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Clavicle Fractures
Updated: Dec 10, 2014
Author: Benjamin P Kleinhenz, MD; Chief Editor: Craig C Young, MD more...

OVERVIEW

Practice Essentials
Although clavicle fractures are common and usually heal regardless of the selected treatment,
complications are possible, warranting careful attention to these injuries. Multiple attempts have
been made to devise a classification scheme for clavicle fractures. The most common system is the
following one, created by Allman, in which the clavicle is divided into thirds [1] :
Group I fractures: Middle third injuries
Group II fractures: Distal third injuries
Group III fractures: Medial (proximal) third injuries

Signs and symptoms


Clinical signs and symptoms of clavicle fracture include the following:
The patient may cradle the injured extremity with the uninjured arm
The shoulder may appear shortened relative to the opposite side and may droop
Swelling, ecchymosis, and tenderness may be noted over the clavicle
Abrasion over the clavicle may be noted, suggesting that the fracture was from a direct
mechanism
Crepitus from the fracture ends rubbing against each other may be noted with gentle
manipulation
Difficulty breathing or diminished breath sounds on the affected side may indicate a
pulmonary injury, such as a pneumothorax
Palpation of the scapula and ribs may reveal a concomitant injury
Tenting and blanching of the skin at the fracture site may indicate an impending open fracture,
which most often requires surgical stabilization (see the image below)

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Comparison of both clavicles, with the left tenting the skin (wide arrow).

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Nonuse of the arm on the affected side is a neonatal presentation
Associated distal nerve dysfunction indicates a brachial plexus injury
Decreased pulses may indicate a subclavian artery injury
Venous stasis, discoloration, and swelling indicate a subclavian venous injury [2, 3]
See Clinical Presentation for more detail.

Diagnosis
Laboratory studies
Complete blood count (CBC): If a vascular injury is suspected, to check the hemoglobin and
hematocrit values
Arterial blood gas (ABG): If a pulmonary injury is suspected or identified
Imaging studies
Chest radiography: Obtain an expiration posteroanterior (PA) chest film (along with the
above-mentioned ABG test) if a pulmonary injury is suspected or identified
Radiography of the clavicle and shoulder
Computed tomography (CT) scanning with 3-dimensional (3-D) reconstruction: To help
evaluate displaced fractures
Arteriography: If a vascular injury is suspected
Ultrasonography
See Workup for more detail.

Management

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The vast majority of clavicle fractures heal with nonoperative management, which includes the use
of a simple shoulder sling.
Surgical indications include the following:
Complete fracture displacement [4]
Severe displacement causing tenting of the skin with the risk of puncture
Fractures with 2 cm of shortening
Comminuted fractures with a displaced transverse "zed" (or Z-shaped) fragment [4]
Neurovascular compromise
Displaced medial clavicular fractures with mediastinal structures at risk [5]
Polytrauma (with multiple fractures): To expedite rehabilitation
Open fractures
An inability to tolerate closed treatment
Fractures with interposed muscle
Established, symptomatic nonunion
Concomitant glenoid neck fracture (floating shoulder)
When a midshaft clavicle fracture requires surgical fixation, the commonly performed procedure
involves open reduction of the fracture, followed by either insertion of an intramedullary device or
fixation with a plate and screws. [6, 7, 8, 9]
In a distal clavicle fracture, stable fixation can be achieved in many ways, including through
combinations of a coracoclavicular screw, Dacron or Mersilene tape, tension banding, a Kirschner
wire (K-wire), and clavicular plates. Regardless of the exact technique used, the general principles
of fracture reduction and fixation and stabilization of the coracoclavicular interval apply.
See Treatment and Medication for more detail.

Background
Clavicle fractures are common and easily recognized because of their subcutaneous position, as
shown in the images below. Fracture union usually progresses regardless of the treatment initiated.
Despite the innocuous appearance of clavicle fractures, however, potential treatment difficulties
and possible complications warrant careful attention to these injuries. (See Prognosis, Treatment,
and Medication.)

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A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can potentially lead to an
open fracture.

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Comparison of both clavicles, with the left tenting the skin (wide arrow).

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Close-up view of clavicle tenting the skin (arrow).

