Clavicular Injury Management and Surgical Techniques

Clavicular injuries encompass a spectrum from midshaft fractures to acromioclavicular joint dislocations and distal clavicle avulsions. Management strategies range from non-operative care—immobilisation, analgesia and physiotherapy—to a variety of surgical interventions. Surgical fixation techniques include plate osteosynthesis with pre-contoured locking plates, hook plate systems for distal fractures or joint dislocations, and suspensory loop devices that reconstruct coracoclavicular ligaments. Decision-making is guided by fracture displacement, comminution, patient age and activity level. Non-operative treatment often yields satisfactory outcomes in minimally displaced midshaft fractures, but risks of malunion and functional deficits increase with severe displacement. Advances in preoperative planning, such as three-dimensional modelling for plate contouring, have improved restoration of anatomy in comminuted fractures. For acromioclavicular dislocations, the Rockwood classification informs whether operative stabilisation is indicated; acute high-grade separations benefit from anatomic ligament reconstruction or suspensory fixation, whereas lower grades may be managed conservatively. Rehabilitation protocols emphasise early mobilisation and muscle strengthening to restore scapulothoracic rhythm and shoulder girdle stability. Global trends favour minimally invasive surgical approaches, augmented by biologic grafts or synthetic ligaments in chronic cases, to reduce hardware irritation and optimise long-term function.

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Clavicular Injury Management and Surgical Techniques publication trend

The graph below shows the total number of articles in clavicular injury management and surgical techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Midshaft clavicle fracture: A break occurring in the central one-third of the collarbone, commonly seen in young adults after direct trauma.

Acromioclavicular (AC) joint: The articulation between the lateral clavicle and the acromion of the scapula, stabilised by acromioclavicular and coracoclavicular ligaments.

Hook plate fixation: A surgical device that anchors under the acromion to stabilise distal clavicle fractures or AC joint dislocations, often requiring later removal.

Rockwood classification: A grading system for AC joint injuries based on severity of ligamentous disruption and displacement, guiding treatment decisions.

Scapular kinematics: The movement patterns of the shoulder blade relative to the thorax, essential for coordinated shoulder elevation and function.

References

1. Residual kinematic deviations of the shoulder during humeral elevation after conservative treatment for mid-shaft clavicle fractures. Frontiers in Bioengineering and Biotechnology (2024).
2. Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate. Journal of Orthopaedics and Traumatology (2023).
3. Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures. Journal of Orthopaedic Surgery and Research (2015).
4. Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. Journal of Orthopaedics and Traumatology (2013).
5. High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA‐ESSKA members. Knee Surgery, Sports Traumatology, Arthroscopy (2020).