Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle Diaphyseal multifragmentary, fragmentary spiral

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Glossary

General considerations

The main goal treating these fractures is to restore length and rotation. Bridge plating is the most commonly used technique. Nailing will not be a suitable option due to potential telescoping effect (shortening).

Nonoperative treatment
Main indication Skill Equipment
Shortening and displacement < 2 cm Basic surgical experience, no specialized skills Basic equipment only


Supporting indications

  • Situations where larger interventions are contraindicated

Advantages

  • No surgery

Disadvantages

  • Immobilization up to 6 weeks
  • Yield more incidences of nonunion or shortening

Contraindications

  • Open fracture
  • Neurovascular injury
  • Risk of skin penetration by bone
ORIF - Bridge plate
Main indication Skill Equipment
Shortening and displacement > 2 cm Highly experienced and skilled surgeon Full specialized surgical and imaging resources


Supporting indications

  • Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)
  • Added stability needed due to repaired lesions to neurovascular structures

Advantages

  • Less stripping of soft tissues necessary, especially for the wedge fragments
  • Less pain and quick recovery of function (early return to work)

Disadvantages

  • General surgical risk
  • Risk of compromising subclavicular neurovascular structures
  • Prominent hardware necessitating hardware removal
  • Potentially poor cosmetic outcome (scar)

Contraindications

  • Infection
  • Metal allergy
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

2.0 2016-12-05