Current concepts in the treatment of fractures of the clavicle

Clavicle fracture is a common injury in all age groups. Injuries can be classified into groups. Group I includes fractures of the middle one third, the most frequent site. Group II fractures account for 10% of fractures of the clavicle and involve the clavicle lateral to the coracoclavicular ligament and are caused by direct violence. These injuries are divided into two subsets. Group II Type I fractures occur lateral to the coracoclavicular ligaments and are stable. Group II Type II fractures occur just medial to the coracoclavicular ligaments and are unstable. These latter injuries require stabilization. Group III fractures are uncommon and involve the medial end of the clavicle and are rarely caused by direct violence. Most fractures of the clavicle can be treated closed with excellent results. Open treatment is only occasionally indicated and then only under certain stringent conditions. Most complications occur with open treatment and include nonunion and infection. Neurovascular complications are uncommon but not unusual. Although reasonable shoulder function is compatible with surgical resection of the clavicle, it cannot be done with impunity.