Clavicle originates from the sternum at the medial line to the acromion of the scapula. Its most important landmarks are conoid tubercle, trapezoid line, impression for the costoclavicular ligament. The main functions of the clavicle are to attach the upper limbs to the trunk, to protect the neurovascular structures and to transfer the force from the upper limb to the axial skeleton.
The fractures of the clavicle are common in the individuals of all ages. The majority of fractures occur in the middle portion (shaft) of the clavicle. In certain cases, the bone nay fracture where it attaches at the ribcage or shoulder attachment. The most common mechanism of the fracture is the fall on the shoulder or outstretched upper limb. The fracture may be present due to pathologic conditions, such as metastatic or metabolic disease. In younger individuals, the most common mechanism of injury is the sequela of motor vehicle accidents or sports injuries.
The treatment is to wear a sling to prevent the affected limp and shoulder from moving in the healing phase of the process (conservative treatment). In certain fractures, operative management is indicated to realign the clavicle.
In the case of comminuted fracture, the clavicle is broken into a larger number of pieces. If those bone parts are out of place, the fracture is termed as a displaced fracture.
The first classification of clavicle fractures was described in 1967 by Allman. The fractures were classified into type I fractures (occur in the middle portion of the clavicle), type II and type III (involvement of the lateral and medial thirds of the bone). The fractures of the lateral third were then classified by Neer due to the involvement of the coracoclavicular ligaments. Type I lateral fracture was described as the one that occurs distal to the coracoclavicular ligament (displaced fracture). Type II injuries are the ones with a medial fragment that is discontinuous with the coracoclavicular ligaments. Type III injuries are described as an intra-articular fracture of the acromioclavicular joint with the intact coracoclavicular ligament.
The relative indications for acute surgical treatment are younger individuals, active patients with clavicle shortening more than 1.5-2 cm, major esthetic deformity or multiple trauma. In those cases, closed or open reduction is performed to reduce the displaced fragments.
Open reduction and internal fixation of the collar bone is performed with a plate or intramedullary pin fixation. Plate fixation leads to faster healing and mobilization. Antegrade or retrograde intramedullary pin fixation is a more aesthetic approach. It is performed through a smaller incision
