Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Fractures of the clavicle
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Fractures of the clavicle
from Chapter 1
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Fractures of the clavicle
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF MIDSHAFT FRACTURES
Indications
(a) Open fractures.
(b) Painful non-union.
(c) Associated injury to the brachial plexus and/or subclavian artery.
(d) Floating shoulder.
(e) Bilateral fractures.
(f) Multiple-injured patient.
(g) Soft tissue interposition between the fragments.
(h) Impending skin necrosis or penetration from a prominent fragment.
Pre-operative planning
Clinical assessment
Mechanism of injury: motor vehicle accident, sports injury, fall on outstretched hand, direct trauma.
Deformity, ecchymosis, swelling, tenderness, crepitation.
Look for pneumothorax or haemothorax, especially in presence of associated injuries.
Assess and document vascular status of the upper arm and any difference in peripheral pulses between the injured and contralateral extremity.
Assess neurological status (usually brachial plexus injury presents as an upper roots traction injury).
Radiological assessment
Anteroposterior view of the clavicle, including sternoclavicular and acromioclavicular joints (Fig. 1.1).
Oblique views.
Lordotic view (usually after surgery for ORIF evaluation).
Operative treatment
Anaesthesia
General anaesthesia at induction.
Administration of prophylactic antibiotics as per local hospital protocol (usually second generation of cephalosporin is administered).
Table and equipment
AO small fragment (3.5 mm) set.
Ensure availability of the pre-planned plate length. A 3.5 DCP plate or a reconstruction plate can be used (Fig. 1.2a,b).
Standard osteosynthesis set as per local hospital protocol.
Table set up
The instrumentation is set up on the side of the operation.
Image intensifier is from the ipsilateral side.
Position the table diagonally across the operating room so that the operating area lies in the clean air field.
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- Publisher: Cambridge University PressPrint publication year: 2006