title: Open reduction and internal fixation of clavicular fractures.
abstract: Extensive clinical studies reported in the literature have indicated that non-operative treatment is the treatment of choice for clavicular fractures. It has also been suggested by some that open reduction may contribute to the development of non-union. From 1970 to 1978, twenty-five of approximately 800 patients with a fracture of the clavicle were treated by open reduction and internal fixation with a threaded intramedullary wire or pin or with cerclage suture (one case). The patients' ages ranged from thirteen to fifty-nine years. All fractures healed without infection or migration of the pin. Based on this experience and a review of the English-language literature, we concluded that the indications for open reduction and internal fixation should be: (1) neurovascular compromise due to posterior displacement and impingement of the bone fragments on the brachial plexus, subclavian vessels, and even the common carotid artery; (2) fracture of the distal third of the clavicle with disruption of the coracoclavicular ligament; (3) severe angulation or comminution of a fracture in the middle third of the clavicle; (4) the patient's inability to tolerate prolonged immobilization (required by closed treatment) because of Parkinson's disease, a seizure disorder, or other neuromuscular disease; and (5) symptomatic non-union following treatment by closed methods.
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography