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The concept of shoulder narrowing by removing a segment of the clavicle bone is straightforward. Since the clavicle is a horizontally oriented bone that keeps the shoulder from collapsing into the sternum, shortening its length will move the outer contour of the shoulders inward. And as a result there is a good correlation between the amount of bone removed and how much each shoulder moves inward.

While the concept of the surgery is straightforward its execution is more difficult than it appears. Cutting the bone out is the easy part but putting it back together is far more challenging. Unlike a fractured bone where the natural length of the bone is re-established with the application of plates and screws fixation, in clavicle reduction osteotomes a shorter bone length needs to be established before the fixation hardware is applied. This is difficult because it requires lifting up the whole shoulder and bringing in the outer half of the clavicle to meet the medial clavicle, compressing the two tightly together and then applying the both sides of the plates and screws.

To make alignment and plate application process a little bit easier, I find that preapplying part of the superior plate is helpful. The medial and lateral bone cuts are made partially through the clavicle but not enough to make it unstable. The superior plate is applied with a single bicortical screw in the hole closest to the osteotomy line. Then the bone cuts are completed and the bone segment removed. 

With the superior plate partially stabilized by a single screw, the outer clavicle bone segment is brought in up against the medial bone segment and a screw placed through the bone hole closest to the osteotomy line. Then the rest of the screws can be placed in the remaining plate holes and the anterior plate easily applied. By applying the at least one hole of the plate on one side of the osteotomy cut before the bone segment is removed it eliminates the need for a hand needed to stabilize the plate before any screws are placed.

Dr. Barry Eppley

Indianapolis, Indiana

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