Bilateral Distal Clavicle Nonunion: A Case Report
A 75-year-old man, right-handed, followed up for a chronic obstructive pulmonary disease, was a victim of a road traffic accident that resulted in direct trauma in both shoulders. He has no occupation. He suffered from pain and functional impotence of both shoulders. The physical examination found pain in the palpation of both clavicles, and the piano key sign was absent. The Neurovascular examination of both upper limbs was normal. His chest and shoulder radiographs revealed bilateral distal clavicle fractures “type Neer 1”. These were treated with a figure-of-eight bandage for 6 weeks. He missed the follow-up consultation planned after 6 weeks of immobilization.

One year later, the patient complained of mild pain at both shoulders occasionally in cold weather and during an unaccustomed effort without associated neurovascular symptoms. He reported that the bandage has been applied for 6 weeks. His physical examination stated that there was no obvious deformity of both shoulders, but the patient complained of pain on palpation of both distal clavicles. It was also found that the range of motion was limited (right shoulder: flexion 100°, extension 40°, external rotation 50°, and internal rotation 90°/left shoulder: flexion 110°, extension 40°, external rotation 60°, and internal rotation 100). The constant shoulder score was 60 for the right side and 65 for the left one. Furthermore, radiographs of both shoulders showed bilateral distal clavicle nonunion and the wide left coracoclavicular interval. Nonoperative treatment was prescribed: nonsteroid anti-inflammatory for local application and oral paracetamol to the onset of pain and recommended him to avoid excessive and unusual stress on the shoulder girdle. A review after 2 years following his initial injury, we noted a satisfaction of the patient and a full range of motion without neurovascular symptom associated. On the same examination, the Constant shoulder score was 83 for the right shoulder and 85 for the left shoulder.