Study on distraction osteogenesis shows it works in clavicle lengthening

https://www.researchgate.net/publication/236038637_Clavicle_Lengthening_by_Distraction_Osteogenesis_for_Congenital_Clavicular_Hypoplasia_Case_Series_and_Description_of_Technique

Mean gain was 31mm (1.22”)

“Mean preoperative oxford shoulder score improved from 28.5 to 41 and all patients were extremely satisfied with their result”

Paley said to not do it with 2cms done on each side with DO. The patient ended up begging for it to be reversed due to discomfort. I will see if that is the only patient or if this is a reoccurring pattern.
The study while only on 5 people seemed to show success and had a mean follow up time of 35 months so very significant that it lasted with no problems.

Correct me if I’m wrong but isnt the limiting factor here the acromion? I would imagine any lengthening of the clavicle would just result in it bending forwards.

I talked with dr Leif rogers and the limiting factor is the soft tissue. If you move too much too quickly it can cause brachial plexus injury. One of his patients had gotten the sliding osteomy which left tingling all down his arm but went away. The problem with the sliding osteomy is again the soft tissue as the scapula is just floating in muscle when your move the clavicle as far as 20mm the scapula will push back due to the tight soft tissue. Slow distraction osteogenesis circumvents this problem as it mimics a growth spurt of the clavicles (he confirmed this). He also confirmed that the soft tissue grows as well so your chest will literally widen and lats so you in theory you will get stronger by not lifting any weights due to increased muscle tissue. Dr rogers actually confirmed in  theory you could go 1.5” or more on EACH clavicle with distraction osteogenesis which is insane. Only hurdle for some is if you’re Willing to live with two metal bars on your shoulders for months (possibly a year) and deal with the usual risks of DO such as non union and pin site infections. I have looked at some of the studies shoulder progression with DO and it does seem a lot slower than what I have seen with leg lengthening (haven’t seen much data on limb lengthening to be sure though)

I talked with paley and his only patient who got 2cm per clavicle with DO experienced a lot of pain, and dr rogers thinks this could have been from arthritis on the ac joint due to the pressure as you mentioned. However in the studies I’ve linked previously, I went ahead and contacted these English shoulder surgeons and they confirm it does work successfully and in the cases of clavicle hypoplasia it increases shoulder function and comfort even after 35 month follow up. So distraction osteogenesis does seem to work for clavicles. They even did one purely for cosmetic and it was a success as well.  Dr rogers also confirmed range of motion should be fine even after widening. All of his patients with the sliding osteomy were very pleased and comfortable.

Also on the point of bending forwards it will go slightly back however it’s not a bad going back type of motion like I thought it would be. The patients who got the sliding osteomy never minded it. Also the sliding osteomy back motion shouldn’t be like the DO method as far as I know as the soft tissue is slowly growing so it won’t aggressively pull the scapula back which pulls the clavicle back as a result of that ac joint. Now this is my own thoughts not his but the reason it goes back is because if you were to look directly above a person the clavicle bone goes from the sternum and backwards to the scapula and with a mono lateral device, which is just a straight metal bar, it can only continue going backwards as the positioning of the bar due to the clavicle anatomy forces it to push back at an angle. I have some pictures of the actual procedure and results if you want to see it.