Is 30mm Of Clavicle Lengthening Possible?

Q: Dr. Eppley, I wanted to inquire aabout if 30mm of clavicle lengthening per side is possible.

A: One of the major limiting factors in clavicle lengthening is how much resistance is met by the shoulder girdle tissues. When lengthening the clavicle you are pushing out against the AC joint and all of its surrounding bony and soft tissue attachments. As a result, once the bone is cut (sagittal split completed) the shoulder does not unfortunately just fall to the side. (lengthen) This is quite different than in clavicle reduction where upon removing a segment of bone it does indeed fall inward. It requires a fair amount of force to get the bone lengthened due to the shoulder girdles tissue whose resistance must be overcome. This is why it is a challenge to just get 20mms of lengthening…and even that can be a struggle. This is why I thing there is merit in shoulder stretching exercises preoperatively to try and ‘loosen up’ the soft tissue attachments.

The other limiting factor is the length of the clavicle plate. The longest 10 hole clavicle plate is only going to permit three screws per side even up to a 25 mm lengthening.

Thus for anatomic and fixation plate restrictions a 30mm increase in any patient is not a technical possibility. I wish it were as more is always better but we are asking the body to do something beyond what it was designed/developed to be. As a result it does pose limitations sometimes from our ideal aesthetic goals.

Dr. Barry Eppley

Indianapolis, Indiana