Young active patients

Displacement:

1. 
   

   Medial:

   
   
   
   
   1. 
      

      Sternocleidomastoid (SCM): Pulls medial fragment posteromedially.

   
   
2. 
   

   Lateral:

   
   
   
   
   1. 
      

      Weight of arm and pectoralis pull lateral fragment inferomedially.

   
   
3. 
   

   Open fractures → fragment buttonholes through the platysma.

Associated injuries are rare but include:

1. 
   

   Scapulothoracic disassociation

   
   
2. 
   

   Ipsilateral scapular fracture

   
   
3. 
   

   Neurovascular injuries

   
   
4. 
   

   Rib fracture

   
   
5. 
   

   Pneumothorax

   
   
6. 
   

   Lateral 1/3 fractures can have concomitant glenohumeral pathology.

“S” shape with six muscular attachments

Acts as a strut connecting the axial and appendicular skeleton

Sternoclavicular joint medially

Acromioclavicular joint laterally

The first bone to start ossification and the last one to complete union.

Neer:

1. 
   

   Middle Third (Group 1):

   
   
   
   
   1. 
      

      Nondisplaced:

      
      
      
      
      • 
        

        i. <100% displacement.

      
      
   2. 
      

      Displaced:

      
      
      
      
      • 
        

        i. >100% displaced.

   
   
2. 
   

   Lateral third (Group 2):

   
   
   
   
   1. 
      

      Type 1:

      
      
      
      
      • 
        

        i. Nondisplaced

        
        
      • 
        

        ii. Fractures occur between the acromioclavicular (AC) and coracoclavicular (CC) ligaments and ligaments are intact

        
        
      • 
        

        iii. Treatment is nonoperative.

      
      
   2. 
      

      Type 2:

      
      
      
      
      • 
        

        i. 2A:

        
        
        
        
        • 
          

          CC ligaments attached to distal fragment.

        
        
      • 
        

        ii. 2B:

        
        
        
        
        • 
          

          Trapezoid ligament intact

          
          
        • 
          

          Conoid ligament torn.

        
        
      • 
        

        iii. Highest rate of nonunion

        
        
      • 
        

        iv. Consider open reduction and internal fixation (ORIF):

        
        
        
        
        • 
          

          Hook plate versus ligament reconstruction with fragment fixation.

      
      
   3. 
      

      Type 3:

      
      
      
      
      • 
        

        i. Articular fractures

        
        
      • 
        

        ii. Typically nondisplaced

        
        
      • 
        

        iii. Nonoperative treatment:

        
        
        
        
        • 
          

          Distal clavicle excision for symptomatic patients.

Allman’s classification:

1. 
   

   Distal third:

   
   
   
   
   1. 
      

      Group II

      
      
   2. 
      

      15%.

   
   
2. 
   

   Middle third:

   
   
   
   
   1. 
      

      Group I

      
      
   2. 
      

      80%.

   
   
3. 
   

   Medial third:

   
   
   
   
   1. 
      

      Group III

      
      
   2. 
      

      5%.

X-rays primary imaging

Compare with contralateral side:

1. 
   

   Evaluate for shortening

   
   
2. 
   

   Zanca view:

   
   
   
   
   1. 
      

      15 degrees cephalad tilt.