Summary Midshaft Clavicle fractures are common traumatic injuries caused by a direct impact to the shoulder girdle and is most commonly seen in young, active adults. Diagnosis can be made radiographically with AP and cephalic tilt clavicle x-rays. Treatment is nonoperative or operative based on patient activity and demands, along with degree of displacement, shortening, and comminution. Epidemiology Incidence common login to view 4 more bullets Demographics often seen in young, active patients login to view 1 more bullet Location 75-80% of all clavicle fractures will occur in the middle third segment Etiology Pathophysiology mechanism of injury login to view 2 more bullets pathoanatomy login to view 7 more bullets Associated conditions medical login to view 2 more bullets orthopedic login to view 8 more bullets ANATOMY Osteology Shape login to view 2 more bullets Articulations sternoclavicular joint login to view 5 more bullets acromioclavicular joint login to view 3 more bullets Muscles sternocleidomastoid login to view 3 more bullets deltoid login to view 4 more bullets trapezius login to view 2 more bullets pectoralis major login to view 3 more bullets subclavius login to view 3 more bullets sternohyoid login to view 2 more bullets platysma login to view 3 more bullets Ligaments coracoclavicular (CC) ligaments login to view 6 more bullets Blood Supply subclavian vessel login to view 2 more bullets Nervous System supraclavicular nerves login to view 1 more bullet brachial plexus Biomechanics middle third is weakest portion of clavicle login to view 3 more bullets Classification Neer Classification (simple) Nondisplaced < 100% displacement Nonoperative Displaced > 100% displacement Operative AO classification Type A = Simple A1 = spiral A2 = oblique A3 = transverse Nonoperative vs. operative Type B = Wedge B1 = spiral wedge B2 = bending wedge B3 = fragmented wedge Nonoperative vs. operative Type C = Complex C1 = complex spiral C2 = segmental C3 = irregular Operative Presentation History popping or cracking sound near shoulder after fall Symptoms acute onset of anterior shoulder pain or directly over clavicle Physical exam inspection login to view 2 more bullets neurovascular exam login to view 1 more bullet Imaging Radiographs recommended views login to view 7 more bullets optional views login to view 3 more bullets findings login to view 3 more bullets measurements login to view 8 more bullets CT indications login to view 5 more bullets views login to view 2 more bullets Differential Adult distal third clavicle fx older, osteoporotic patient x-ray may show increased CC distance Sternoclavicular dislocation high energy mechanism may present with dysphagia, stridor, asymmetric pulses, paresthesias due to compression of surrounding structures serendipity view or CT best demonstrate displacement Acromioclavicular Joint Injury pain and prominence more lateral over AC joint zanca or axillary views shows displaced distal clavicle relative to acromion Treatment Nonoperative sling immobilization login to view 12 more bullets Operative open reduction internal fixation (ORIF) login to view 20 more bullets Techniques Sling Immobilization technique login to view 6 more bullets advantage login to view 2 more bullets disadvantage login to view 2 more bullets complications login to view 5 more bullets Plate Fixation approach login to view 2 more bullets technique login to view 14 more bullets advantages login to view 7 more bullets disadvantage login to view 3 more bullets complications login to view 6 more bullets postoperative Rehabilitation login to view 5 more bullets Intramedullary Fixation (IMN) technique login to view 10 more bullets advantages login to view 4 more bullets disadvantages login to view 5 more bullets contraindications login to view 2 more bullets complications login to view 2 more bullets Complications Nonoperative treatment nonunion (~15%) login to view 13 more bullets malunion (~20%) login to view 11 more bullets Operative treatment hardware prominence login to view 2 more bullets neurovascular injury login to view 2 more bullets supraclavicular nerve injury login to view 3 more bullets nonunion (1-5%) infection (~4.8%) login to view 4 more bullets mechanical failure (~1.4%) pneumothorax adhesive capsulitis login to view 1 more bullet