1. Displaced clavicle fracture
Case for small group discussion: Upper extremity fractures—decision making and methods of stabilization
AO Trauma Advanced Principles Course

2. 42-year-old man, fell off mountain bike
Displaced fracture of the clavicle
Neurovascular intact
Treatment options?
Discussion points:
How should this fracture be treated: operative treatment vs nonoperative treatment?
Advantages and disadvantages of each treatment?

3. Discussion points:
How should the patient be positioned: beach chair vs supine with a bump between the shoulders?
Which surgical approaches should be used and what structures should be taken care of?
Discuss the choice and implant selection.
What type of reduction is needed? What are the reduction techniques required to treat this fracture?

4. Contouring of LC-DCP and DCP is easier for anteroinferior plating due to the anatomy of the clavicle (S-shape).
Discussion points:
Discuss plate contouring for superior plating vs anteroinferior plating.
Where should the plate be placed? Discuss the advantages and disadvantages of the different placement choices.

5. Discussion points:
Discuss plate placement and the positions of screws and the structures at risk for refracture or implant failure.
Discuss screw length and why length is important (especially in osteoporotic bone)? The diagram shows the length of the screws and the position of the plate and the surgical anatomy.

6. Postoperative X-rays Discussion points:
How should the patient be advised regarding early weight bearing?
Are there any complications that could arise if this patient had osteoporotic bone?

7. Discussion points:
What is the rehabilitation protocol for this patient: sling for how long, physical therapy, range of motion?

8. Summary
In displaced clavicle fractures there is strong evidence (RCT) that operative treatment have better patient oriented outcomes.
Using a DCP/LC-DCP is better than reconstruction plates according to biomechanical studies. [Iannotti et al (J Shoulder Elbow Surg. 2002;11:457–462)]
Surgical approach and plate placement depends on surgeon preference.
Moderator should ask participants to summarize what else they have learned from this case.
Source:
Iannotti MR, Crosby LA, Stafford P, et al. Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg Sep-Oct;11(5):457–462.