Case Study: Open Reduction and Internal Fixation
of the Left Clavicle in a 30 year-old patient
A damaged bone can be stabilized and healed using a procedure called open reduction and internal fixation (ORIF). This operation can be required to fix your fractured collarbone (clavicle).
The clavicle is a long, thin bone that is situated between your shoulder blade and sternum. Nerve or blood vessel damage may be among the complications that develop.
Occasionally, the sharp edges of a shattered collarbone might graze adjacent blood vessels and nerves. For numbness or coldness in an arm or hand, seek emergency medical assistance.
A 30-year-old patient visited our office with complaints of left collar bone pain. He was snowboarding, he was doing a jump and landed badly causing injury to his collarbone. He went to a hospital in CT where he was evaluated and x-rays were taken. He was discharged with a sling.
The severity of the pain was mild, when he was resting, when he was moving it. He denies any numbness or tingling. He presented results of x-ray which showed status post internal fixation with plate and screws of the left clavicle.
Bilateral Shoulder X-ray AP External and AP Internal
We discussed treatment options and considering that the patient is young and has a comminuted fracture of the mid clavicle along with a Z fragment, we agreed to go for an operative management of the clavicle in the form of open reduction and internal fixation with a use of a plate and screws.
We discussed risks and benefits including infection, bleeding, injury to adjacent nerves and vessels, failure of implant and failure of fracture, need for repeat surgery, shoulder stiffness and weakness, need for rehabilitation among others.
We discussed systemic complications including blood clot, cardiac, pulmonary, neurological complications among others. The patient understood and signed an informed consent.
The patient was taken to the operating room where he was placed on a beach chair table. Supraclavicular block was done by the anesthesia team. An endotracheal intubation was performed. Preop antibiotic was given. Left shoulder was prepped and draped aseptically in usual fashion.
A fluoro was brought in to check adequate exposure which was there. A curvilinear incision was given about 0.5 cm distal to the anterior edge of the clavicle. With sharp dissection, the bone and fracture site was reached.
The Periosteum elevator was used to clean. used to clean the fracture sites. There were two comminuted fragments apart from the two main fragments. Soft tissue attachment of the comminuted fragments was kept intact.
After curettage and irrigation of the fracture fragment on the interior aspect was reduced to the lateral fragment and was held by clamp and fixed with a wire along with interfrag screw. The inferior fragment was also attached to the soft tissue, but was not amenable for interfragmentary fixation.
The fracture was reduced and held in clamp and a superior plate was positioned and checked under fluoro. It was found to be in an acceptable position. The plate was fixed to the proximal and distal fragment through the compression of screws to achieve further compression.
Again, the reduction was checked under fluoro and found to be acceptable. Lateral opposition. A FiberWire was passed around the fracture and the plate and tied under a Tegaderm. The patient was extubated, put in a shoulder immobilizer sling and moved to recovery in stable condition.
The patient was seen for post operative check up. We have decided to do formal physical therapy as well as a home exercise program for rehabilitation of the clavicle. Patients regularly followed an office visit every 3-4 weeks.
Patient did well after the surgery and continued physical therapy. Patient checked in for a follow up visit after a month and saw significant improvement on his clavicle.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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