Clavicle Fractures

Modern Study Review (AI-Generated)

High-Yield Summary

Clavicle fractures are common injuries, accounting for approximately 2-5% of all adult fractures, with the majority occurring in the middle third. Understanding fracture location and displacement is critical for guiding treatment, as distal clavicle fractures have a higher risk of nonunion and may require surgical intervention. Modern management balances non-operative care for stable fractures with operative fixation for displaced or complex injuries to optimize pain control and functional recovery.

Key Diagnostic Findings

Anatomy

The clavicle is divided into three segments: medial (5%), middle (85%), and distal (10%) thirds.
The coracoclavicular (C-C) ligaments (conoid and trapezoid) stabilize the distal clavicle and are key to fracture classification and management.

Clinical Presentation

Patients typically present with localized pain, swelling, and deformity over the clavicle.
Neurovascular injury is rare but important to assess, especially with displaced fractures or open injuries.
Associated injuries include ipsilateral scapular fractures or flail chest in high-energy trauma.

Imaging

Standard AP and 15-30° cephalic tilt radiographs of the clavicle are essential.
CT scan may be indicated for complex distal fractures or intra-articular involvement.

Classification Systems

Classification	Description	Clinical Relevance
Neer Classification (Distal Clavicle)	Type I: Fracture lateral to intact C-C ligaments (stable) Type II: Fracture medial to C-C ligaments with ligament disruption (unstable, high nonunion risk) Type III: Intra-articular fracture of the AC joint	Guides treatment: Type II often requires surgery due to instability and nonunion risk
Rockwood Classification	Similar to Neer with subtypes based on ligament involvement and displacement	Used interchangeably with Neer for distal clavicle fractures

Current Gold Standard Treatment

Non-operative

Indicated for midshaft fractures with minimal displacement and Neer Type I and III distal fractures.
Treatment includes sling immobilization, early pendulum exercises, and progressive range of motion.
Close follow-up to monitor for displacement or nonunion.

Operative

Indicated for:
Displaced midshaft fractures with >2 cm shortening or comminution.
Neer Type II distal clavicle fractures due to high nonunion risk.
Open fractures, neurovascular compromise, skin tenting, or ipsilateral scapular fractures.
Surgical options include plate fixation (locking compression plates), intramedullary devices, or hook plates for distal fractures.
Early fixation improves pain, function, and union rates.

Modern Complications & Outcomes

Complications

Complication	Notes
Nonunion	Higher risk in displaced midshaft and Neer Type II distal fractures if treated non-operatively
Malunion	Can cause cosmetic deformity and functional impairment
Neurovascular Injury	Rare but critical to identify preoperatively
Hardware Irritation	Common with plate fixation, may require removal
Infection	Low incidence with modern surgical techniques

Outcomes

Non-operative treatment of minimally displaced fractures generally yields excellent functional outcomes.
Operative fixation of displaced fractures results in faster return to function and lower nonunion rates.
Patient-reported outcomes focus on pain relief and restoration of shoulder strength and range of motion.

Classic Clinical Notes