What is the definition of a clavicle fracture?

Definition of Clavicle Fracture

A clavicle fracture is a break in the collarbone, which commonly occurs due to direct trauma from falls onto the shoulder or the posterolateral edge of the acromion, and less frequently from indirect trauma with a fall onto an outstretched hand. 1

Anatomical Considerations

• The clavicle is particularly vulnerable to fracture at the junction of the outer and middle third, which is the thinnest part of the bone and lacks muscle and ligamentous protection 2
• Fractures of the clavicle account for 2.6-5% of all fractures in adults, with midshaft fractures representing 69-82% of all clavicular fractures 2, 1
• In younger populations (under 25 years), clavicle fractures are more common in males, while above age 65, they occur more frequently in women 1, 3

Classification

• Clavicle fractures are classified according to the Allman system into three groups based on anatomical location 4:
  • Group I: Mid-shaft fractures (most common)
  • Group II: Lateral fractures
  • Group III: Medial fractures
• Displacement characteristics are critical in determining treatment approach, with upright radiographs recommended for accurate assessment of displacement 5

Clinical Presentation

• Clavicle fractures typically present following trauma, often from contact sports or falls 3
• The clinical presentation is usually obvious, with pain, swelling, and sometimes visible or palpable deformity 1
• Displaced fractures may present with a characteristic "Z" deformity due to the pull of the pectoralis major and the weight of the arm 6

Diagnostic Evaluation

• Plain standard radiographs are the primary imaging modality to confirm the diagnosis 1
• Upright radiographs are preferred as they better demonstrate the degree of displacement compared to supine views 5
• In children with no history of trauma, alternative diagnoses such as malignancy, rickets, or physical abuse should be considered 3

Treatment Considerations

• Treatment decisions are based on fracture location, displacement, comminution, and patient factors 4
• Non-displaced fractures are typically managed conservatively with a sling rather than a figure-of-eight brace 5
• Displaced fractures with shortening exceeding 1.5cm may benefit from surgical intervention 5
• Surgical options include plate fixation (with manufacturer-contoured anatomic plates preferred) or intramedullary nailing 5
• Concerns about nonunion and symptomatic malunion have led to increased surgical treatment of displaced clavicle fractures in recent years 6

Potential Complications

• Nonsurgical management of widely displaced fractures may result in malunions affecting shoulder strength and function 6
• Nonunion rates can reach up to 15% with nonsurgical treatment of displaced fractures 6
• Smoking increases the rate of nonunion and leads to inferior clinical outcomes 5
• Surgical complications may include the need for hardware removal, particularly with non-precontoured plates 5

Outcomes

• Surgical treatment of displaced fractures provides higher union rates and better early patient-reported outcomes 6
• Long-term patient-reported outcomes and satisfaction are similar between surgical and nonsurgical approaches for most fractures 6, 5
• Surgical treatment may provide faster functional recovery and earlier return to work, which is particularly relevant for active adults 6