Successful Open Reduction and Internal Fixation (ORIF) for Right Clavicle Fracture in a 29 Y.O. Male

PACE Hospitals’ expert Orthopaedic team successfully performed Open Reduction and Internal Fixation (ORIF) with Plating of the right clavicle on a 29-year-old male patient diagnosed with a displaced midshaft fracture of the right clavicle. The procedure aimed to accurately realign and stabilise the fractured clavicle, promote proper bone healing, relieve pain, restore shoulder function, and facilitate a safe return to daily activities.

Chief Complaints

A 29-year-old male patient with a body mass index (BMI) of 20 presented to the Orthopaedic Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain in the right shoulder following a slip-and-fall accident in a washroom. He also experienced difficulty performing overhead activities and lifting weights with the right upper limb.

Past Medical History

The patient had no significant past medical history or known chronic medical conditions. He was physically active before the injury and had no history of previous major surgeries or relevant comorbidities.

On Examination

On examination, the patient was conscious, alert, and oriented, with stable vital signs. Local examination of the right shoulder revealed tenderness and swelling over the middle third of the right clavicle, with painful restriction of shoulder movements, particularly during arm elevation and overhead activities. The skin over the affected area was intact, with no open wound or significant bruising. No distal neurovascular deficit was noted.

Diagnosis

Following the clinical evaluation, the Orthopaedic team at PACE Hospitals conducted a detailed assessment of the patient's complaints of right shoulder pain and difficulty using the right upper limb following a slip-and-fall accident in a washroom.

A comprehensive clinical examination revealed swelling and tenderness over the middle third of the right clavicle, with painful restriction of right shoulder movements, particularly during elevation and overhead activities. The skin over the affected region was intact, and no distal neurovascular deficit was noted.

X-ray evaluation of the right clavicle confirmed a displaced fracture involving the middle third (midshaft) of the right clavicle. The displacement and fracture pattern were considered significant and required operative management to achieve proper alignment and stable fixation. Routine laboratory investigations and preoperative assessments were performed and were within acceptable limits for surgical intervention.

Based on these findings, the patient was advised to undergo Right Clavicle Fracture Treatment in Hyderabad, India, under the expert care of the Orthopaedic Department, to achieve anatomical alignment, stable fracture fixation, promote bone healing, relieve pain, restore shoulder function, and facilitate a safe return to daily activities.

Medical Decision Making (MDM)

After a detailed consultation with Dr. Raghuram (Consultant Orthopaedic Surgeon), a comprehensive clinical evaluation was performed focusing on the patient's right shoulder pain and difficulty using the right upper limb following a slip-and-fall accident in a washroom. Clinical examination revealed swelling and tenderness over the middle third of the right clavicle, with painful restriction of shoulder movements.

Further assessment and X-ray evaluation of the right clavicle confirmed a displaced midshaft fracture of the right clavicle. The fracture displacement was considered significant and required surgical management to restore proper alignment and provide stable fixation.

Based on the clinical findings and radiological assessment, it was determined that Open Reduction and Internal Fixation (ORIF) with plating of the right clavicle was the most appropriate surgical intervention. The procedure was planned to accurately realign the fractured clavicle, provide stable fixation for bone healing, relieve pain, restore shoulder function, and reduce the risk of malunion or nonunion.

The patient and family members were counselled regarding the diagnosis, planned surgical procedure, potential risks and benefits, postoperative sling support, rehabilitation, activity restrictions, and the importance of regular follow-up to monitor fracture healing and functional recovery.

Surgical Procedure

Following the diagnosis, the patient was scheduled for Open Reduction and Internal Fixation (ORIF) with plating of the right clavicle 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 completing the necessary preoperative evaluation and confirming fitness for surgery, the patient was taken to the operating room and administered appropriate anaesthesia. Standard aseptic precautions and sterile draping were maintained throughout the procedure.

• Surgical Exposure: The patient was positioned appropriately, and a surgical incision was made over the right clavicle. The soft tissues were carefully dissected to expose the fracture site while preserving the surrounding structures.

• Fracture Identification and Reduction: The displaced fracture involving the middle third of the right clavicle was identified. The fracture fragments were carefully mobilised and reduced into proper anatomical alignment to restore the normal position and contour of the clavicle.

• Plate Fixation: The reduced fracture was stabilised using an appropriate clavicular plate and screws. Intraoperative imaging with C-arm fluoroscopy was used to confirm satisfactory fracture reduction, alignment, and implant positioning.

• Haemostasis and Wound Closure: After confirming stable fixation and satisfactory alignment, haemostasis was achieved. The surgical wound was irrigated and closed in layers, followed by application of a sterile dressing. The procedure was completed without intraoperative complications.
  

Postoperative Care

The postoperative period was uneventful, and the patient remained hemodynamically stable throughout the hospital stay. He received appropriate treatment for pain relief, prevention of infection, and overall postoperative recovery. The right upper limb was supported with an arm sling, and the surgical wound was monitored regularly. Dressings were performed as required and remained clean and healthy. Elbow and wrist movements were encouraged to prevent stiffness and maintain joint mobility.

Discharge Medications

Upon discharge, the patient was prescribed medicines to prevent postoperative infection, relieve pain and inflammation, protect the stomach from medication-related irritation, and support nutritional needs and wound healing. He was advised to take all prescribed medicines as directed.

Advice on Discharge

The patient was advised to continue using the arm sling as instructed to support and protect the right clavicle during healing. He was encouraged to perform regular elbow and wrist range-of-motion exercises while avoiding strenuous shoulder movements until advised by the Orthopaedic team. He was also advised to maintain a nutritious diet with adequate calcium and vitamin D and attend scheduled follow-up visits to monitor fracture healing and recovery.

Emergency Care

Review and Follow-up Notes

Conclusion