Is clavicular reconstruction imperative for total and subtotal claviculectomy? A systematic review

Background: The effects of clavicular reconstruction on total and subtotal claviculectomy are controversial. The aim of this study is to disclose the impact of clavicular reconstruction on the efficacy of this rare surgical procedure. Methods: This is a systematic review of multiple medical databases for level I through IV evidence. Results: Eleven studies (level IV) with a mean follow-up duration of 53 months (range, 12-156 months) met the inclusion criteria. There were 70 subjects (70 shoulders) including 36 male patients (51%), and the average age at operation was 30 years (range, 2-77 years). The etiology included tumors in 34 subjects (49%) and other disorders in 36 (51%). Of the patients, 41 (59%) underwent total claviculectomy whereas 29 (41%) underwent subtotal clavicular excision. Clavicular reconstruction was performed in 14 subjects (20%), with bone allograft in 8, autograft in 1, and a bone cement prosthesis in 5. Objective measurement disclosed compromised strength and mobility in aclaviculate limbs; however, no studies investigating clavicular reconstruction used similar means of measurement. Functional assessment scales implied global limb function following the 2 procedures was similar (American Shoulder and Elbow Surgeons score, P = .13; Constant score, P = .38). Claviculectomy with and without reconstruction resulted in a similar incidence of complications (P = .45); however, isolated claviculectomy was related to fewer further surgical procedures (P < .001) and faster recovery (P < .001). The 2 procedures were associated with similar satisfaction rates (P > .99). Conclusions: No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy. It is noteworthy that isolated excision of the clavicle was associated with a lower risk of further surgery and faster rehabilitation. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.