Learning card
Claviculafractuur met non-union en pseudoarticulatie
Published by
Ali Talib · Radiologist
Last updated
The case
Objective findings
- Chronic fracture through the midshaft of the clavicle.
- Persistent fracture line without osseous bridging beyond the expected healing period (>6 months).
- Rounded and sclerotic fracture margins.
- Hypertrophic callus formation surrounding the fracture ends.
- Motion-related pseudoarthrosis with formation of a false joint.
- Variable shortening, displacement and angulation of the clavicle.
- No imaging signs of acute refracture.
- Evaluate for implant failure if previous fixation is present.
Impression
Established clavicular non-union with pseudoarthrosis.
Why this case matters
Clavicle fractures usually heal uneventfully with conservative treatment. Failure of union is uncommon but has important clinical consequences.
Radiologists should recognize imaging features of established non-union because persistent instability may explain chronic shoulder pain, weakness, deformity or neurovascular symptoms. The report often determines referral for surgical reconstruction.
Anatomy you must name
When reporting a clavicular non-union, describe:
- Fracture locationmedial thirdmiddle thirdlateral third
- Distance from the acromioclavicular joint (if lateral)
- Degree of shortening
- Degree of displacement
- Angulation
- Fragment rotation
- Callus formation
- Cortical bridging
- Relationship to:acromioclavicular jointsternoclavicular jointcoracoclavicular ligaments
- Adjacent neurovascular structures (if CT)
Classifications
Robinson classification
Describe fracture location and morphology.
Most symptomatic non-unions occur after displaced Robinson type 2B midshaft fractures.
Weber & Cech classification
Hypertrophic
- abundant callus
- biologically active
- instability is the primary problem
Oligotrophic
- little callus
- viable bone
- inadequate stability
Atrophic
- no callus
- tapered bone ends
- biologically inactive
- often requires grafting
Include the type whenever possible, as it influences treatment planning.
Protocol & reporting checklist
Report systematically:
Fracture
- exact location
- transverse/oblique/comminuted
- displacement
- shortening
- angulation
Healing
- persistent fracture line
- cortical bridging
- sclerosis
- callus
- pseudoarthrosis
HardwareIf present:looseningbroken platebroken screwsmigrationhardware failureAssociated findingsAC joint degenerationSC joint degenerationrib fracturespneumothorax (acute trauma)vascular abnormality (rare)Finish with:Established hypertrophic (or atrophic) clavicular non-union with pseudoarthrosis.
Pitfalls
Do not diagnose non-union before the expected healing interval (typically >6 months).
Hypertrophic callus is not synonymous with union.
Persistent cortical interruption on multiple cortices is more important than callus volume.
Compare with prior radiographs whenever available.
Distinguish delayed union from established non-union.
CT is superior to radiographs for assessing cortical bridging and subtle pseudoarthrosis.
Evaluate shortening, which may influence surgical management but is frequently underreported.
Management implication
Imaging findings that increase the likelihood of operative treatment include:
- symptomatic non-union
- persistent fracture gap
- pseudoarthrosis
- marked shortening (>15–20 mm)
- significant displacement
- hardware failure
- atrophic non-union
Typical surgical management consists of:
- open reduction and internal fixation (plate fixation)
- compression across the non-union
- autologous bone graft when biologic healing potential is poor
Asymptomatic fibrous non-unions may be managed conservatively.
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