Clavicle: diaphyseal simple fracture and scapular neck fracture (floating shoulder)
Case description
A 23-year-old man was struck on the left shoulder by a falling tree. The patient suffered direct trauma with a resulting floating shoulder (clavicular midshaft fracture and displaced scapular fracture). He had extensive closed soft-tissue damage across the left shoulder and concomitant traction injury of the brachial plexus. Venography of the massively swollen left arm showed normal arterial circulation and drainage over the subclavian vein. The soft tissue showed great improvement 7 days after initial treatment.
Indication for MIPO
The combination of a clavicular fracture with a scapular fracture (floating shoulder) is an established indication for operative plate stabilization of the clavicle. With deep skin abrasions at the site of the planned incision a minimally invasive approach is a better alternative in this case.
Preoperative planning
In unstable fracture situations, as in this case (floating shoulder), the desired plate position is anterocaudal allowing use of a stronger (but not reconstruction) plate when compared with a cranial position. From this anterocaudal view, the clavicle is a straight bone and therefore the plate has to be bent slightly concave on the lateral end only in one plane. The length of the plate is chosen according to the fracture length (plate span ratio is 2–3:1). Contouring of the chosen plate can be performed the day before surgery using a plastic bone model then sent for sterilization, or immediately before the operation using the opposite side as a reference (manual palpation or image intensification in the oblique craniocaudal view) (see Fig 11.2-2 ). The locking compression plate (LCP) instruments (drill guides and drill bits) can be used for indirect reduction and preliminary stabilization which is helpful in this type of minimally invasive surgery.
Operating room setup
Anesthesia
This procedure is usually performed with the patient under general anesthesia.
Patient and image intensifier positioning
The patient is placed in the supine position on a radiolucent operating table. The region of the anterior shoulder girdle including the entire clavicle is prepared. Alternatively, the entire upper extremity is prepared for free manipulation of the upper arm. The image intensifier is best positioned to allow projection of the entire clavicle in the caudocranial and craniocaudal directions. Therefore, the patient might be placed the opposite way around on the ordinary operating table allowing for the table column to be sited distally of the hip. This enables rotation of the C-arm in the desired directions.
Related posts:
Humerus, proximal
Humerus, shaft—introduction
Femur, proximal: extraarticular fracture, trochanteric area pertrochanteric simple—31-A1
Femur, distal: extraarticular simple fracture—33-A1.2
Extraarticular, bifocal closed fracture—42-A1, and articular trimalleolar ankle fracture—44-C2.3 (closed transverse fracture of the medial malleolus, lateral malleolus, and posterior malleolus)
Tibia and fibula, distal—introduction
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
