The Journal of Bone & Joint Surgery

Introduction

Epidemiology

Classification

Clinical and Radiographic Assessment

Treatment of Shaft Fractures (Edinburgh Type 2)

Treatment of Lateral-End Fractures

Treatment of Medial-End Clavicular Fractures (Edinburgh Type 1)

Complications of Clavicular Fractures

Overview and Recommendations

Appendix

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L.A. Kashif Khan, Timothy J. Bradnock, Caroline Scott, C. Michael Robinson; Fractures of the Clavicle. The Journal of Bone & Joint Surgery. 2009 Feb;91(2):447-460.

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JBJS Case Connector

	Probability of a Nonunion
	Not Displaced, Not Comminuted			Displaced, Not Comminuted			Comminuted, Not Displaced		Displaced and Comminuted
Age (yr)	Males	Females	Males	Females	Males	Females	Males	Females
20	<1%	2%	8%	16%	2%	7%	18%	30%
30	<1%	3%	10%	20%	4%	9%	20%	35%
40	1%	5%	13%	26%	5%	12%	25%	38%
50	2%	6%	18%	28%	6%	13%	29%	40%
60	2%	7%	19%	30%	8%	15%	31%	44%
70	4%	10%	21%	37%	9%	18%	35%	49%

	Probability of a Nonunion
	Not Displaced, Not Comminuted			Displaced, Not Comminuted			Comminuted, Not Displaced		Displaced and Comminuted
Age (yr)	Males	Females	Males	Females	Males	Females	Males	Females
20	<1%	2%	8%	16%	2%	7%	18%	30%
30	<1%	3%	10%	20%	4%	9%	20%	35%
40	1%	5%	13%	26%	5%	12%	25%	38%
50	2%	6%	18%	28%	6%	13%	29%	40%
60	2%	7%	19%	30%	8%	15%	31%	44%
70	4%	10%	21%	37%	9%	18%	35%	49%

	Probability of a Nonunion
Age (yr)	Not Displaced	Displaced
20	1%	16%
30	3%	21%
40	5%	27%
50	6%	37%
60	10%	44%
70	17%	52%

	Probability of a Nonunion
Age (yr)	Not Displaced	Displaced
20	1%	16%
30	3%	21%
40	5%	27%
50	6%	37%
60	10%	44%
70	17%	52%

Type of Fracture/Technique	Grade of Recommendation*
Acute displaced diaphyseal (Edinburgh Type-2B) fracture
Plate fixation	C
Intramedullary fixation	C
Nonunion after diaphyseal (Edinburgh Type-2) fracture
Plate fixation with bone graft	B
Intramedullary fixation with bone graft	C
Acute lateral-end (Edinburgh Type-3B) fracture
Coracoclavicular screw fixation	C
Plate fixation	C

Abstract

Introduction

Epidemiology

Classification

Clinical and Radiographic Assessment

Treatment of Shaft Fractures (Edinburgh Type 2)

Acute Injuries: Operative or Nonoperative Management?

Nonoperative Treatment

Primary Operative Treatment

Operative Techniques

Plate Fixation

Intramedullary Fixation

Other Techniques

Treatment of Lateral-End Fractures

Undisplaced Lateral-End Fractures (Neer Type I, Edinburgh Type 3A)

Displaced Lateral-End Fractures (Neer Type II, Edinburgh Type 3B)

Operative Treatment for Displaced Lateral-End Fractures (Neer Type II, Edinburgh Type 3B)

Coracoclavicular Screw (Fig. 4)

Plate and Hook-Plate Fixation

Kirschner Wire Fixation

Suture and Sling Techniques

Intra-Articular Lateral-End Fractures (Neer Type III, Edinburgh Types 3A2 and 3B2)

Treatment of Medial-End Clavicular Fractures (Edinburgh Type 1)

Complications of Clavicular Fractures

Nonunion of Shaft Fractures

Plate Fixation

Other Methods

Nonunion of Lateral-End Fractures

Malunion

Neurological Complications

Refracture

Osteoarthritis of the Acromioclavicular Joint

Complications of Operative Treatment

Overview and Recommendations

Appendix

References

Topics

References