A New Frontier for the Medial Clavicle

Abstract

HISTORY: A 63 year-old male presented with a 2-week history of left upper extremity pain after being hit by a car on his left side while riding his bicycle. He sustained fractured ribs, an extraarticular fracture-dislocation of the left medial clavicle, a minimally displaced oblique fractured left scapular body, and a displaced, comminuted fractured left distal radius for which he underwent ORIF. While hospitalized, he was informed there were no surgical options to treat his left clavicle fracture-dislocation. PHYSICAL EXAMINATION: Examination revealed a male with his left arm in a sling. He had a prominent anterior sternoclavicular joint and deformity of his medial clavicle. His range of motion was limited due to pain and guarding. He had 2+ radial pulses, intact sensation to light touch, and no obvious motor dysfunction of his upper extremities. DIFFERENTIAL DIAGNOSIS: 1. Anterior sternoclavicular joint dislocation 2. Medial clavicular fracture-dislocation TESTS AND RESULTS: Left shoulder CT scan: 1. Comminuted, anteriorly angulated fracture of the medial aspect of the left clavicle with severe shortening and subluxation of sternoclavicular joint. 2. Minimally displaced oblique fracture through scapular body. Multiple anterior and posterior ribs. No pneumothorax. FINAL DIAGNOSIS: 1. Medial clavicular fracture with significant shortening and fracture-dislocation of sternoclavicular joint. 2. Minimally displaced scapular body fracture. 3. Anterior and posterior rib fractures. TREATMENT AND OUTCOMES: He underwent an ORIF of his medial clavicle fracture-dislocation using a 7-hole 15-mm hook plate. The plate was placed under the inferior border of the medial head of the clavicle and superior to the first rib to push the lateral clavicle fragment posteriorly to reduce the fracture. Screws were placed in the hook plate to stabilize the fracture and maintain the clavicle out to length as much as possible. The arm was ranged with mild motion of the hook plate under the sternum and the fracture stable. His scapular and rib fractures were treated nonoperatively. A hook plate is designed for fixation of a lateral clavicle fracture, but its use in medial clavicle fractures has not been well established. We offer this case as an example of a successful outcome using this novel operative approach.