Hyaluronic Acid-Based Mesh Add-On Iliac Autograft Improves Bone Healing and Functional Outcomes in Atrophic Nonunion of Clavicular Midshaft: A 2-Year Followup

BACKGROUND: Atrophic nonunion may frequently be seen after clavicular midshaft fractures. Despite a variety of surgical options, clavicular nonunion cases are associated with impaired bone healing. The aim of current study was to evaluate efficacy of perioperatively administered hyaluronic acid (HA)-based mesh in patients with atrophic midshaft clavicular nonunion managed with iliac wing autograft and plate fixation. MATERIALS AND METHODS: This retrospective clinical study investigated 44 patients with atrophic midclavicular nonunion who underwent open reduction plate fixation with iliac wing autografts. Patients were divided into two groups as those managed with iliac wing autograft and anatomical locking plate (ALP) fixation alone and those managed with add-on perioperative HA-based mesh, i.e., Group 1 (n = 24) and Group 2 (n = 20), respectively. Age, duration till to surgery, fracture healing time, length of gap, and length of injured and contralateral clavicle were also invastigated. The 2-year Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores were evaluated. Kolmogorov–Smirnov test, Mann–Whitney U-test, and Spearman's correlation test were used to assess variables. RESULTS: Patients’ age, followup time, and duration till surgery were similar between two groups. The study groups did not significantly differ in terms of postoperative clavicular length, as measured relative to unaffected side. Mean duration of the fracture healing was significantly shorter in Group 2 compared to that in Group 1. Mean postoperative 2-year Constant score was statistically higher in Group 2 compared to that of Group 1. In addition, Group 2 had also significantly higher DASH score than that of Group 1. CONCLUSIONS: HA-based mesh application added on the iliac wing autografting with ALP fixation may be an efficacious alternative for atrophic nonunion of clavicular midshaft.