Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a small sandbag placed between the scapulae to elevate the shoulder girdle, facilitating access to the clavicle.

Anatomical surgical approach:  A direct approach to the clavicle was utilized, involving a longitudinal incision overlying the fracture site. Subcutaneous tissues were carefully dissected, and the platysma muscle was incised in line with its fibers. The fracture site was exposed by elevating the periosteum and preserving soft tissue attachments as much as possible.

During the procedure, anatomic reduction of the butterfly fragments was achieved using 2.4mm lag screws for interfragmentary compression. The main segment reduction proved challenging due to instability; hence, a 2.4mm "clamp replacement plate" was temporarily used to maintain reduction. A reconstruction plate was contoured and applied to the anterior inferior clavicle, providing a neutralization construct. Absolute stability was achieved, anticipating primary bone healing.

Postoperative protocol:   Postoperatively, the patient was instructed to wear a sling for comfort and protection. Passive range of motion exercises for the shoulder were initiated at two weeks post-surgery, progressing to active-assisted exercises by four weeks. Full active range of motion and strengthening exercises were commenced at six weeks postoperatively.

Follow up:   Not specified.

Orthopaedic implants used:   2.4mm lag screws, 2.4mm clamp replacement plate, reconstruction plate.