle non-unions often result after nonoperative treatment for the acute fracture. Those that require >1 surgical procedure in order for a nonunion to heal are termed recalcitrant. The aims of the present study were (1) to determine healing rates of clavicle non-unions following plate osteosynthesis using either a conventional or locked plate, (2) compare iliac crest bone graft (ICBG) versus bone morphogenetic protein (BMP) on non-union healing, (3) identify risk factors for the development of a recalcitrant non-union.
We performed a retrospective analysis of a prospectively collected database of 78 clavicle non-unions treated with open reduction and plate fixation with or without graft augmentation by a single surgeon over 25 years. Seventy-one patients over the age of 18 with at least 12 months follow-up comprised the study group. We analyzed healing rates after the index clavicle non-union surgery comparing plate type and graft technique as well as identifying risk factors for developing a recalcitrant non-union.
62 patients (87.3%) healed after their index non-union surgery at our institution. Three patients (4.2%) required additional surgery but healed, and six patients (8.5%) remain un-united; these nine patients (12.7%) were defined as recalcitrant. There was no statistically significant difference in healing rates between plate type (p = 0.633) or type of bone graft (p = 0.157). There were no identifiable risk factors for the development of a recalcitrant non-union.
Plate fixation of clavicle non-unions remains a successful method of treatment. The type of plate or the method of bone graft did not produce different results. There were no demographic, patient, or injury characteristics associated with the development of a recalcitrant non-union.

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