Three cases of persistent nonunion of the clavicle with segmental bone loss were treated with autogenous, vascularized fibular grafts. In each case, the patient presented with pain and shoulder dysfunction after an average of 3.7 procedures. Each case was characterized by segmental bone loss that failed to unite after treatment of clavicle nonunion by traditional means. Union was achieved in all 3 cases. Average follow-up was 2.8 years. Both pain and shoulder function were improved with the procedure. To date, the use of vascularized fibular grafts has not been described in clavicle reconstruction. We believe that vascularized fibular grafting may be used successfully as a salvage procedure when traditional means of achieving union have failed.
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