Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle Diaphyseal simple, oblique

back to skeleton

Glossary

General considerations

A2 fractures are common fractures of the clavicle. They can be treated conservatively or operatively depending on the displacement and the functional demand of the patient. Plate or intramedullary fixation is possible.

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 - Lag screw with neutralization plate
Main indication Skill Equipment
Shortening and displacement > 2 cm Some specialized surgical experience Simple surgical and imaging resources


Indication is a fracture with shortening greater than 2 cm. The choice between compression plate with lag screw and lag screw with neutralization plate is surgeon's preference. The lag screw provides absolute stability.

Supporting indications

  • High demand patients
  • Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)

Advantages

  • Less pain and quick return 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
ORIF - Compression plate with lag screw
Main indication Skill Equipment
Shortening and displacement > 2 cm Some specialized surgical experience Full specialized surgical and imaging resources


The choice between compression plate with lag screw or lag screw with neutralization plate is surgeon's preference.

Supporting indications

  • High demand patients
  • Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)

Advantages

  • 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
Flexible intermedullary nail
Main indication Skill Equipment
Shortening and displacement > 2 cm Some specialized surgical experience Simple surgical and imaging resources


Supporting indications

  • High demand patients
  • Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)

Advantages

  • Less pain and quick recovery of function (early return to work)
  • Minimally invasive procedure
  • Small scars

Disadvantages

  • General surgical risk
  • Risk of compromising subclavicular neurovascular structures
  • Prominent pin end necessitating secondary pin shortening

Contraindications

  • Narrow intramedullary canal
  • 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