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Reduction of wide or broad shoulders can be successfully done by clavicle osteotomies. By removing a segment of the largely horizontally oriented clavicle the shoulder moves in a near equal amount as the length of bone removed. This is an operation in which the risk of being overdone is virtually nil as the shoulders can never be made too narrow. The question then becomes how much bone can be safely removed and not affect shoulder function as well as proceed to a bony union. 

Some insight can be gained from that of clavicle fracture repair in which shortening of the bone is well known to occur in unrepaired bone injuries. Studies have shown that clavicle bone length shortening of even 10% creates some abnormal scapular positions in cadaver studies. But outcome assessments of unrepaired clavicle fractures in human clinical studies have shown that up to 30% lengthening can occur without significant functional compromise.

While I never seen functional range of motion arm issues in any clavicle reduction patient, I think there is merit to establishing the amount of bone removal based on the existing clavicle length. A good guideline is to keep the length of bone removed to no more than 20% of the total clavicle length. While this varies by the individual patient females average clavicle lengths of around 15cms while males are about 1cm longer on each side. As a result bone resection lengths can range between 2 to 3 cms. To no surprise the taller a patient is the longer the clavicle is and maximum lengths of 3cm of bone can be safely removed in my experience.

Regardless of the length of bone removed, good plate and screw fixation is needed to resist motion and encourage primary bone healing. The length of bone removed does not change the fixation method used as resisting elevation and retraction forces on the healing clavicle ostetotomy lines requires strong support.

Dr. Barry Eppley

Indianapolis, Indiana

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