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?