Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle Diaphyseal simple, transverse

back to skeleton

Glossary

General considerations

A3 is the most suitable fracture pattern for nailing. Transverse fractures indicate a high-velocity trauma and careful examination for associated injuries should be performed.

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 - Compression plate
Main indication Skill Equipment
Shortening and displacement > 2 cm Some specialized surgical experience Full specialized 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)

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