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Clavicle fractures

Robert L Hatch, MD, MPH
James R Clugston, MD, MS
Jonathan Taffe, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Clavicle fractures occur commonly, often as a result of indirect or direct trauma to the shoulder region. Clinicians working in emergency departments and general clinics should be familiar with the common presentations and complications of this injury, as well as basic management.

This topic review will discuss the presentation and management of clavicle fractures. Other shoulder injuries and the approach to undifferentiated shoulder pain are reviewed elsewhere. (See "Acromioclavicular joint injuries ("separated" shoulder)" and "Rotator cuff tendinopathy" and "Evaluation of the patient with shoulder complaints".)


Clavicle fractures account for approximately 2.6 percent of all fractures [1,2]. The peak incidence occurs in children and young adults. Over one-third of clavicle fractures in males occur between the ages of 13 and 20 years, while 20 percent of clavicle fractures in women occur in the same age group [3]. Incidence falls over subsequent decades before rising again in older men and women.

In a study of 1000 consecutive fractures, 69 percent occurred in the middle third of the bone, 28 percent in the distal third, and 2.8 percent in the proximal third [3]. Distal third fractures are further subdivided into three types [4]. These locations provide the basis for clavicle fracture classification. (See 'Classification' below.)

In older studies, fractures of the proximal clavicle constituted only 2 to 3 percent of all clavicle fractures [1,3]. However, a subsequent study found that 9.3 percent of clavicle fractures involved the medial third [5]. The authors hypothesized that their higher rate was due to the institution's liberal use of CT (22 percent of medial clavicle fractures were seen only on CT).