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The clavicle is the first bone in the body to ossify, beginning at the fifth week of gestation. [2]
Through age 5 years, the growth is primarily through intramembranous ossification. The medial
epiphysis ossifies late, beginning at age 12-19 years, and may not completely fuse until age 22-25
years. Physial injuries around this area may be mistaken for fractures, and care should be taken in
evaluating injuries. (For patients aged 22-25 years, the Salter-Harris classification for physial
injuries can be used, and nonoperative treatment can often be initiated.) (See Anatomy, Clinical
Presentation, DDx, and Workup.)
Historically, clavicle fractures have been considered best treated nonoperatively, with good
outcomes. Management typically included the use of either a shoulder sling or a figure-of-eight
brace. The vast majority of these fractures healed, with variable amounts of cosmetic deformity.
Studies have examined the different patterns of displacement and clinical outcomes of clavicle
fractures according to their location. The medical literature has focused predominantly on fractures
of the middle and distal clavicle but is still lacking concerning the management of medial clavicle
fractures; the literature does, however, indicate that medial clavicle fractures respond well to
nonoperative management. Controversy remains concerning operative versus nonoperative
treatment of middle and distal clavicle fractures. [10, 11, 12, 13] (See Treatment and Medication.)

Fracture classification
Multiple attempts have been made to devise a classification scheme for clavicle fractures. The
most common system is the following one, created by Allman, in which the clavicle is divided into
thirds [1] :
Group I fractures: Middle third injuries
Group II fractures: Distal third injuries
Group III fractures: Medial (proximal) third injuries
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Neer made a significant revision to the Allman classification scheme. Group II (distal clavicle)
fractures were further divided into 3 types, based on the location of the clavicle fracture in relation
to the coracoclavicular ligaments. The reason for this modification was that distal clavicle fractures
behave differently depending on the exact location of the injury. The designations are as follows
(see Clinical Presentation and Workup) [14] :
Type I fractures: Minimally displaced and occur lateral to an intact coracoclavicular ligament
complex; these fractures may be treated nonoperatively and symptomatically (see the image
below)
Type II fractures: Occur when the medial fragment is separated from the coracoclavicular
ligament complex; the medial fragment is displaced cephalad by the pull of the
sternocleidomastoid muscle, and the distal fragment is displaced caudally by the weight of the
upper extremity, with the intact coracoclavicular ligament complex; the resulting deformity
leads to marked displacement of the fracture ends, predisposing this fracture type to a higher
prevalence (up to 30%) of nonunion
Type III injuries: Minimally displaced or nondisplaced and extend into the acromioclavicular
(AC) joint; as with type I fractures, these injuries can be treated symptomatically; the
development of late AC degenerative changes can be treated with distal clavicular excision

Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in place.

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A type II distal clavicle fracture. In type IIA, both conoid and trapezoid ligaments are on the distal segment,
while the proximal segment, without ligamentous attachments, is displaced.

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A type IIB fracture of the distal clavicle. The conoid ligament is ruptured, while the trapezoid ligament
remains attached to the distal segment. The proximal fragment is displaced.

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The Neer type II fracture was later divided into types IIA and IIB, as follows (see the images below):
Type IIA - Displaced due to fracture medial to the coracoclavicular ligaments; the conoid and
trapezoid remain attached to the distal fragment
Type IIB - Displaced due to fracture medial to the coracoclavicular ligaments; either the
conoid is torn or, more rarely, both the conoid and trapezoid are torn

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Anatomy of the clavicle indicating potential fracture sites.

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Anatomy
The clavicle is an S-shaped bone that acts as a strut between the sternum and the glenohumeral
joint. Another function of the clavicle is to help protect the neurovascular bundle that runs behind it.
The junction of the middle and distal thirds of the clavicle is a common site of fracture because this
is the thinnest part of the bone, and there is relatively little protection by muscular attachments.
Numerous muscular and ligamentous forces act on the clavicle, and knowledge of these differing
forces is necessary to understand the nature of displacement of clavicle fractures and why certain
fracture patterns tend to cause problems if not reduced and surgically stabilized. (See the image
below.)

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Anatomy of the clavicle indicating potential fracture sites.

