PMC7341426_01
(a, b) 10 mm sized defect of the middle third of the right clavicle. (c) Initial surgery with resection of the pseudarthrosis, placement of an autologous iliac bone graft, and plate fixation.
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Radiography and computed tomography revealed a 10 mm sized defect of the middle third of the right clavicle (Figures 1(a) and 1(b)), and the patient was diagnosed with CPC. His pain was attributed to CPC, and we performed surgery with pseudoarthrosis resection, placement of an autologous iliac bone graft, and plate fixation (Zimmer-Biomet A.L.P.S. distal fibula plate with six holes) (Figure 1(c)).
(a, b) Radiographs and computed tomography revealed nonunion and implant loosening one year after the initial surgery.
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Unfortunately, radiographic bone nonunion persisted, and we observed implant loosening one year later (Figure 2).
(a) A thin periosteum MFC flap was harvested. (b) MFC flap is wrapped around the clavicle.
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Using the descending genicular artery and vein as a vascular pedicle from the left MFC, a thin periosteal 20 x 10 mm MFC flap was harvested (Figure 3(a)). MFC and wrapped around the clavicle with a periosteal MFC graft (Figure 3(b)). Microvascular anastomoses were performed on the transverse cervical artery and vein.
(a, b) Radiographic and tomographic bone fusion was achieved three months after the second operation. (c) The graft could be harvested without damaging the epiphyseal line.
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Three months after the revision surgery, radiographic bone fusion was achieved (Figure 4(a)), and no symptoms such as pain or limited shoulder joint range of motion were observed for one year after the operation.