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Clavicle Fractures

Classification

Allman

Allman Classification of Clavicle Fractures
Group Description  
I middle third fractures 85%
II lateral third fractures 10%
III medial third fractures 5%

Neer divided Allman's group II (lateral third)

Neer's Classification of Lateral Third Clavicular Fractures
Type Description
I coracoclavicular ligaments intact, attached to medial segment
II coracoclavicular ligaments detached from the medial segment but trapezoid intact to distal segment
IIA both the conoid & trapezoid remain attached to the distal segment
IIB the conoid is torn
III intraarticular extension into the acromioclavicular joint

Craig Classification

Craig Classification of Clavicle Fractures
Group Description
1 Fracture of the MiddleThird
2 Fracture of the Distal Third
  Type I minimal displacement (interligamentous)
Type II

displaced secondary to fracture line medial to the coracoclavicular ligaments

A - conoid & trapezoid attached

B - conoid torn, trapezoid attached
Type III fractures of the articular surface
Type IV periosteal sleeve fracture (children)
Type V comminuted with ligaments attached neither proximally nor distally, but to an inferior comminuted fragment
3 Fracture of the Proximal Third
  Type I minimal displacement
Type II displaced (ligaments ruptured)
Type III intraarticular
Type IV epiphyseal separation (children & young adults)
Type V communited

Treatment

Nonoperative

  • Options
    • Broad arm sling
    • Figure of eight brace
  • Indications
    • medial third fractures
    • middle third fractures
    • distal third types I, IV, V

Operative

  • ORIF
    • Indications
      • Distal type II (a and b)
  • Closed treatment with late excision arthroplasty
    • Indications
      • Distal third Type III

 

  • Lateral Fractures
    • Treatment controversial
    • Operative methods
      • ORIF clavicle (may not have enough screw purchase is distal segment)
      • Bridge AC joint with wires or plates
      • Fixation to coracoid (temporary coracoclavicular screw, loop of Dacron tape)
Webpage Last Modified: 4 March, 2010