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The clavicle articulates with the sternum at the sternoclavicular (SC) joint and with the acromion at
the AC joint. Many ligamentous structures attach to the clavicle and provide stability for the
articulations with the sternum and the acromion. The primary stabilizers of the SC joint are the
anterior and posterior capsules. Other ligamentous structures attaching here are the interclavicular
ligament and the costoclavicular ligament. Stability of the SC joint in the anterior-posterior plane is
derived predominantly from the posterior capsule, with additional stability conferred by the anterior
capsule. The interclavicular and costoclavicular ligaments have little effect on stability of the joint.
At the level of the AC joint, the coracoclavicular and AC ligaments provide stability for the joint. The
coracoclavicular ligament is actually 2 separate ligaments, the conoid and the trapezoid, which both
attach from the coracoid to the inferior surface of the distal clavicle. Debski et al have delineated
the different functions of the conoid and trapezoid in resistance to applied loads to the AC joint. [15]
The conoid is the predominant restraint to anterior and superior loading, while the trapezoid is the
major restraint to posterior loading at the AC joint. The AC ligament is at the superior-lateral aspect
of the clavicle and overlies the AC joint.
Three muscles originate on the clavicle, and 3 muscles insert on it. The muscles that take their
origin from the clavicle are as follows:
Sternohyoid
Pectoralis major
Deltoid
The muscles that insert on the clavicle are as follows:
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Sternocleidomastoid
Subclavius
Trapezius
These 6 muscles may become deforming forces on the clavicle in the presence of a fracture, with
the displacement of fracture fragments depending on the location of the fracture in relation to the
muscular and ligamentous attachments.
Many other important structures are in extremely close contact with the clavicle and are thus
subject to injury in the context of clavicle fractures. The subclavian artery (which becomes the
axillary artery as it passes anteriorly to the first rib) and vein are both in close proximity to the
middle portion of the clavicle. Additionally, the brachial plexus also passes behind the clavicle
posterolateral to the subclavian vessels and is at risk with displaced fractures of the middle clavicle.
The subclavius muscle lies between the clavicle and these neurovascular structures, and, though
small, it is believed to prevent more frequent damage to these structures. Reports also exist of
injuries to the apices of the lung, most commonly with displaced middle third clavicle fractures.

Pathophysiology
Because of its subcutaneous position, the clavicle may be fractured easily, with the fracture often
being an isolated injury. However, clavicle fractures are also common in the context of high-energy
injury or multiple traumatic injuries. In these situations, it is important to examine the patient for
other associated injuries, such as rib fractures, scapula fractures, other fractures about the
shoulder girdle, pulmonary contusion, pneumothorax, hemothorax, and closed head injuries. (See
the image below.)

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Clavicle fracture with rib fractures. Remember to look for associated injuries.

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The frequency with which the 3 groups of fractures occur is as follows:
Group I (middle third) - Approximately 80%
Group II (distal third) - 12-15%
Group III (medial third) - Less than 5%

Group I fractures
Most group I fractures occur medial to the coracoclavicular ligament, at the junction of the middle
and outer third of the clavicle. The proximal fragment is typically displaced upward because of the
pull of the sternocleidomastoid muscle. The usual mechanism of injury involves a direct force
applied to the lateral aspect of the shoulder as a result of a fall, sporting injury, or motor vehicle
accident. Group I fractures are shown in the images below

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Nondisplaced middle clavicle fracture.

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Displaced fracture of middle clavicle.

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Displaced middle clavicle fracture.

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Group II fractures
Fractures of the distal third of the clavicle result from a direct blow to the top of the shoulder. They
occur distal to the coracoclavicular ligament. [16]

Group III fractures


Fractures of the medial third of the clavicle occur as a result of a direct blow to the anterior chest. A
diligent search for associated injuries should accompany group III fractures because considerably
strong forces are required to fracture this area of the clavicle.
Greenstick or buckle-type fractures are common in children. Most of these fractures are
nondisplaced and heal uneventfully.

Etiology
Clavicle fractures may be caused by direct or indirect trauma. The most common mechanism is an
indirect one, involving a fall directly onto the lateral shoulder. [17, 18, 19] Examples of a direct
mechanism would be a blow from a hockey stick or a direct fall onto the clavicle. At-risk athletes
include those in football, hockey, and soccer and those at risk for falling during roller skating, skiing,
bicycling, or horseback riding.
A less common mechanism for clavicle fractures is a fall onto an outstretched hand (ie, a FOOSH
injury). The radiographs below depict clavicle fracture in a hockey player.

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Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.

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Additional view of fracture displacement and comminution in a hockey player. The sternocleidomastoid is the
deforming force of the medial fragment.

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Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey player.

