Surgical Treatment of a Non-union of Medial End Clavicle Fracture with Dual Plating and its Clinical Outcome – A Case Report

Introduction: Medial end clavicle fractures are rare, constituting only 2–3% of all clavicular fractures. Although these fractures are typically managed conservatively with favorable outcomes, symptomatic non-union occurs in approximately 8% of cases, often requiring surgical intervention. Non-union, particularly in medial end fractures, presents a significant challenge due to the anatomical complexity and biomechanical forces involved. This report presents a symptomatic non-union of a medial end clavicle fracture successfully treated with dual plating, resulting in favorable clinical and functional outcomes. Case Report: A 42-year-old male laborer with a history of chronic alcoholism sustained a medial end clavicle fracture following a fall. Initially managed conservatively, the patient presented 2 years post-injury with persistent pain, instability, and deformity. Imaging confirmed a non-union with a small distal fragment. Surgical management involved open reduction and internal fixation using a dual plating technique – utilizing a lateral end clavicle locking plate anteriorly and a superior recon plate. The procedure was successful, with no intraoperative complications. At the 12-month follow-up, the patient demonstrated radiographic union, significant improvement in the Constant-Murley score from 34 to 85, and restored range of motion without pain, enabling him to return to his previous activity level. Mild implant prominence was noted but did not necessitate removal. Conclusion: Dual plating for medial end clavicle non-union provides enhanced stability, reduces the risk of hardware migration, and yields excellent clinical outcomes, particularly in cases involving small or unstable fragments. This technique effectively achieves union and restores function, making it a viable option in challenging clavicle non-union. Keywords: Medial end clavicle fracture, non-union, dual plating, open reduction internal fixation, Constant-Murley score.