Introduction and importance: Refracture through a malunited clavicle is an uncommon complication, especially in adolescents. However, when it occurs early after conservative management, it brings with it unique technical and clinical challenges. Presentation of case: A 17-year-old male presented with acute right shoulder pain after falling from a horse. He had previously sustained a displaced right midshaft clavicle fracture 2.5 months earlier, which was managed nonoperatively and had healed in malunion with a prominent callus. Radiographs revealed a refracture through the malunion site. He underwent open reduction and internal fixation using a precontoured distal locking clavicle plate. Intraoperatively, dense callus and sclerotic bone ends complicated the reduction, with the loss of a small butterfly fragment during K-wire manipulation. Postoperative recovery was uncomplicated, with early physiotherapy and stable fixation on follow-up imaging. Clinical discussion: This case underscores the risk of early mechanical failure through incompletely remodeled bone in adolescents. Prominent hard callus and sclerotic fracture ends may hinder anatomical reduction and fixation. Careful surgical planning is required in such cases. Conclusion: Significantly displaced midshaft clavicle fractures in adolescents may benefit from early surgical management to reduce the risk of malunion and refracture. Anticipating technical challenges in malunited fractures is essential for optimal outcomes.
Shahul et al. (Wed,) studied this question.