Successful ORIF & Plating for Right Clavicle Fracture in a 54 Y.O. Male

Chief Complaints

A 54-year-old male patient with a body mass index (BMI) of 21 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of severe pain in the right shoulder associated with difficulty in performing activities using the right upper limb. He also complained of right-sided chest pain and difficulty in breathing due to pain following an alleged history of a road traffic accident (bike vs dog). The patient sustained multiple abrasions on the right elbow. There was no history of loss of consciousness, seizures, ear, nose, or throat (ENT) bleeding following the injury.

The patient had no known history of major medical comorbidities such as diabetes mellitus, hypertension, or other chronic illnesses, and had no history of previous surgeries or significant past medical conditions.

The patient was conscious, coherent, and oriented. Chest examination revealed tenderness over the axillary border of the right 5th and 6th ribs. Local examination of the right shoulder showed swelling, tenderness, and crepitus over the middle one-third region of the clavicle, with painful restriction of shoulder movements. Examination of the right elbow revealed multiple abrasions over the posterolateral aspect, while elbow movements were normal. No distal neurovascular deficit was noted. 

Following the clinical evaluation, the Orthopaedic team at PACE Hospitals conducted a detailed assessment of the patient’s complaints of right shoulder pain, right-sided chest pain, and difficulty in performing daily activities involving the right upper limb following a road traffic accident (bike versus dog).

A comprehensive clinical and systemic examination was performed. The examination of the right shoulder revealed swelling, tenderness, deformity, and palpable crepitus over the middle one-third region of the right clavicle. The range of movements of the right shoulder was painfully restricted. Chest examination demonstrated tenderness over the axillary border corresponding to the right 5th and 6th ribs. Multiple abrasions were also observed over the posterolateral aspect of the right elbow. No distal neurovascular deficit was noted.

Investigations and radiological assessment confirmed the diagnosis of fracture of the right clavicle along with fractures of the right 5th and 6th ribs. Laboratory investigations were within acceptable limits for surgical intervention. 

Based on these findings, the patient was advised to undergo Right Clavicle (Collarbone) Fracture Treatment in Hyderabad, India, alongside management for fractures of the Right 5th and 6th Ribs and Multiple Abrasions Over the Right Elbow, under the care of the Orthopaedic Department, to achieve anatomical reduction, stable fixation, pain relief, restoration of shoulder function, and early mobilization while preventing long-term functional disability.

After a detailed consultation with Dr. Raghuram, Consultant Orthopaedic Surgeon, in coordination with cross consultation from Dr. Pradeep Kiran Panchadi, Consultant Interventional Pulmonologist, a comprehensive evaluation was conducted focusing on the patient’s presentation of severe right shoulder pain and right-sided chest pain following a road traffic accident, associated with significant difficulty in performing daily activities involving the right upper limb. Clinical examination revealed swelling, tenderness, deformity, and palpable crepitus over the middle one-third of the right clavicle, along with painful restriction of right shoulder movements. Tenderness was also present over the right 5th and 6th ribs, and multiple abrasions were noted over the right elbow.

Further assessment and radiological evaluation confirmed a displaced fracture of the right clavicle associated with fractures of the right 5th and 6th ribs. 

Based on the above findings, it was determined that Open Reduction and Internal Fixation (ORIF) with plating of the right clavicle was the most appropriate surgical intervention. This decision was made with the aim of restoring clavicular alignment, providing stable fixation, relieving pain, improving shoulder function, facilitating early mobilization, and preventing long-term functional impairment or malunion.

The patient and family members were counselled regarding the diagnosis, planned surgical procedure, possible risks and benefits, postoperative rehabilitation, use of arm sling, chest physiotherapy, breathing exercises, and the importance of regular follow-up to ensure optimal recovery and functional outcome. 

Following the diagnosis, the patient was scheduled for Open Reduction and Internal Fixation (ORIF) with plating of the right clavicle Surgery in Hyderabad at PACE Hospitals, under the expert supervision of the Orthopaedic Department.

The surgical procedure involved the following steps:

• Preoperative Preparation and Anaesthesia: After proper preoperative work-up and fitness assessment, the patient was taken up for surgery under general anaesthesia. Standard aseptic precautions and surgical draping were performed prior to the procedure.

• Surgical Exposure: The patient was positioned supine, and an incision was made over the borders of the right clavicle. Soft tissues were carefully dissected to expose the fracture site while preserving surrounding anatomical structures.

• Fracture Identification and Reduction: Intraoperatively, the fracture of the middle one-third of the right clavicle was identified. The fracture fragments were carefully reduced into anatomical position to restore proper clavicular alignment and shoulder contour.

• Fixation with Implant: Stable internal fixation was achieved using a 7-hole titanium SMPL locking plate along with an interfragmentary screw. Intraoperative image guidance using C-arm fluoroscopy confirmed satisfactory reduction and implant positioning. The fixation provided adequate stability and alignment of the fracture fragments.

• Wound Closure and Postoperative Care: Haemostasis was secured following fixation, and the wound was closed in layers using Vicryl 2-0 sutures and skin staples. A sterile dressing was applied after closure.

The postoperative period was uneventful, and the patient remained hemodynamically stable throughout the hospital stay. The patient received adequate pain control, infection prevention, and supportive care for pain management and recovery. Supportive care, such as chest physiotherapy and incentive spirometry, was advised to improve respiratory function and prevent pulmonary complications. Regular wound dressings were performed during the postoperative period and were found to be clean and healthy. 

Upon discharge, the patient was prescribed medications for the prevention of postoperative infection, pain relief, gastric protection, nutritional supplementation, and enhancement of wound healing and recovery.

The patient was advised to continue using the arm sling as instructed for support and immobilization of the right upper limb. He was instructed to perform elbow and wrist range-of-motion exercises regularly to maintain joint mobility and aid rehabilitation. Chest physiotherapy and incentive spirometry were advised as part of the recovery protocol to improve respiratory function and facilitate healing of the associated rib fractures. The patient was also advised to attend regular follow-up visits for postoperative evaluation and monitoring of fracture healing. 

The patient was advised to report immediately to the emergency ward at PACE Hospitals in case of fever, increasing pain over the surgical site or chest region, difficulty in breathing, swelling, redness, wound discharge, vomiting, or any unusual worsening symptoms.

The patient was advised to return for follow-up with the Orthopaedic Doctor in Hyderabad at PACE Hospitals, after 3 days for postoperative review and assessment of the surgical wound and dressing status. Further periodic follow-up visits were advised for clinical and radiological evaluation of fracture healing, monitoring of implant position, assessment of shoulder function, and progression of rehabilitation exercises.

This case highlights a traumatic fracture of the right clavicle associated with fractures of the right 5th and 6th ribs following a road traffic accident, which was successfully managed with Open Reduction and Internal Fixation (ORIF) using a 7-hole titanium locking plate and interfragmentary screw. The patient underwent successful surgical stabilization after appropriate preoperative evaluation and pulmonary clearance.

The postoperative recovery was uneventful, with satisfactory fracture fixation, adequate pain control, and gradual improvement in shoulder function. Chest physiotherapy, incentive spirometry, arm sling support, and rehabilitation exercises aided recovery. The patient was discharged in stable condition with postoperative instructions and scheduled follow-up.