Clavicle Fracture Fixation

Indications

Clavicle Fractures, radiograph of a left clavicle fracture
Radiograph of a left clavicle fracture. Image by Majorkev (talk) (Uploads), Wikimedia Commons, CC BY 3.0.
  • Open fracture or threatened skin
  • Shortening over 2 cm or complete displacement in active adults
  • Floating shoulder, polytrauma, neurovascular injury
  • Symptomatic nonunion
  • Plate fixation of displaced midshaft fractures lowers nonunion and improves early function (COTS, JBJS 2007)
  • Distal third fractures with coracoclavicular disruption

Position

  • Beach chair with the head turned away
  • Image intensifier with cephalic and caudal tilt views

Operative Steps

  1. Incision along the inferior border of the clavicle so the scar lies off the plate
  2. Identify and protect supraclavicular nerve branches
  3. Raise a full thickness myofascial layer
  4. Reduce and hold with clamps, lag screw for an oblique fracture
  5. Superior or anteroinferior precontoured plate
  6. Three bicortical screws each side
  7. Use drill guides and avoid plunging inferiorly or posteriorly toward the subclavian vessels
  8. Close the myofascial layer over the plate
  9. Intramedullary devices are an alternative for simple fractures

Postoperative Care

  • Sling for comfort, early pendulum exercises
  • Avoid heavy lifting until union
  • Avoid heavy lifting until union at about 6 to 12 weeks
  • Return to contact sport at about 3 months

Complications

  • Prominent hardware needing removal
  • Numbness below the incision
  • Subclavian vessel or brachial plexus injury
  • Nonunion and infection
  • Hardware prominence and removal
  • Infraclavicular numbness
  • Nonunion and refracture after plate removal

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.