A midshaft clavicle fracture with over 2cm of shortening was visualized on an x-ray. An incision was made over the projected inferior aspect of the clavicle after reduction. The fracture was reduced using a clamp and then fixed with a reconstruction plate placed on the inferior surface of the clavicle to avoid contouring. Postoperative x-rays confirmed successful fixation of the clavicle fracture with the plate.

3. AP chest radiograph demonstrating displaced midshaft
clavicle fracture with over 2cm of shortening.

4. Clinical picture demonstrating the prominence of the
clavicle and the clear displacement of the fragments.

6. The incision is made over what is projected to be
the inferior aspect of the clavicle once it is reduced.

7. The incision is brought directly down through skin and platysma
muscle to the periosteum. Once the clavicle is identified, a
subperiosteal dissection is performed on the inferior edge of the
clavicle and circumferentially only at the fracture site.

8. The fracture reduction is demonstrated using a clamp.

9. When the inferior aspect of the bone is used for the fixation, the plate
does not need to be contoured as much as when using the anterior
(superior) surface of the bone. This figure demonstrates the clavicle
reduction against a reconstruction plate. A 3.5 DCP plate may also be
utilized.

10. The plate is affixed to the distal fragment…

11. …and the proximal fragment is then
reduced and fixed to the plate.

12. The radiograph demonstrating the fixation
using an inferior position on the clavicle.

13. Closure is performed as a full-thickness layer over the plate.
It is noted that the plate is not prominent when placed inferiorly.

14. Postoperative radiograph of the clavicle fixation.