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 |  |
 |
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 |  |
 |
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 | |
|
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 |
 |
Some specialized surgical experience |
|
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
 |
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |