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Clavicle Fracture CPT
- 23515 (open treatment of clavicular fracture, with or withou internal or external fixation)
- 20902 (Bone graft any donor area; major of large)
- 20900 (Bone graft any donor area; minor or small)
Clavicle Fracture Indications
- Open fracture
- Associated neurovascular injury
- Impending skin compromise
- Shortening >20mm
- Significant comminution
- Scapulothoracic dissociation
- Floating shoulder
- Bilateral clavicle fx
- Ipsiliateral UE fx
- Nonunion
Clavicle Fracture Contraindications
- Non-displaced fractures (no comminution, <3mm displacement)
- Infection
- Elderly, low-demand, high surgical risk patients
Clavicle Fracture Alternatives
- Non-operative treatment
- Intramedullary pin fixation: 100% union, 50% complication rate (Strauss EJ, JSES 2007 pending publication) Can be done with specially designed screw, or 6.5mm cannulated screw.
Clavicle Fracture Pre-op Planning / Special Considerations
- Accumed congruent clavicle plate www.acumed.net888-627-9957. Often need to use plate labeled "right" for left side and vise versa.
- Consider anterior inferior plating with 3.5mm pelvic recon plate, lag screws and bone graft.
- Consider using AO locking plates
- ORIF c compression plateing = load bearing
- Intramedullary pins/screws = load sharing, provide resistance to bending moments; no rotational stability. No elevation beyond 90 degrees for 6wks.
- Consider using shoulder positioner (Spyder Smith/Nephew).
- Clavicle ORIF Case Card.
Clavicle Fracture Technique
- Pre-operative antibiotics, +/- regional block
- General endotracheal anesthesia
- position. All bony prominences well padded.
- Examination under anesthesia.
- Prep and drape in standard sterile fashion.
- Irrigate.
- Close in layers.
Clavicle Fracture Complications
- Infection
- Refracture
- Delayed union / nonunion
- Hardware failure
- Malunion
- Incisional scar (cosmesis)
- Potentiall visible plate due to its subcutaneous location
- Numbness below the incision (supraclavicular nerve injury)
- Painful hardware
- CRPS
- Shoulder pain
- Shoulder stiffness
- Risk of anesthesia including heart attack, stroke and death
- DVT/PE
Clavicle Fracture Follow-up care
- Post-op: sling for comfort, no overhead motion. Immediate pendelum ROM exercises.
- 10-14 Days: Wound check, sutures removed. Start PT for gentle ROM exercises. No resistive exercises/activities. Sling as needed for comfort.
- 6 weeks: Xrays, if union is evident begin strengthening and resistive exercises. No contant athletics.
- 3 months: Repeat xrays. If pt is painfree and union is obvious pt may return to sport. If no signs of union, consider bone stimulator, see Nonunion. Generally avoid contact sports and heaving lifting for 4-6 months.
- Nonoperative outcomes: (Robinson CM, JBJS 2004;86A:778).
- Mean time to union = 28.4 weeks for non-operative treatment and 16.4 weeks for operative treatment for displaced clavicle fractures. (McKee MD, JBJS 2007;89A:1).
- Shoulder Outcome measures.
Clavicle Fracture Outcomes
- Mean time to union = 28.4 weeks for non-operative treatment and 16.4 weeks for operative treatment for displaced clavicle fractures.(McKee MD, JBJS 2007;89A:1)
Clavicle Fracture Review References
- Master's Techniques: Shoulder
- Rockwood and Green's Fractures in Adults 6th ed, 2006
- OKU - Shoulder and Elbow 2nd ed, 2002
- Zenni EJ Jr, Krieg JK, Rosen MJ: Open reduction and internal fixation of clavicular fractures. J Bone Joint Surg 1981;63A:147-151.
- Nordqvist A, Redlund-Johnell I, von Scheele A, et al: Shortening of the clavicle after fracture: Incidence and clinical significance. A 5-year follow-up of 85 patients. Acta Orthop Scand 1997;68:349-351.°
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