Trauma · Shoulder

Clavicle ORIF

Plate-and-screw fixation of a displaced clavicle fracture to restore shoulder length, alignment, and function.

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus).
Shoulder anatomy. The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.
Wikimedia Commons · CC BY-SA 4.0

The clavicle is the strut that holds the shoulder out from the chest wall. Most clavicle fractures occur in the middle third of the bone after a direct fall onto the shoulder. Many heal well in a sling, but fractures that are significantly shortened, displaced, or comminuted have a higher rate of nonunion and poor shoulder function when treated non-operatively.

Surgery is typically offered for shortening greater than about two centimeters, wide displacement, skin tenting, open injury, or certain fracture patterns in active patients who want the most reliable return to full strength.

Why it's done

Clavicle ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Displacement greater than one bone width

    Non-operative healing rates fall sharply with this degree of displacement.

  2. Significant shortening (>2 cm)

    Shoulder mechanics and scapular position are altered.

  3. Skin tenting or open fracture

    At-risk skin requires reduction and fixation.

  4. Floating shoulder or neurovascular injury

    Associated injuries often demand stabilization.

  5. Active patient with functional demands

    Plating offers a more predictable return to overhead and throwing activity.

How it works

AP shoulder X-ray showing a displaced clavicle fracture fixed with a superior plate and six screws.
Post-op clavicle ORIF. A pre-contoured plate sits along the top of the clavicle, anchored by screws on each side of the fracture line to hold the bone in anatomic alignment while it heals.
Wikimedia Commons · CC BY-SA 3.0

Through an incision along the top or front edge of the clavicle, the fracture is reduced to restore length and rotation. A pre-contoured plate is laid on the bone — either superior or anterior — and secured with multiple screws on each side of the fracture.

Comminuted fragments are typically held in place with small lag screws or sutures. Fluoroscopy confirms reduction and screw length.

Recovery

The arm is kept in a sling for a few weeks, with pendulum and gentle passive motion starting right away. Active motion progresses as pain allows, with return to full overhead use around six to eight weeks. Union is typically confirmed on X-ray by three months. Hardware irritation at the plate is not uncommon; elective hardware removal can be considered once the fracture is fully healed.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: