Classification of clavicular fractures

Classification of clavicle fractures

The anatomic location of the fracture is usually described according to the Allman classification, which divides the clavicle into thirds (1)

• group I (midshaft) - fractures occur on the middle third of the clavicle
  • most common type and accounts for around 69% to 82% of fractures
  • often associated with overlap of the fragments (2)
• group II (distal) - fractures on the lateral third
  • account for 21% to 28% of all fractures
  • may result in superior displacement of bone if the coracoclavicular ligaments are involved

• group III (proximal) - fractures on the medial third
  • are uncommon and accounts for 2% to 3% of all fractures

Another proposed classification system, “The Edinburgh classification” has been introduced recently and is gaining popularity in the literature. It classifies fractures according to the anatomical site involved (medial end, midshaft, lateral end), articular involvement (sternoclavicular or acromioclavicular joint), displacement, and extent of comminution (3).

• Type 1 medial-end fracture
  • 1 A-undisplaced
    • 1 A 1-extra-articular
    • 1 A 2-intra-articular
  • 1 B-displaced
    • 1 B 1-extra-articular
    • 1 B 2-intra-articular
• Type 2 shaft fracture
  • 2 A-cortical alignment
    • 2 A 1-undisplaced
    • 2 A 2-angulated
  • 2 B-displaced
    • 2 B 1-simple or wedge comminuted
    • 2 B 2-isolated or comminuted segmental
• Type 3 lateral-end fracture
  • 3 A-cortical alignment
    • 3 A 1-extra-articular
    • 3 A 2-intra-articular
  • 3 B-displaced
    • 3 B 1-extra-articular
    • 3 B 2-intra-articular

Reference:

1. Toogood P et al. Clavicle fractures: a review of the literature and update on treatment. Phys Sportsmed. 2011;39(3):142-50.
2. Russell RC, Williams NS , Bulstrode CJ. Bailey & Love's Short Practice of Surgery. 24th edition
3. Faldini C et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J Orthop Traumatol. 2010;11(4):229-36.