Shoulder pain and bone graft

Dear Ask The Doctor: I broke my collar bone in 2005 and found out that it was a nonunion in 2008. I had surgery where they took a bone graft out of my hip and placed it in my collar bone, plated it with 9 screws and I am still in pain. My bone graft site is still there, it is not healed and my shoulder still has been in constant pain ever since 2005. What can cause this? I don't think my bones healed in my hip or my collar bone; is the something that can cause this. Oh and I am currently 19 years old and in good health otherwise. What would you suggest I do next to investigate this problem?

Dear Jeana: The reason for your chronic shoulder pain is not clear. As you have already assumed, the most likely possibility is failure of the collar bone to heal despite the bone graft i.e a recurrence of the nonunion. Factors that adversely affect healing include Diabetes Mellitus, Smoking and improper immobilization of the fracture site. To identify if the fracture has healed xrays need to be done and reviewed by an Orthopedic surgeon. A decision can then be made as to the appropriate management.