Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Clavicle Lateral, displaced fracture with CC disrupted, extraarticular

back to skeleton

Glossary

General considerations

In the injuries in which the AC ligament is disrupted and the injury involves the joint or the outer 1/3 of the clavicle medial to the AC ligaments there is no bony or ligamentous connection between the medial 2/3 of the clavicle which is fixed to the sternum and the scapula and the arm. As a result the weight of the arm displaces the arm downwards and forwards as the scapula is directed forwards by the shape of the rib cage. There are several operative techniques described for these injuries, however, there is no single standard technique yielding excellent result as a rule.

Nonoperative treatment
Main indication Skill Equipment
Minimally displaced fractures or low demand (typically elderly) patients Basic surgical experience, no specialized skills Basic equipment only


Supporting indications

  • Minimally displaced fractures
  • Low demand patients

Contraindications

  • Open fractures
  • Fractures with neurovascular compromise
  • Severe displacement
  • Active young patient
  • Combined injuries like floating shoulder
ORIF - Hook plate
Main indication Skill Equipment
Severely displaced fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources


Supporting indications

  • Small lateral fragment
  • Open fractures
  • Fractures with neurovascular compromise
  • Severe displacement
  • Active young patient

Contraindications

  • Poor soft tissue coverage
  • Active infection
  • Anticipated patient non-compliance (especially substance abuse)

Disadvantages

  • The hook of the plate often leads to alteration of the acromion and AC joint
  • Hardware is routinely removed
ORIF - Pre-contoured distal plate
Main indication Skill Equipment
Severely displaced fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources


Supporting indications

  • Lateral fragment of sufficient size for multiple screw fixation
  • Open fractures
  • Fractures with neurovascular compromise
  • Severe displacement
  • Active young patient

Contraindications

  • Poor soft tissue coverage
  • Active infection
  • Anticipated patient non-compliance (especially substance abuse)

Advantage

  • Generally no need for implant removal
*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