Management of a Complex Medial-End Clavicle Fracture With Hook Plate Fixation After Failed Prior Surgeries: A Case Report and Narrative Review of Surgical Options.

Abstract

Medial-end clavicle fractures are rare, and the published literature is limited. Most injuries can be managed nonoperatively with favorable outcomes; however, displaced or comminuted fractures, symptomatic delayed union/nonunion, or fixation failure may require surgery, and operative management is challenging because of the proximity to vital mediastinal structures. We describe a 38-year-old man with a left medial-end clavicle fracture sustained in a fall from approximately 9-10 m. Two prior plate fixation attempts at an outside clinic failed to maintain stable reduction, with persistent pain and fracture-site prominence. At our facility, computed tomography confirmed an intact sternoclavicular joint but revealed severe comminution at the proximal fracture site with anterosuperior displacement of the distal fragment. We removed the failed hardware and performed revision fixation using a clavicle hook plate, intentionally limiting screw purchase to the distal fragment to reduce mediastinal risk. Postoperatively, teriparatide was administered as an adjunctive therapy because of concern for impaired healing after repeated fixation failure. The implant was removed on 28 October 2024 after radiographic union, and at the final follow-up on 18 April 2025, union was maintained and pain was minimal (VAS ≤ 1/10); standardized functional outcome scores were not available. This single case suggests that hook plate fixation may be a salvage option when safe medial screw purchase is not feasible; interpretation is limited by the case-report design and adjunctive pharmacologic therapy.