Clavicle ORIF

Hardware is used to correct significantly displaced or comminuted clavicle fractures.

Clavicle ORIF (Open Reduction and Internal Fixation)​

Surgical management of midshaft clavicle fractures is usually warranted when there is >15mm of significant shortening, 100 percent displacement, or significant comminution, especially in pediatric patients involved in high-demand activities. It has been shown that in pediatric patients 10 years and older with these fracture patterns, the use of an elastic stable intramedullary nail leads to less pain during recovery, increased patient satisfaction and less time immobilized. 

There are two options to consider when surgical management is decided. The first is fixing the bone with a plate and screws that lie on top of the bone. This will provide a secure and adequate reduction, although it does require stripping of muscle off the bone where the plate will rest. The plate and screws also require an extensive incision over a the majority of the clavicle so it can be positioned properly. The patient may be able to feel the plate after surgery and it can potentially be bothersome when wearing a backpack, purse or anything that puts pressure on the collarbone. A clavicle plate often needs to be removed with a second surgery due to the irritation it causes. Despite the drawbacks of using a clavicle plate and screws, it may be the best option if the fracture is significantly comminuted or in multiple pieces.

The second option is fixing the bone with a clavicle nail. A clavicle nail sits inside the bone in the intramedullary canal. This eliminates the need to strip down muscle overlying the clavicle. The surgery is done through three small incisions. The hardware is placed inside the bone and cannot be felt by the patient after surgery. The clavicle nail also eliminates the irritation that patients sometimes experience from straps and backpacks. The clavicle nail rarely needs to be removed after surgery.

Clavicle ORIF (Open Reduction and Internal Fixation)​​
Clavicle ORIF (Open Reduction and Internal Fixation)​​

The second option is fixing the bone with a clavicle nail. A clavicle nail sits inside the bone in the intramedullary canal. This eliminates the need to strip down muscle overlying the clavicle. The surgery is done through three small incisions. The hardware is placed inside the bone and cannot be felt by the patient after surgery. The clavicle nail also eliminates the irritation that patients sometimes experience from straps and backpacks. The clavicle nail rarely needs to be removed after surgery.

Video Transcript:

Alli:                              I was snowboarding and it was my first year snowboarding and all my friends had been snowboarding for years on years and like, “Let’s go.” And I was like yeah, I’m doing good. I’m actually keeping up with them. Doesn’t last that long. Hit an edge, face-plant. But I was just like, that hurts so bad.

Dr. Peter DeNob…:        I first met Alli when she was 14 and had just fallen and broken her clavicle. Alli was really the perfect candidate for surgery because the ends of her fracture were really far apart and shortened. Even if the fracture had healed, she most likely would have had a permanent deformity and shoulder dysfunction with activities. All we really needed to do was realign it in a very simple way.

Alli:                              I don’t remember being in a lot of pain the whole time. Maybe I was a little sore and awkward, not being able to lift my arm.

Dr. Peter DeNob…:        The clavicle, also known as the collarbone, is commonly fractured in people of all ages. Historically, most clavicle fractures were treated without surgery but more recent studies have shown that this type of nonoperative management can lead to long-term dysfunction. And in adults, the bone has a higher likelihood of not healing. Generally, there are two ways to surgically fix a clavicle bone. The first is with a plate and screw construct that overlies the bone and stabilizes it. This is a great option to restore stability and anatomic alignment, particularly when the fracture is significantly comminuted or in multiple pieces.

                                    Second option, as in Alli’s case, is fixing the bone with a clavicle nail. This is a metal rod that is essentially hidden within the tubular structure of the bone and cannot be felt under the skin after surgery. This minimizes the chance of irritation from the straps of a backpack or a handbag. This surgical technique also minimizes the size of the incisions, which are about two and a half centimeters in length and fall in line with the clavicle. Once they’re healed, they are barely noticeable.

Alli:                              I thought it was going to be worse but it’s barely a scar at all. Some people, they look at me and they’re like, “Oh, I didn’t know you had that there.” I was like, “Yeah.” My friend, he has a broken collarbone, he has this huge nasty thing on it. I was like…

Dr. Peter DeNob…:        I like patients to limit their range of motion for the first four weeks to minimize the chance for displacement. Motion typically returns quickly and physical therapy is not usually necessary. Within six weeks, Alli had nearly full range of motion of her shoulder.

Alli:                              I wasn’t afraid to snowboard. I went back that season, the first season of snowboarding.

Dr. Peter DeNob…:        Clavicle nails are really a great option for patients who have displaced clavicle fractures but want a nice cosmetic result and early return to normal function.

Alli:                              I liked it, you guys are awesome. Coming here is exciting and cool, to see how it’s worked out and how perfect… I was really scared that I wasn’t going to be able to tumble or anything and actually, tumbling back to even better.

Dr. Peter DeNob…:        I’m so proud of Alli. She did a great job with recovery and as you can see, she’s back to all of her activities and she’s very happy.

Alli:                              It’s pretty awesome, it doesn’t even hurt or bother me. It’s crazy, how badly broken it was.

Frequently Asked Questions

Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem

At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.

Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.

Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.

Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.

Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.

Physical therapy can be extremely helpful in addressing shoulder issues. It will likely be involved in your treatment to some extent, whether it’s to help manage pain, increase strength or mobility, or rehabilitation after surgery. Your therapist will design a program that is unique to your problem and help guide you through exercises and stretches. Generally, we send patients to therapy three times a week so they can develop a consistent routine. We can recommend the names of specific therapists who are particularly skilled in treating shoulder issues. Although therapy is time consuming, it may help you avoid surgery or manage your pain without medication. Physical therapy also helps you to develop good techniques and habits for exercise that you can then use at home.

Personalized care

As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free. 

Get in touch

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