Background: Shoulder reduction surgery is performed on a wide variety of patients, particularly when it comes to their height. I have performed this surgery on patients from 5’3”to 6’2” tall. Wile the surgery itself does not change regardless of the patient’s height the amount of clavicle bone that can be removed does. It makes sense that taller patients have longer clavicles thus permitting or needing more length removed for a similar effective result as shorter patients..
However as the patient height increasrs the amount of bone length that can be removed is not necessarily linear. The location of the clavicle bone removal occurs in its straight mid-shaft portion which occupies the middle third of its length. On each end is a curved section which ends in joint articulation. These ends of the bone needs to be curved to accommodate the different heights of the two ends of the bone.
Since the only 3.5mm straight clavicle plates that are currently available are straight one has to be careful to not remove too much straight mid-shaft bone. If too much is removed the last hole on the plate may not fit over the bone limiting the number of screws that can be placed. Insufficent screw placement may result in fixation failure and adversely affect one healing.
Case Study: This tall (5’ 11”) female desired to have less wide shoulders. Her bideltoid distance was 53cms with a clavicle length of 17cms. Under general anesthesia a bone length of 2.7cms per side was removed and put back together with double plate fixation. Her intraop before and after showed the visible reduction in her shoulder width.
Her upright standing before and after pictures showed a similar amount of improvement as seen in the front view.
The back view, int which shoulder narrowing is often less impressively seen, showed a good change as well.
Her postop x-ray showed good bicortical screw engagement of the larger top plate on all 12 screws.
Key Points:
1) Shoulder reduction surgery is performed on a wide range of patient heights with increasing amounts of bone length removal.
2) Due to the double reverse curve of the clavicle the amount of bone removal with increasing patient height is not linear.
Dr. Barry Eppley
World-Renowned Plastic Surgeon