Satisfactory results in five patients with septic clavicle nonunion using the modified Masquelet technique and structural iliac crest autograft.

BACKGROUND

Indications for clavicle fracture fixation have increased dramatically over the last 20 years. Chronic surgical site infection is a particularly severe complication arising from this procedure and can induce nonunion and clinical disability. In such cases, the modified Masquelet technique using an iliac crest autograft (cancellous or tricortical) enables treatment of any bone infection as well as reconstruction of the segmental defect. The aim of this study was to analyze the clinical and radiological results of this procedure at mid-term follow-up.

METHODS

In this monocentric retrospective study, patients suffering from a septic clavicle nonunion were treated with a modified Masquelet technique and reviewed at a minimum follow-up point of two years. They were clinically assessed using active range of motion, pain score (visual analog scale 0 to 10), Constant score, American Shoulder and Elbow Surgeons score, and subjective shoulder value score. Bone healing was measured using standard X-rays and CT scans.

RESULTS

Five patients were included (mean age 49 years; range 30 to 62). C. acnes was involved in 80% (n = 4) of these cases. Following the first stage of treatment, the mean bone defect was 3.4 cm (range 2.6 to 6.4 cm). The second stage, performed at a minimum of six weeks (mean 7 ± 1 weeks), used an iliac crest bone autograft in all cases. At a mean follow-up of 5 ± 3 years, the mean pain score was 0.3/10 points (0 to 1), the mean Constant score was 86 points (78 to 96), the mean American Shoulder and Elbow Surgeons score was 98 ± 2%, and the subjective shoulder value score 91 ± 11%, with two "forgotten shoulders" out of five. On CT scan analysis, bone healing was achieved in 100% of cases. One plate (20%) was removed one year following the procedure due to the patient's discomfort; pain and discomfort at the iliac crest site were reported in 5/5 (100%) patients.

CONCLUSION

The modified Masquelet technique using an iliac crest autograft is a reliable and effective technique for treating septic nonunion of the clavicle. It both treats the bony defect and eradicates infection when conducted in association with débridement and antibiotics. In the five cases reported here, this approach had satisfactory results, both subjectively and objectively, with a very low reoperation rate despite persistent pain from iliac bone harvesting.