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Epidemiology
Occurrence in the United States
The clavicle is the most frequently fractured bone in the body in childhood, accounting for 10-16%
of all fractures in this age group.
In adults, clavicle fractures account for 2.6-5% of all fractures and 44% of all shoulder girdle
injuries. [20, 21, 22] Middle third (group I) fractures account for 69-82% of all fractures of the clavicle,
whereas distal third (group II) fractures account for 12%, and medial third (group III) fractures occur
in 6% of cases. [20, 21]
Clavicular injuries affect 1 in 1000 people per year. Bimodal incidence occurs in men younger than
25 years and older than 55 years. Pneumothorax occurs in 3% of patients.

International occurrence
The annual incidence rate of clavicular fractures is estimated to be between 30 and 60 cases per
100,000 population. [12]

Sex- and age-related demographics

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Clavicular injuries occur 2.5 times more commonly in males than in females, reflecting a greater
involvement of males in contact and violent sports and motor vehicle accidents (MVAs).
Clavicle fractures, the most common of all pediatric fractures, can present even in the newborn
period, especially following a difficult delivery. A large peak incidence occurs in males younger than
30 years due to sports injuries. A smaller peak occurs in elderly patients, who tend to sustain
clavicle fractures (in association with osteoporosis) during low-energy falls. [12]

Prognosis
Most clavicle fractures treated nonoperatively heal, although with variable amounts of cosmetic
deformity. Younger children generally require shorter periods of immobilization (2-4 wk) than do
adolescents and adults (4-8 wk).

Complications
Nonunion
Nonunion is a failure to show clinical or radiographic progression of healing after 4-6 months. The
following are risk factors for nonunion:
Fracture comminution
Significant fracture displacement or shortening
Type 2 fractures of the distal third of the clavicle
Refracture
Female sex
Advanced age
Fractures with more than 2 cm of shortening
The nonunion rate for all midclavicle fractures treated nonoperatively is 6%; the rate is 15% for
displaced midclavicle fractures treated nonoperatively. [23] Symptoms of nonunion can be pain,
motion, or loss of function. Note, however, that many nonunions are asymptomatic and require no
treatment. Refer patients with symptomatic nonunion to an orthopedic surgeon to discuss surgical
options. In some situations, a bone stimulator to help promote bone healing can be tried before
surgery.
Murray et al reported that smoking was the greatest risk factor for nonunion among patients treated
nonoperatively for diaphysial clavicle fractures. In a study, the investigators followed the healing
course of 941 patients with such fractures and, using multivariate analysis, found that, along with
smoking, both comminution and fracture displacement were particularly significant factors in
nonunion.
The investigators determined that by using known risk factors, a statistical model can be used to
estimate the probability of nonunion in a specific patient and can therefore help to determine
whether he or she should be treated surgically. The investigators also concluded that smoking
cessation needs to be included in the treatment of diaphysial clavicle fractures. [24]
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Malunion
Malunion is when the fracture heals with significant angulation, shortening, and a poor appearance.
Mild malunion is common after clavicle fractures, but it is usually not clinically significant.
Occasionally, the patient can have pain or a mild limitation in motion or strength. Symptoms from
nerve impingement may occur but are uncommon. Surgeries for malunion attempt to restore the
clavicular length and correct any angular deformity of the clavicle.
Neurovascular injuries
Group I fractures (middle third of the clavicle) have been associated with injuries to the
neurovascular bundle and the pleural dome.
Neurovascular compromise can develop from exuberant callus formation or from malunion. The
medial cord and ulnar nerve are affected most often; treatment is surgical in nature. Brachial plexus
compression resulting from hypertrophic callus formation may cause peripheral neuropathy.
Intrathoracic injuries
These include the following:
Pneumothorax
Subclavian artery and vein injury
Internal jugular vein injury
Axillary artery injury
Other
A spike of bone can form subcutaneously after angulated fractures heal. This can be symptomatic
for athletes who wear shoulder pads or for backpackers. If a donut pad is not sufficient to relieve
symptoms, surgical excision can be considered. Posttraumatic arthritis can develop if a clavicle
fracture enters the AC or SC joints.
Complications after group III fractures (medial third of the clavicle) resemble those associated with
posterior sternoclavicular dislocations, including pneumothorax and compression or laceration of
the great vessels, trachea, or esophagus.

