Collarbone Fractures (Clavicle Fractures): Open Reduction Internal Fixation With a Plate and Suture Implant

Collarbone Fractures (Clavicle Fractures): Open Reduction Internal Fixation With a Plate and Suture Implant

This video demonstrates the use of a plate, screws, and suture button implant to repair a break in the end of the collarbone at the distal, or outer end, of the bone. The procedure will be demonstrated on a cadaveric specimen. A suture button implant will be used to provide support to the associated coracoclavicular ligament tear, which often occurs with this fracture.

Here, we see a right shoulder with the front of the patient facing this direction and the back of the patient facing this direction. In this demonstration, the surgeon has already made an incision and has placed a plate and a few of the screws on the top of the distal clavicle. The surgeon has left open holes in the middle of the plate for the use of the suture button implant. The arthroscopic incisions and instruments have already been inserted in preparation for the suture button portion of the procedure.

Next, you see the view from the arthroscopic camera showing a portion of the shoulder blade just below the torn ligament. This bone in the shoulder blade is called the coracoid. The base of the coracoid is where one of the implants will eventually sit. A drill guide will be used to help position the drill. Here, you see a portion of the guide going to the base of the coracoid and here, attaching to 1 of the desired open holes on the plate.

The surgeon will then place a drill bit down the drill guide. The surgeon will drill through the hole in the plate, clavicle, and coracoid. When the drill passes through the cutout in the drill guide in the shoulder, the surgeon knows the hole is in the right place. Now that the drill is placed, the guide can be removed. A suture will be passed through the drill. The camera shows the suture passing through the base of the bone in the recently drilled hole. It is retrieved by an arthroscopic instrument, and the end is brought out of the shoulder.

The drill bit can now be removed. Here, you can see the suture passing through the plate, clavicle, and coracoid, and out of the arthroscopic portal. This suture will be used temporarily as a passing suture to help shuttle the suture implant that will be used. The shuttle suture will be looped in the suture implant. Then, the shuttle suture will be gently pulled by the surgeon until the suture implant is passed through to the outside.

The shuttle suture will be removed, and a metal button implant will be placed on the white, looped suture. Finally, the button will then be gently pulled back into the shoulder and directed to the underside of the coracoid. The surgeon will cinch the suture implant down until the button on top snaps flush into the plate. The surgeon will then cut the remaining suture. The remaining screws will be inserted into the plate and bone. Once complete, the incision will be closed, and the patient will head to the recovery room.