OR2.1 | Clavicle Fracture Management — Summary & Reflection

KEY TAKEAWAYS

Clavicle fractures are the most common fractures of the shoulder girdle, with mid-shaft (Allman Group I) fractures accounting for ~80%. Displacement is driven by trapezius pulling the medial fragment upward and arm weight dropping the distal fragment. The Allman classification (Groups I-III) and Neer subclassification of lateral third fractures guide management. Mid-shaft fractures with shortening >=2 cm, complete displacement, skin tenting, open injury, or floating shoulder are operative indications; undisplaced fractures are managed with a broad-arm sling for 3-6 weeks. Neer type II lateral third fractures carry a 30-40% non-union risk and generally require hook-plate or coracoclavicular fixation. Key complications include non-union (most common), malunion, brachial plexus injury, and pneumothorax in high-energy mechanisms. A full neurovascular examination -- pulses plus median, radial, ulnar, musculocutaneous, and axillary nerve function -- must never be omitted.

REFLECT

Consider a patient in fracture clinic with a 10-week-old undisplaced clavicle fracture who remains symptomatic with pain on arm raising and radiographs showing no callus. How would you distinguish delayed union from non-union, what additional investigations would you request, and what non-surgical and surgical options would you discuss? Reflect on how you would involve the patient in the management decision, weighing the risks of surgery against continued non-operative management.