duplex

@dirtbagluvin: I'll chime in as an ortho MD. Nonunion rates are reported up to 15-20% in various sources. For the general population, however, an overwhelming majority of these fractures are treated nonoperatively with no difference in outcomes. For the high-level athlete, most of my peers will offer surgical intervention and there is often minimal debate. Even in the general population for certain Z-type and distracted fracture patterns, we will at least offer surgery as union rates after ORIF approach 100%. Also, our fixation strategies have evolved significantly. Over this past weekend I fixed one with dual low-profile plating. Anecdotally these lower profile plates are better tolerated and the dual plate offers a biomechanical advantage. Ultimately patient specific factors dictate treatment options - high level athlete, certain fracture patterns, polytrauma patients, open fractures, etc.

@kcy4130: Definitely more involved than a standard clavicle fracture, but looking at his x ray it’s a very straightforward fracture. The incision would be extended slightly, old plate removed, and a longer plate applied. In orthopedics, where the plate ends is a stress riser and the force is concentrated at that area so that’s why it fails. To your question, however, if the screws are broken, it takes a bit more time to remove the hardware and makes it a bit more challenging.