Mortality
While the overwhelming majority of clavicle fractures are benign, there is a possibility of associated,
life-threatening intrathoracic injuries.
Kendall et al reported a fatality from an isolated clavicle fracture from transection of the subclavian
artery, [25] the first such report in the literature. The fatality may have been due to the fact that the
fall was not witnessed and the patient lay unassisted for an unknown period of time. The patient
never regained spontaneous circulation, and the injury to the subclavian artery was diagnosed at
autopsy. The postmortem examination revealed a midclavicular fracture with transection of the
subclavian artery. A 2.6-L hemothorax and damage to parietal and apical pleura were noted, but no
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other injuries were present.


Although this case is unique, it does emphasize the need to be aware of the potentially catastrophic
complications of damage to the vascular structures in close proximity to the clavicle.

Patient Education
At the initial visit, discuss the following with the patient who has a clavicular injury:
A visible prominence may remain at the fracture site after it heals; this may be more evident in
thin individuals
Fracture nonunion is possible, and surgery may be necessary
Refracture is a possibility if the patient engages in contact sports, particularly if he or she
returns to play before the bone healing is solid
Educate patients about proper placement and adjustment techniques for a figure-of-eight bandage
(clavicle strap) and inform them that paresthesias or edema in the hands or fingers indicate that the
strap is too tight and should be removed.

Neonatal clavicle fracture


Advise parents to minimize pressure and movement of the ipsilateral arm during handling of a
neonate with a clavicle fracture. The parent may try to pin the shirt sleeve of the affected arm to the
front of the childs shirt to minimize movement.
For patient education information, see the First Aid and Injuries Center, as well as Broken
Collarbone (Broken Clavicle) and Shoulder Dislocation.
Clinical Presentation
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[Medline].
33. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the
clavicle gives poor results. J Bone Joint Surg Br. 1997 Jul. 79(4):537-9. [Medline].
34. Wick M, Mller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of
more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001. 121(4):207-11.
[Medline].
35. Huang JI, Toogood P, Chen MR, Wilber JH, Cooperman DR. Clavicular anatomy and the
applicability of precontoured plates. J Bone Joint Surg Am. 2007 Oct. 89(10):2260-5.
[Medline].
36. Formaini N, Taylor BC, Backes J, Bramwell TJ. Superior versus anteroinferior plating of
clavicle fractures. Orthopedics. 2013 Jul. 36(7):e898-904. [Medline].
37. Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A. Biomechanical
comparison of fixation techniques in midshaft clavicular fractures. J Orthop Trauma. 2011
May. 25(5):272-8. [Medline].
38. Neer CS. Nonunion of the clavicle. JAMA. 1960. 172:1006-1011.
39. Checchia SL, Doneux PS, Miyazaki AN, Fregoneze M, Silva LA. Treatment of distal clavicle
fractures using an arthroscopic technique. J Shoulder Elbow Surg. 2008 May-Jun. 17(3):3958. [Medline].
40. Motta P, Bruno L, Maderni A, Tosco P, Mariotti U. Acute lateral dislocated clavicular fractures:
arthroscopic stabilization with TightRope. J Shoulder Elbow Surg. 2013 Aug 9. [Medline].
41. Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of
surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg. 2010 Oct.
19(7):1049-55. [Medline].
42. Chen CH, Chen WJ, Shih CH. Surgical treatment for distal clavicle fracture with
coracoclavicular ligament disruption. J Trauma. 2002 Jan. 52(1):72-8. [Medline].
43. Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture
using Kirschner wires and tension-band wires. J Trauma. 2001 Sep. 51(3):522-5. [Medline].
44. Mizue F, Shirai Y, Ito H. Surgical treatment of comminuted fractures of the distal clavicle using
Wolter clavicular plates. J Nippon Med Sch. 2000 Feb. 67(1):32-4. [Medline].
45. Low AK, Duckworth DG, Bokor DJ. Operative outcome of displaced medial-end clavicle
fractures in adults. J Shoulder Elbow Surg. 2008 Sep-Oct. 17(5):751-4. [Medline].
Media Gallery

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A posterior view demonstrating a closed clavicle fracture tenting the skin (arrow), which can
potentially lead to an open fracture.

Comparison of both clavicles, with the left tenting the skin (wide arrow).

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Close-up view of clavicle tenting the skin (arrow).

Comminuted fracture in a hockey player. Note the medial fragment tenting the skin.

Additional view of fracture displacement and comminution in a hockey player. The


sternocleidomastoid is the deforming force of the medial fragment.
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Radiographs after open reduction and internal fixation of a comminuted fracture in a hockey
player.

