Displaced Clavicle Fractures

The controversy concerns the best management of the young athlete with the completely displaced clavicle fracture. Is the optimum management a figure of 8 bandage, with a high incidence of delayed and non-union, or an open operation with complications such as loss of fixation and non-union?

The typical problem case is:

This xray is of a displaced clavicle fracture sustained in a mountain bike fall. The patient is a 32 year old ophthalmologist. The questions are:

How long will this take to heal with conservative treatment?
When can he return to work?
Conservative treatment the problems associated with non-operative care are:
  • When to return to play
  • The high incidence of delayed union and non-union
  • The shortening of the shoulder girdle with loss of biomechanical function
  • Re-fracture on return to play

The use of a acetabular reconstruction plate and bone grafting the site, will help ensure a good result.

ORIF the problems associated with operation are:
  • Loss of fixation
  • Delayed union
  • When to return to play
  • Should the hardware be removed before returning to play?