Comment to the Article by O.A. Kaplunov et al. “Hypotrophic Clavicle Pseudoarthrosis Treatment: A Case Report”

In the comment on the article «Treatment of Hypotrophic Nonunion of the Clavicle: A Clinical Case», the reasons for the failure of primary and refixation of the clavicle closed fracture are analyzed in detail. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive — behavioral features of the patient, are considered as possible reasons for the treatment failure. The author of the comment highlights modern approaches to the treatment of clavicle fractures, and also briefly dwells on the theory of fracture fixation in general. He pays special attention to biological and mechanical factors affecting fractures healing. The author considers the compliance with the basic principles of osteosynthesis to be the main factor in achieving good results in fracture treatment.