From the Guidelines
Clavicle fractures typically need open reduction and internal fixation (ORIF) when there is significant displacement, shortening, or comminution, as surgical treatment is associated with higher union rates and better early patient-reported outcomes than nonsurgical treatment 1.
Indications for ORIF
- Significant displacement (greater than 2 cm)
- Shortening (greater than 2 cm)
- Comminution (multiple fragments)
- Open fractures
- Fractures that threaten to pierce the skin
- Fractures involving the dominant arm in athletes or manual laborers
- Fractures with neurovascular compromise
- Floating shoulder injuries (combined with scapular fractures)
- Fractures at high risk of nonunion, such as those in the distal third of the clavicle
Considerations for ORIF
- The procedure involves surgically exposing the fracture site, realigning the bone fragments, and securing them with plates and screws
- Surgical approach provides better anatomical alignment, potentially faster healing, improved functional outcomes, and reduced risk of malunion compared to conservative management
- Surgery carries risks, including infection, hardware irritation, and the potential need for hardware removal later
- The decision for ORIF should be individualized based on patient factors, fracture characteristics, and functional demands, with consideration of the strong recommendation for surgical treatment of displaced midshaft clavicle fractures in adult patients 1
From the Research
Clavicle Fracture Treatment
- Clavicle fractures can be managed nonoperatively or surgically, with open reduction and internal fixation (ORIF) being a common surgical technique 2.
- ORIF is often used to treat displaced midshaft clavicle fractures, as it allows for early pain relief and effective anatomical restoration 2.
- The decision to perform ORIF depends on various factors, including the fracture classification, displacement, and comminution 3.
Indications for ORIF
- Displaced fractures with little or no cortical contact between fragments may require ORIF 3.
- Type II distal clavicle fractures are associated with high rates of nonunion with nonoperative management, making surgical fixation a recommended treatment option 4.
- In adolescent patients, the role of ORIF is still being debated, with some studies suggesting that there may not be significant functional outcome differences between operative and non-operative intervention 5.
Complications and Considerations
- ORIF is associated with a risk of complications, including adhesive capsulitis or stiffness, paresthesia, and superficial infection 2.
- The choice of surgical approach, such as vertical or horizontal incision, can affect outcomes, including scar length and hypoesthetic skin area 6.
- Meticulous closure of the subcutaneous tissue is recommended to minimize the risk of complications, such as haematomas 6.