Treatment of atrophic pseudarthrosis of the clavicule with the use of biogel

The aim of the study is to improve the results of the treatment of atrophic pseudarthrosis of the clavicle by using collagen biogel.Material and method.A two-stage sequential retrospective-prospective controlled single-center study was conducted from 2015 to 2021. At the first stage, an analysis was made of the treatment of fifteen patients with atrophic pseudarthrosis of the clavicle, which consisted of osteosynthesis and bone grafting. We studied the terms of union, functional results, and complications. At the second stage (12 patients), a prospective study was conducted: in patients with atrophic pseudarthrosis of the clavicle, biogel was used during surgical treatment. A total of 27 patients were included, all males, mean age 29.6±7.5 years. The average duration oftreatment from the moment of injury to hospitalization was 357.1±78.1 days. Low-energy injuries occurred in 18 (66.6%) patients: domestic 12 (44.4%) and sports 6 (22.2%); high-energy 9 (33.3%): traffic accident - 7 (25.9%), catatrauma 2 (7.4%). All fractures were closed according to the AO type classification: B (70.5%) and C (29.5%). The results of treatment were assessed by clinical signs of adhesion (pain and physiological axial load); X-ray and CT signs of adhesion, functional result of treatment (clinical and testing according to the DASH and SF-36 scales.Results. Fusion of the pseudarthrosis (according to clinical and radiological signs) with the use of biogel was faster (239.4±55.3 days) than with standard bone autoplastic (299.74±67.9 days) statistically significant (p=0.0023). When testing on the DASH scale in the first group, the results at 1 and 3 months were statistically significantly better (1 month: DASH group I=77.6±3.3 and DASH group II=80.4±4.2 (p=0.0065), 3 months DASH group I=63.6±4.3 and DASH group II=70.4±4.5 (p=0.0336), no significant difference between the groups was noted at later terms. On the SF-36 scale, statistically significant values were after 3 months after surgery, in group I (FF) = 44.6±4.4, in group II (FF) = 37.2±3.3 (difference 16.6% p=0.0065).Conclusion: the use of collagen hydrogel in combination with spongy bone autograft improves the results of treatment of atrophic pseudarthrosis of the clavicle and reduces the fusion period by 20% (p=0.0023) with a high functional result.