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The width of the shoulders is impacted by several tissue factors including muscle and bone. But none is more significant than the length of the clavicles which separates the sternum from the shoulder joint. For this reason shoulder width reduction, what is also known as shoulder feminization, is achieved by shortening the length of the clavicle. Through a full thickness wedge osteotomy placed at the inner third of the bone, the horizontal clavicular length is shortened by 2cms per side.

Fixation of the shortened clavicle is done through the application of plates and screws on its superior surface. The exact length of the plate and the number of screws needed for immediate stabilization and early rehabilitation has never been studied for this clavicle bone procedure as of yet. But extrapolating from biomechanical studies in clavicle fracture repair, even though this is not an exact corollary, suggests that a single six hole 2.7mm or 3.5mm plate with bicortical screws should be sufficient.

Like the biomechanical studies, radiographic assessment of the healing of clavicular osteotomies has also not been reported. I do not routinely get after surgery x-rays unless there is a reason to do so. Persistent pain, mobility across the osteotomy site or crepitus or noise with arm motion would be reasons to do so. Such postoperative issues have not historically occurred until a more recent patient noted that she had a ‘clicking’ noise over the right osteotomy site with neck movement at 6 weeks after surgery. It was not painful but a clicking noise nonetheless. X-rays were done which showed good alignment, stable plate and screw fixation and incomplete healing of both osteotomy sites. There was no evidence of plate fracture or screw loosening. The origin of the clicking noise remains unclear. Further healing time will be allowed to determine the fate of the noise.

While the plate and screw fixation across the clavicle osteotomy site can always be removed, I would not do so until three months after surgery unless there is radiographic evidence of its failure. Adequate time should be given to allow for full bony consolidation.

Dr. Barry Eppley

Indianapolis, Indiana

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