ununited fractures of clavicle are occasionally seen in adults , but are rarely found in children . post - traumatic non - union of the clavicle is a rare complication in adulthood with a frequency of about 1% .
this condition is also exceptional in children , despite the frequency of clavicular fracture at any given age .
clavicular fractures usually occur at the junction of the medial two third with the lateral one third of the bone and usually heal by conservative treatment within three weeks .
surgery is required in about one in 100 cases in which there is remaining deformity .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
clavicular non - union is rarely asymptomatic and often results in disability from pain at the site of non - union , altered shoulder mechanics , or a compression lesion involving the underlying brachial plexus or vascular structures .
fractures of the clavicle are usually in the medial two third of the bone , which may result from a fall and subsequent outstretched hand during the fall .
the lateral fragment is displaced forward and downward by the weight of the limb , while the medial fragment is held at a higher level by the sternocleidomastoid muscle .
the essential treatment is to support the weight of the limb by a sling tied over the opposite shoulder .
the fractures are almost always clinically united within three weeks . about one in 100 fractures of the clavicle require primary surgical treatment .
sir robert peel , who established the police force of great britain , died of a fractured clavicle which ruptured the subclavian vein .
peel was attended by sir benjamin brodie who wrote ,  the hemorrhage itself was the consequence of the subclavian vein having been lacerated by splinters of the fractured bone  .
if deformity persists at the bony ends of the clavicle after several months , surgical smoothening of these ends is indicated by a short incision in the line of the skin creases .
this causes less deformity than the scarring resulting from more extensive operative procedures that may be required for primary open reduction with internal fixation .
in addition , major surgical procedures may carry the risk of additional surgery for non - union .
the non - union rate of fractures of the lateral end of the clavicle can rise to 37% when a nonsurgical treatment protocol is initially adopted . reported results for the nonsurgical treatment of fractures of the clavicle
have been uniformly positive ; a combined series of over 3000 fractures showed a rate of non - union of 0.4% .
occult fracture has been well documented in the hip and the scaphoid and failure to recognize this type of fracture could lead to serious consequences . while clavicular fracture is often viewed as benign , it is important for patients to be aware that any fracture may impact expected time of recovery .
in addition , complications such as non - union do occur and inadequate initial immobilization is a common cause .
patients who have suffered a clavicular fracture often recover well in spite of the risk of non - union ; fatal complications that may occur following vascular injuries are extremely rare .
fracture location and the type of immobilization have little effect on the final result or prognosis .
careful attention should be paid when obtaining a detailed history and physical examinations , as traumatic arthritis at either clavicular joint may mimic the symptoms of non - union .
the explicable evidence of osseous non - union on radiographs may be minor and may not correlate with the clinical symptoms .
a patient with an atrophic pattern of non - union may become asymptomatic with time .
surgeons should be cautious when operating on the non - union merely due to its presence , although asymptomatic .
if a surgical procedure is planned , possible outcomes should be communicated to the patient , including the possibility of additional surgery , if required .
 context : fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures . radiographs and mri of the shoulder provide helpful investigations for diagnosis and treatment . in the following cases , 
 an anterior - posterior view revealed non - union of the clavicle on the right side , which is atypical in children.case report : non - union of a clavicular fracture is an extremely rare condition , especially in children . 
 we are reporting two cases in this paper ; in the first case ; an 8-year - old male child visited the hospital with a history of fracture of the right clavicle one year ago . in the second case , 
 a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago.conclusion:careful attention should be paid when obtaining a detailed history and physical examinations , as traumatic arthritis at either clavicular joint may mimic non - union . 
 the explicable evidence of osseous non - union on radiographs may be minor and may not correlate with the clinical symptoms . 