The entire operative arm is prepped and draped free, permitting easy manipulation of the extremity during reduction and fixation. The endotracheal tube should be secured on the opposite side of the involved clavicle and the sternal notch should be included in the prep and drape. A small towel bump is positioned beneath the patient’s ipsilateral scapula and the patient’s head and neck are gently rotated away from the operative clavicle, improving access. A radiolucent arm board can be attached to the table on the operative side and positioned against the side of the bed for operative extremity support. The c arm is placed on the opposite side, perpendicular to the table. In the supine position, the patient’s operative shoulder is positioned on the edge of the bed and the patient’s nonoperative arm is tucked to the side of the body. If a flat-top table is used, the patient should be positioned as far distal on the table as possible, permitting maximum c-arm tilt. “Flat-top” radiolucent tables with support at the head and the feet make it difficult to obtain inlet and outlet images of the clavicle. For supine positioning, the patient is placed on a reversed cantilever radiolucent table ( Fig. Supine positioning is a simple setup with easier fluoroscopic imaging, while the beach-chair position is more familiar to many surgeons. Open reduction and internal fixation (ORIF) of distal clavicle fractures is accomplished in either the supine or the beach-chair position and is based on surgeon preference. We review indications for operative intervention, technique for fixation, postoperative care, and pearls/potential pitfalls in practice.Ħ9.5 Preoperative Preparation/Positioning This chapter reviews two preferred operative techniques for open reduction and internal fixation of distal clavicle fractures: anatomic distal plate fixation (with or without coracoid augmentation) and hook plate fixation. During surgical treatment, hardware purchase in the distal fracture segment may prove challenging due to a limited area for fixation. Although most distal clavicle fractures can be treated nonoperatively, surgical management is indicated for widely displaced fracture fragments, as these are associated with increased risk of nonunion. Treatment of distal clavicle fractures is more complex than midshaft clavicle fractures due to the potential involvement of the coracoclavicular ligaments, the acromioclavicular ligament, and the close proximity to the acromioclavicular joint. ![]() McDonaldĬlavicle fractures account for approximately 4% of all fractures, with distal clavicle fractures comprising 15 to 20% of all clavicle fractures. ![]() 69 Open Reduction and Internal Fixation of Distal Clavicle Fractures Sean McIntire, Bradley K.
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