Successful ORIF for Displaced Left Collarbone Fracture in a 55 Y.O. Male

Chief Complaints

A 55-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 pain over the left collarbone region, associated with difficulty in movements of the left shoulder joint. He reported a history of a fall on an outstretched left hand. There was no history of loss of consciousness (LOC), ear, nose, or throat (ENT) bleeding, or vomiting following the injury, and he denied any known drug allergies or chronic illnesses.

The patient had no known history of chronic medical illnesses such as diabetes mellitus, hypertension, cardiovascular disease, or respiratory disorders. There was no history of prior similar trauma or previous surgeries. He also denied any known drug allergies and had no significant past hospitalizations.

Following the clinical evaluation, the Orthopaedic team at PACE Hospitals conducted a detailed assessment of the patient’s complaints of left shoulder pain associated with difficulty in performing daily activities such as shoulder movements and lifting the arm.

A thorough clinical and systemic examination was performed. The examination revealed deformity, swelling, and tenderness over the middle third of the left clavicle, with palpable crepitus. The range of movements of the left shoulder was grossly restricted and painful. No distal neurovascular deficit was noted, and systemic examination findings were within normal limits. X-ray of the left clavicle revealed a comminuted, displaced fracture involving the middle third of the clavicle.

Based on these findings, the patient was advised to undergo Comminuted and Displaced Collarbone Fracture Treatment in Hyderabad, India, under the care of the Orthopaedic Department to achieve anatomical reduction, stable fixation, pain relief, restoration of shoulder function, and prevention of long-term functional impairment.

After a detailed evaluation by Dr. Anand Agroya, Senior Orthopaedic Consultant, the patient was assessed for left shoulder pain following a history of trauma due to a fall on an outstretched hand, associated with significant difficulty in performing daily activities such as lifting the arm and shoulder movements. Clinical examination revealed deformity, swelling, tenderness over the middle third of the left clavicle, palpable crepitus, and gross restriction of left shoulder movements. Radiological assessment confirmed a comminuted, displaced long oblique fracture of the middle third of the left clavicle.

Based on the clinical and radiological findings, it was determined that Open Reduction and Internal Fixation (ORIF) with a titanium plate and screws was the most appropriate surgical intervention. This decision was made with the intent to achieve anatomical reduction of the fracture, provide stable fixation, relieve pain, restore shoulder function, and facilitate early mobilization while preventing malunion or long-term functional impairment.

The patient and his family members were counselled regarding the diagnosis, the planned surgical procedure, potential risks and benefits, postoperative care including immobilization and rehabilitation, expected recovery course, and the importance of regular follow-up for optimal functional outcomes.

Following the diagnosis, the patient was scheduled for Open Reduction and Internal Fixation (ORIF) of the Left Clavicle Surgery in Hyderabad at PACE Hospitals, with a titanium plate and screws 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.

• Surgical Exposure: A standard incision was made over the left clavicle region, and soft tissues were carefully dissected to expose the fracture site while preserving surrounding neurovascular structures.

• Fracture Identification and Reduction: Intraoperatively, a comminuted, displaced, long oblique fracture of the middle third of the clavicle was identified. The fracture fragments were carefully mobilized and anatomically reduced to restore clavicular alignment.

• Fixation with Implant: Stable internal fixation was achieved using a 3.5 system titanium plate with screws (PDL system), ensuring proper alignment, stability, and compression of the fracture fragments.

• Wound Closure and Postoperative Care: Haemostasis was secured, and the wound was closed in layers with subcuticular suturing. A sterile dressing was applied, and an arm pouch was provided for support and immobilization. The procedure was completed uneventfully.

Postoperatively, the patient was monitored in the Intensive Care Unit (ICU) for a few hours and later shifted to the room on the same day of surgery. On the first postoperative day, the dressing was changed, and the wound was found to be healthy with no active discharge. Postoperative X-ray demonstrated satisfactory reduction with the implant in situ. The patient was continued on intravenous medications for prevention of infection, pain control, and supportive care during the hospital stay.

On the second postoperative day, discharge planning was initiated after clinical assessment. The patient remained hemodynamically stable throughout the hospital course and showed satisfactory postoperative recovery. He was discharged in stable condition with appropriate postoperative care instructions and advised regular follow-up.

Upon discharge, the patient was prescribed a short course of oral medications aimed at preventing postoperative infection, controlling pain and inflammation, providing gastric protection, and managing severe pain on an as-needed basis. He was also advised to continue his regular antihypertensive medications as per the physician’s advice for blood pressure control.

The patient was advised to continue using the arm pouch until further instruction. He was instructed to keep the surgical dressing clean and dry and avoid wetting it. Chest physiotherapy was advised as per protocol to aid recovery and maintain respiratory function.

The patient was advised to contact the emergency ward at PACE Hospitals immediately in case of any emergency or if symptoms such as fever, increasing pain at the surgical site or shoulder region, swelling, redness, wound discharge, or any other unusual or worsening symptoms.

The patient was advised to return for follow-up with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after 3 days for dressing review, followed by a second follow-up after 3 weeks for clinical and radiological assessment, and a third follow-up after 5 weeks for evaluation of fracture healing and functional recovery of the left shoulder.

This case highlights a displaced comminuted long oblique fracture of the left mid-clavicle managed successfully with Open Reduction and Internal Fixation using a titanium plate and screws. The patient had an uneventful postoperative recovery with stable implant positioning and satisfactory fracture reduction. He was discharged in a hemodynamically stable condition with appropriate postoperative care instructions and scheduled follow-up to ensure optimal functional recovery of the left shoulder.