Midshaft Clavicle Fractures Pathway Updated: 10/9/2017
CPT Codes: 23515 Open treatment of clavicular fracture, includes internal fixation, when performed

Clavicle Shaft Fracture ORIF

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Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

  • template fracture with instrumentation

2

Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case

3

Description of potential complications and steps to avoid them

F

Room Preparation

1

Surgical instrumentation

  • appropriate precontoured plate or LCP

2

Room setup and equipment

  • standard operating table
  • fluoroscopy

3

Patient positioning

  • place in the supine or modified beach chair position
  • place a bump on the medial portion of the scapula on the operative shoulder
G

Approach

1

Identify and mark the fracture

  • infiltrate area with dilute epinephrine to minimize bleeding
  • make a longitudinal incision just inferior to and in line with the clavicle

2

Identify critical structures

  • identify the supraclavicular nerves
  • these nerves cross the clavicle at the level of the platysma
  • minimize removal of muscle attachments and periosteum as much as possible
H

Fracture Reduction and Provisional Fixation

1

Reduce the fracture

  • realign the fracture with a distractor
  • use clamps and kwires to reduce comminuted fractures
I

Superior Plate Final Fixation

1

Place the superior plate

  • place a LCP or precontoured plate to the superior aspect of the clavicle

2

Prepare screw placement

  • drill the clavicle in a superior to inferior direction

3

Place screws

  • use depth gauge to measure the length of each screw
  • a minimum of three screws should be placed bicortically in each major fragment of the fracture
  • place interfragmentary screw
  • this screw greatly enhances the stability of the construct
J

Anterior Plate Final Fixation (alternative placement)

1

Prepare the fracture site

  • partially remove the origins of the deltoid and the pectoralis major

2

Place the plate anteriorly

  • place a LCP or precontoured plate on the anterior aspect of the clavicle

3

Prepare screw placement

  • drill the clavicle from an anterior to posterior direction

4

Place screws

  • use the depth gauge to measure the appropriate length screw
  • a minimum of three screws should be placed in each major fragment
  • place interfragmentary screw
  • this screw greatly enhances the stability of the construct
K

Wound Closure

1

Irrigation and hemostasis

  • copiously irrigate the wound

2

Deep closure

  • close the platysma with 0-vicryl

3

Superficial closure

  • close the subcutaneous tissue with 3-0 vicryl
  • close the skin with 3-0 monocryl
Postoperative Patient Care
 

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