What Type of Bone Grafts Can Be Used For Clavicle Lengthening?
Q: Dr. Eppley, I have a couple of questions regarding clavicle lengthening surgery.
Firstly, it appears on your social media that clavicle shortening* is far more prevalent? Is there a reason for this? Are there additional cases of lengthening that can be shared or perhaps a follow up photo of the bodybuilder from your article https://exploreplasticsurgery.com/plastic-surgery-case-study-shoulder-widening-by-clavicle-lengthening-in-a-muscular-male/
Secondly my question is regarding the procedure itself. I’m happy to see that you offer a sagittal split cut for increased stability and thickness. As surgeons often use ground cow bone powder for grafting purposes in surgery, I would like to know if it is possible to use human bone as a solid graft for the same purpose? For example in the saggital split, the two gaps created need to be filled with bone putty. It is possible to completely clean out a donated piece of clavicle from another human for the purposes of placing this in the gap instead of bone putty? This would act to physically prevent relapse/the clavicles sliding backwards and presumable be far more stable than putty.
If this is the case, then can the same graft be applied to a single osteotomy in the middle of the clavicle as opposed to a saggital cut?
Thank you and kind regards,
A: In answer to your clavicle lengthening questions:
1) Clavicle reductions are performed in far greater numbers because there is a greater medical need as well as being a surgery that is more effective and with a much lower risk of complications.
2) As for grafting the bone defects in the lengthened clavicle bone demineralized human bone particles is the most common graft material used in my experience. Other options include human cadaveric corticocancellous blocks as well as the patient’s own bone.
3) The reality is that clavicle lengthening has two distinct features that make it far more problematiic than clavicle shortenng in my experience. First to lengthen the clavicle you have to push out all of the shoulder soft tissue aftachments so the bone can lengthen. This not only is not easy but limiting in the lengthening amount possible. While clavicle reductions can easily shorten the bone 2.5cms or greater per side the maximum lengthening is around 1.5cms per side. Secondly, and a major issue, is that in the lengthened clavicle the shoulder soft tissues act like a fulcrum pushing down across the osteotomy site…often bending even a 3.5mm rigid plate. In short the biomechanical forces applied to the clavicle bone are very different between lengthening vs shortening.
3) Compared to the issues in #3, the choice of bone graft is the least important element in the whole clavicle lengthening process. If the expanded bone can not be maintained structurally stable in the short term the long term effects of the different types of bone grafts are irrelevant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon