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Background: Clavicle reduction osteotomies has become an effective surgery for patients affected by dysphoria of their shoulder width and square shape. It works by the obvious shortening of the length of the clavicle which produces close to a linear reduction effect. But it also has a rounding effect on the shoulders given the lazy s-shape to the bone. 

Good healing of the two clavicle bone ends occurs with stable plate and screw fixation. How long that takes to occur is not exactly known but the blunt ends of an osteotomy should heal together faster than that of that of non-linear patterns seen in clavicle fracture repairs. One other healing issue that separates clavicle reduction osteotomies from clavicle fracture repairs is that it is bilateral and not just on one side. So there is not a good arm to use during the recovery so the arms are exposed to a little more motion/stress than in clavicle fracture repairs.

A common question about shoulder reduction surgery is whether the titanium hardware needs to be removed. The answer is no…unless it is symptomatic for the patient. Such symptoms would be visibility, discomfort or just the need to have foreign materials removed.

Case Study: This female had successful shoulder reduction 9 months previously. She had a very thin soft tissue cover and it was suspected that visibility of the hardware may eventually be an aesthetic  problem. That did turn out to be true. 

Under general anesthesia her clavicle hardware (4 plates and 20 screws) were removed. The clavicles were well healed across the osteotomy sites. It is interesting to compare the bone sites at the time of plate and screw fixation and then at the time of their removal.

As would be expected the clavicle osteotomy sites were well healed even  though a line was visible at the left clavicle site. Now the hardware is removed the bone will continue to removal with the screw holes filling in and any residual osteotomy line smoothed over.

Case Highlights:

1) The bone healing from clavicle reduction osteotomies should be structurally stable by 8 weeks after surgery.

2) The plate and screw hardware from shoulder reduction surgery is only ever removed if it becomes symptomatic for the patient.

3) In this shoulder reduction patient the hardware was removed due to visibility 9 months after the initial surgery which showed good healing of the osteotomy sites. 

Dr. Barry Eppley

Indianapolis, Indiana

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