Medial periarticular clavicle fracture repair using inverted distal clavicle plate and sternal fixation: a case study

Background: Fractures of the medial third of the clavicle are rare, comprising less than 3% of all clavicle fractures. Available studies regarding medial clavicle fractures report frequent poor outcomes with traditionally-accepted nonoperative management, especially in cases of complete displacement. The medial periarticular clavicle fracture presents a distinct therapeutic challenge as the medial fragment may be too small for adequate screw fixation. We report a favorable outcome following surgical repair of a fully displaced medial periarticular clavicle fracture using an inverted distal clavicle plate and sternal fixation. Case information: A 29-year-old male presented with left shoulder pain and visible deformity along the left medial clavicle following a motor vehicle collision. Radiographs demonstrated a medial clavicle fracture with greater than 100% displacement and shortening of approximately 2 cm. The surgeon opted to perform open reduction and internal fixation due to significant displacement, shortening and cosmetic deformity. Upon reduction, it was determined that the medial fracture fragment was too small for adequate screw fixation. Instead, a distal clavicle plate normally used for the right shoulder was inverted, placed along the fracture site, and utilized to obtain multiple fixation points in the clavicle and sternum. Final imaging showed adequate fracture reduction and restoration of shoulder length. The patient was placed in a shoulder immobilizer and later discharged with instructions for physical therapy. His plate was removed 6 months after surgery. 8 months after surgery, the patient had full range of motion, strength comparable to the contralateral side, and returned to work without complication. Conclusions: This case describes the unique surgical repair of a medial periarticular clavicle fracture. Traditional management of this injury has been nonoperative, but available literature reports frequent unsatisfactory results, including symptomatic non-union and continued pain. Despite the severity of this case, the patient accomplished a full recovery with no complications. The findings of this case study support surgical intervention for displaced medial periarticular clavicle fractures and suggests that fixation to the sternum is appropriate in cases where the medial fracture fragment is too small for adequate screw fixation.