Clavicle fractures have historically been treated non-operatively. The majority of these types of fractures can heal without surgery and can do well. However, many of these fractures have a gap between the two ends of the bone. Because of this gap there is a strong chance of the bone not healing. In addition, if the clavicle shortens significantly, it can decrease the strength in the upper extremity as well as cosmetically giving the appearace of assymetry. Thus one arm appears closer to the chest than the other.
As a result many surgeons are fixing these fractures more commonly, especially as specialized plates and screws specific to clavicles are now being produced. In addition, I use tiny 1.8mm screws designed for fingers and metacarpals to piece back the tiny fragments that are often the results of these fractures.
Although I am a spine surgeon, I am referred a signficant number of these fractures for repair. Fixation of these fractures is one my favorite procedures. I would like to thank Dr. Brian Solberg during my time at Cedars-Sinai Medical Center during my residency for his expertise in clavicle fracture fixation.
This is a simple clavicle fracture where there are just two large fragments. Although the two fragments appear to be touching in reality they are not and during surgery were noted to be about 1 inch apart.
Clavicle 1 repair
This is after fixation. Three small screws were initially placed to hold those two large fragments followed by a plate and screw construct above to neutralize it.
Here is a more complex fracture with two large fragments and two smaller "butterfly" fragments.
Clavicle 2 repair
This is after repair. The key to repair is to first fixing each of those tiny fragments to the larger fragments with small screws. Then the two large fragments are held together with plates and screws.
This is another simple mid-shaft clavicle fracture with just two large fragments. Given the distance between the two ends of the bone I did not think this had a good chance of healing.
Clavicle 3 repair
This is after simple plate and screw construct.
This is a 16 year old young lady with a clavicle fracture. The butterfly fragment between the two bones was sticking straight up. Because she is so thin the fragment was tenting the skin and the sharp point could be felt under ths skin. In addition, cosmetically her left arm and scapula had shifted and was visible to the patient and parents.
Clavicle 4 repair
The butterfly fragment was fixed with small screws from below to above. A plate was then placed to stabilize fracture.