Evolution of Technology

Clavicle Locking Plates

Clavicle fractures are commonly treated with a plate and screws. Most implants allow for a combination of locking or non-locking screws. The evolution of locking plates has dynamical changed operative treatment of fractures. Locking screws are a type of screw that locks into the plate that allows creation of a stiff fixed angle construct. For clavicle surgery, an incision is commonly made directly superior or anterior on the clavicle. Due to the clavicle being covered by minimal soft tissue, occasionally these plates can be very prominent and aesthetically displeasing. Once the fracture is healed, the plates may be removed if so desired.

Evolution of Procedure

Clavicle Fracture Surgery

The goal of surgical treatment of the clavicle is to restore the natural anatomy, decrease pain, and allow optimal function of the upper extremity. Multiple implants exist for surgical treatment and continue to evolve as the research and technology for treating fractures develops. Historically, these injuries were treated nonoperatively with a sling/brace immobilization for a few weeks then range of motion exercises are gradually introduced. However, recent studies have demonstrated that earlier surgical intervention can help prevent a long immobilization phase and help prevent decreased shoulder function.

Overall, multiple factors determine if surgical or nonoperative intervention is appropriate. Some factors that favor surgical intervention when considered are young age, open fracture, vascular injury, skin tenting at the fracture site, a symptomatic nonunion (bone did not heal), or a malunion (bone healed improperly).

Evolution of Diagnosis

Clavicle Fractures

Clavicle fractures are a fairly common injury that occurs in the upper extremity. These fractures are usually seen following direct trauma to the clavicle (collarbone) or from a fall onto an outstretched hand. Individuals who have osteoporosis or participate in high-risk activities such as contact sports, motocross, and gymnastics are at high risk of having a clavicle fracture.

An injury to the clavicle can be debilitating and require an extended time of immobilization in a sling or figure of 8 brace. Historically, these fractures were commonly treated without surgery. However, recent literature demonstrates that surgical fixation may be appropriate to prevent long term decreased shoulder function.