Anteroposterior view of middle third clavicle fracture illustrating a relatively typical fracture
pattern.

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Anteroposterior view of distal clavicle fracture, type II, showing wide displacement.

The displacing forces on a midshaft clavicle fracture.

The displacing forces on a distal clavicle fracture.

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Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in
place.

A type II distal clavicle fracture. In type IIA, both conoid and trapezoid ligaments are on the
distal segment, while the proximal segment, without ligamentous attachments, is displaced.

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A type IIB fracture of the distal clavicle. The conoid ligament is ruptured, while the trapezoid
ligament remains attached to the distal segment. The proximal fragment is displaced.

Anatomy of the clavicle indicating potential fracture sites.

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Nondisplaced middle clavicle fracture.

Displaced fracture of middle clavicle.

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Displaced middle clavicle fracture.

Clavicle fracture with rib fractures. Remember to look for associated injuries.
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Tables

Back to List
Contributor Information and Disclosures
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Author
Benjamin P Kleinhenz, MD Clinical Instructor, Mary S Stern Hand Surgery Fellowship, University
of Cincinnati College of Medicine; Consulting Surgeon, Hand Surgery Specialists of Cincinnati
Benjamin P Kleinhenz, MD is a member of the following medical societies: American Academy of
Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of
the Hand
Disclosure: Nothing to disclose.
Chief Editor
Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family
Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family
Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine,
Phi Beta Kappa
Disclosure: Nothing to disclose.
Acknowledgements
Lawrence C Brilliant, MD Clinical Assistant Professor, Department of Primary Care and
Community Services, MCP Hahnemann University; Attending Physician, Department of Emergency
Medicine, Doylestown Hospital
Lawrence C Brilliant, MD is a member of the following medical societies: American College of
Emergency Physicians
Disclosure: Nothing to disclose.
Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern
Virginia Medical School
Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega
Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency
Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Kevin J Eerkes, MD Clinical Assistant Professor, Department of Medicine, New York University
School of Medicine; Medical Team Physician, New York University Athletics
Disclosure: Nothing to disclose.
Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University
School of Medicine; Chief of Orthopedic Surgery, Wishard HospitalChief, Sports Medicine and
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Arthroscopy, Indiana University School of Medicine


Janos P Ertl, MD is a member of the following medical societies: American Academy of
Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of
America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.
Amir Estephan, MD Resident Physician, Department of Emergency Medicine, Kings County
Hospital Center, Brooklyn
Amir Estephan, MD, is a member of the following medical societies: Alpha Omega Alpha, American
College of Emergency Physicians, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.
Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family and Community
Medicine, University of Minnesota Medical School
Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American
Academy of Family Physicians, American College of Sports Medicine, American Medical Society
for Sports Medicine, and Minnesota Medical Association
Disclosure: Nothing to disclose.
Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports
Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director,
Orthopaedic Sports Medicine Fellowship
Henry T Goitz, MD is a member of the following medical societies: American Academy of
Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.
Robert J Gore, MD Clinical Assistant Professor, Attending Physician, Assistant Residency
Director, Department of Emergency Medicine, Kings County/State University of New York
Downstate Hospital
Robert J Gore, MD is a member of the following medical societies: American College of Emergency
Physicians, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Matthew W Lawless, MD Assistant Professor of Orthopedic Surgery, Wright State University
School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Miami Valley Hospital
and Dayton Veterans Affairs Medical Center
Matthew W Lawless, MD is a member of the following medical societies: American Academy of
Orthopaedic Surgeons
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Disclosure: Nothing to disclose.


John B Mitchell, MD Consulting Staff, Department of Orthopedics, Kaiser Permanente
Disclosure: Nothing to disclose.
Pekka A Mooar, MD Professor, Department of Orthopedic Surgery, Temple University School of
Medicine
Pekka A Mooar, MD is a member of the following medical societies: American Academy of
Orthopaedic Surgeons
Disclosure: Nothing to disclose.
L Joseph Rubino, MD Assistant Professor, Department of Orthopedic Surgery, Wright State
University
L Joseph Rubino, MD is a member of the following medical societies: Alpha Omega Alpha,
American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and
Mid-America Orthopaedic Association
Disclosure: Nothing to disclose.
Tom Scaletta, MD Chair, Department of Emergency Medicine, Edward Hospital; Past-President,
American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of
Emergency Medicine
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical
Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
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