Midshaft clavicle nonunions treated with intramedullary Steinman pin fixation and onlay bone graft.

The current literature tends to favor rigid internal fixation with plates for symptomatic midclavicular nonunions. From 1985 to 1992, 14 patients with clavicular nonunions were treated by open reduction and intramedullary Steinman pin fixation with onlay iliac crest bone grafting. The average age of patients was 36 years (range 18-62). The majority of nonunions occurred after high-energy injuries to the clavicle. Three patients had failed previous plating and one initial fracture was pathological through irradiated bone. At an average follow-up of 4 years, all nonunions healed uneventfully and all were satisfied with the result of surgery. There were no infections or pin migrations. All hardware was removed at an average of 12.7 weeks (7-24 weeks). The most significant complications were two refractures occurring through osteopenic bone. We have found this technique to be as effective as plating procedures, yet it maintains the great advantage of ease of hardware removal. It allows early motion and has been useful in those whose previous plating procedures have failed.