Clavicle Fractures

Draping to include impervious stockinette and 4 inch elastic bandage wrap for forearm and hand.
Selection of bone clamps for reduction.
- Large and small pointed bone reduction clamps (“Weber clamps”)
- Plate holding clamp (Verbrugge, self-centered)
- Small serrated bone holding clamp (small “lobster claw”)
Threaded K-wires or 2.5-mm Schanz pins (e.g., from small external fixator) for manipulation and intramedullary fixation.
Small distractor (especially for delayed treatment, nonunions or malunions).
Implants.
- Open reduction and internal fixation
  - Anatomically contoured plates
  - 3.5-mm compression or reconstruction plates
  - 2.7-mm compression or reconstruction (non–heat annealed)
- Intramedullary fixation
  - Stainless steel or titanium small diameter flexible intramedullary nails typically 2.5- to 3.5-mm.
  - Intramedullary screw fixation: long 4.5-, 5.0-, 5.5-, or 6.5-mm cannulated screws (use largest size possible to gain endosteal purchase).
- Consider partially threaded screws for compression or using cortical screws placed using a lag screw technique.
K-wires and wire driver/drill.

Captain’s chair (beach chair position) or supine, with patient on radiolucent table (e.g., a reversed position on radiolucent cantilever table).
- A reversed cantilever table is used for clavicle fractures amenable to nail fixation.
- A beach chair or reversed cantilever table is used for clavicle fractures amenable to either plating or intramedullary screw fixation.
  - A flat radiolucent table, typically supported at the head and foot, is not used for clavicle fractures due to difficulties obtaining “inlet” and “outlet” radiographs of the clavicle because of the table’s end-based support structure.
Entire ipsilateral extremity prepped and draped circumferentially to allow freedom of movement and facilitate reduction.

Anteroinferior approach

The incision is centered over the fracture site and extended in line with the inferior border of the clavicle.
Care is taken to preserve the three to five branches of the supraclavicular nerve that run obliquely or perpendicular to the clavicle.¹
Laterally, the deltoid origin is taken sharply off the anterior border of the clavicle.
- It should be repaired at closure.

Anterosuperior approach

Intramedullary nailing approach

Small incision 1.5 cm distal to ipsilateral sternoclavicular joint for medial to lateral flexible nail stabilization.
Small incision posterior to the acromion, collinear with the lateral clavicular shaft, for lateral to medial intramedullary screw placement.