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Clavicle fracture

Last updated: November 12, 2020

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Clavicle fractures are common fractures that usually affect children and adolescents and typically occur from a direct fall onto the shoulder. Clavicle fractures are classified according to the fracture location with the use of the Allman classification. More than two-thirds of cases are due to a fracture in the middle third of the clavicle (group I of the Allman classification). Patients usually present with nonspecific symptoms such as swelling, focal tenderness, and reduced movement of the arm in some cases, more specific signs such as shortening and drooping of the shoulder can occur. Clinical presentation and physical examination help confirm the diagnosis. X-ray is routinely performed to confirm the diagnosis. Further testing may be necessary in certain cases (e.g., arteriography in the case of potential vascular injury). Treatment depends on the location of the fracture and includes conservative and/or surgical measures.

Epidemiological data refers to the US, unless otherwise specified.

  • Direct trauma (∼ 95% of cases) [4]
    • Fall onto the shoulder (most common cause), e.g., from bicycle accident
    • Direct blow to the clavicle, e.g., from a football tackle
  • Indirect trauma (∼ 5% of cases): mainly falls onto an outstretched hand [4]
  • Birth trauma (see “Birth-related clavicle fracture”)
  • Most common site of fracture is the middle third segment of the clavicle because its weakest point is at the junction of the middle and lateral third of the clavicle.

Allman classification system [5]

The Allman classification system categorizes fractures of the clavicle according to fracture location.

Group Location of fracture
I Midshaft fracture/middle third (∼ 69% of cases)
II Lateral/distal third (∼ 28% of cases)
III Medial/proximal third (∼ 3% of cases)

Midshaft (group I) fractures

Lateral (group II) fractures

Medial (group III) fractures

  • Malalignment with cosmetic abnormalities
  • Nonunion

We list the most important complications. The selection is not exhaustive.

  1. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis.. The Journal of bone and joint surgery. British volume. 1988; 70 (3): p.461-4. doi: 10.1302/0301-620X.70B3.3372571 . | Open in Read by QxMD
  2. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification.. J Bone Joint Surg Br. 1998; 80 (3): p.476-84. doi: 10.1302/0301-620x.80b3.8079 . | Open in Read by QxMD
  3. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. Journal of Shoulder and Elbow Surgery. 2002; 11 (5): p.452-456. doi: 10.1067/mse.2002.126613 . | Open in Read by QxMD
  4. Robinson CM. Fractures of the clavicle in the adult. J Bone Joint Surg Br. 1998; 80-B (3): p.476-484. doi: 10.1302/0301-620x.80b3.0800476 . | Open in Read by QxMD
  5. ROBERTS S, HERNANDEZ C, MABERRY M, ADAMS M, LEVENO K, WENDELJR G. Obstetric clavicular fracture: The enigma of normal birth. Obstetrics & Gynecology. 1995; 86 (6): p.978-981. doi: 10.1016/0029-7844(95)00277-x . | Open in Read by QxMD