Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle Diaphyseal wedge, intact bending wedge

back to skeleton

Glossary

General considerations

This is the most common midshaft fracture and if significantly displaced the best results are obtained by means of an open reduction and open fixation.

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
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
  • Large contact surface between the main fragments
  • 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

  • Frequent necessity for open reduction through additional incision over the fracture site

General surgical risk

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

Contraindications

  • Large wedge fragments with low contact of the main fragments
  • Narrow intramedullary canal
  • Infection
  • Metal allergy
ORIF - Lag screw with neutralization 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
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

  • Small contact of the main fragments
  • Associated pathology of the shoulder girdle, scapula fractures or LSSS (floating shoulder)

Advantages

  • Less stripping of soft tissues necessary, especially for the wedge fragment
  • 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