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Literature review current through: Nov 2017. | This topic last updated: Aug 04, 2017.
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  1. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg 2002; 11:452.
  2. Eiff, MP, Hatch, et al. Clavicle and scapula fractures. In: Fracture Management for Primary Care, 2nd ed, WB Saunders, Philadelphia 2002. p.198.
  3. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 1998; 80:476.
  4. Neer CS 2nd. Fractures of the distal third of the clavicle. Clin Orthop Relat Res 1968; 58:43.
  5. Throckmorton T, Kuhn JE. Fractures of the medial end of the clavicle. J Shoulder Elbow Surg 2007; 16:49.
  6. Bishop JY, Flatow EL. Pediatric shoulder trauma. Clin Orthop Relat Res 2005; :41.
  7. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am 1967; 49:774.
  8. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 1988; 70:461.
  9. Jones GL, Bishop JY, Lewis B, et al. Intraobserver and interobserver agreement in the classification and treatment of midshaft clavicle fractures. Am J Sports Med 2014; 42:1176.
  10. Herscovici D Jr, Fiennes AG, Allgöwer M, Rüedi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. J Bone Joint Surg Br 1992; 74:362.
  11. Cross KP, Warkentine FH, Kim IK, et al. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med 2010; 17:687.
  12. Edwards SG, Whittle AP, Wood GW 2nd. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Joint Surg Am 2000; 82:774.
  13. Leung KS, Lam TP. Open reduction and internal fixation of ipsilateral fractures of the scapular neck and clavicle. J Bone Joint Surg Am 1993; 75:1015.
  14. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007; 89:1.
  15. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997; 79:537.
  16. Denard PJ, Koval KJ, Cantu RV, Weinstein JN. Management of midshaft clavicle fractures in adults. Am J Orthop (Belle Mead NJ) 2005; 34:527.
  17. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop 2005; 76:496.
  18. Lenza M, Buchbinder R, Johnston RV, et al. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 2013; :CD009363.
  19. Robinson CM, Goudie EB, Murray IR, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 2013; 95:1576.
  20. Zlowodzki M, Zelle BA, Cole PA, et al. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 2005; 19:504.
  21. Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elbow Surg 2006; 15:191.
  22. Meunier A. Who should be treated surgically for a displaced clavicle fracture? Acta Orthop 2016; 87:539.
  23. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012; 94:675.
  24. Devji T, Kleinlugtenbelt Y, Evaniew N, et al. Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials. CMAJ Open 2015; 3:E396.
  25. Smeeing DPJ, van der Ven DJC, Hietbrink F, et al. Surgical Versus Nonsurgical Treatment for Midshaft Clavicle Fractures in Patients Aged 16 Years and Older: A Systematic Review, Meta-analysis, and Comparison of Randomized Controlled Trials and Observational Studies. Am J Sports Med 2017; 45:1937.
  26. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 1998; 12:572.
  27. Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand 1987; 58:71.
  28. Lenza M, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2016; 12:CD007121.
  29. Ersen A, Atalar AC, Birisik F, et al. Comparison of simple arm sling and figure of eight clavicular bandage for midshaft clavicular fractures: a randomised controlled study. Bone Joint J 2015; 97-B:1562.
  30. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am 2003; 85-A:790.
  31. Housner JA, Kuhn JE. Clavicle fractures: individualizing treatment for fracture type. Phys Sportsmed 2003; 31:30.
  32. Clavicular fractures in children. Wheeless' Textbook of Orthopedics. www.wheelessonline.com/ortho/clavicle_fractures (Accessed on December 12, 2007).
  33. Goldberg JA, Bruce WJ, Sonnabend DH, Walsh WR. Type 2 fractures of the distal clavicle: a new surgical technique. J Shoulder Elbow Surg 1997; 6:380.
  34. Mall JW, Jacobi CA, Philipp AW, Peter FJ. Surgical treatment of fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis. J Orthop Sci 2002; 7:535.
  35. Kao FC, Chao EK, Chen CH, et al. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma 2001; 51:522.
  36. Chen CH, Chen WJ, Shih CH. Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption. J Trauma 2002; 52:72.
  37. Levy O. Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle. J Shoulder Elbow Surg 2003; 12:24.
  38. Deafenbaugh MK, Dugdale TW, Staeheli JW, Nielsen R. Nonoperative treatment of Neer type II distal clavicle fractures: a prospective study. Contemp Orthop 1990; 20:405.
  39. Anderson K. Evaluation and treatment of distal clavicle fractures. Clin Sports Med 2003; 22:319.
  40. Rokito AS, Zuckerman JD, Shaari JM, et al. A comparison of nonoperative and operative treatment of type II distal clavicle fractures. Bull Hosp Jt Dis 2002-2003; 61:32.
  41. Nordqvist A, Petersson C, Redlund-Johnell I. The natural course of lateral clavicle fracture. 15 (11-21) year follow-up of 110 cases. Acta Orthop Scand 1993; 64:87.
  42. Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg 2011; 19:392.
  43. Abbot AE, Hannafin JA. Stress fracture of the clavicle in a female lightweight rower. A case report and review of the literature. Am J Sports Med 2001; 29:370.
  44. Fallon KE, Fricker PA. Stress fracture of the clavicle in a young female gymnast. Br J Sports Med 2001; 35:448.
  45. Peebles CR, Sulkin T, Sampson MA. 'Cable-maker's clavicle': stress fracture of the medial clavicle. Skeletal Radiol 2000; 29:421.
  46. Yamada K, Sugiura H, Suzuki Y. Stress fracture of the medial clavicle secondary to nervous tic. Skeletal Radiol 2004; 33:534.
  47. Brinker MR, Simon RG. Pseudo-dislocation of the sternoclavicular joint. J Orthop Trauma 1999; 13:222.
  48. Lehnert M, Maier B, Jakob H, et al. Fracture and retrosternal dislocation of the medial clavicle in a 12-year-old child--case report, options for diagnosis, and treatment in children. J Pediatr Surg 2005; 40:e1.
  49. Craig, EV. Fractures of the clavicle. In: The Shoulder, Rockwood, CA, Matson, FA (Eds), WB Saunders, Philadelphia 1998. p.428.
  50. Ring, D, Jupiter, et al. Part II, Fractures of the clavicle. In: Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries, Browner, BD, Jupiter, JB, Levine, AL, Trafton, PG (Eds), WB Saunders, Philadelphia 1998. Vol II, p.1670.
  51. Garrick, JG, Webb, DR. Fractures of the proximal and middle thirds of the clavicle. In: Sports Injuries: Diagnosis and Management, 2nd ed, Garrick, JG, Webb, DR (Eds), WB Saunders, Philadelphia 1999. p.93.
  52. Schlegel, TF, Hawkins, RJ. Fractures of the shoulder girdle. In: Shoulder Injuries in the Athlete: Surgical Repair and Rehabilitation, Hawkins, RJ, Misamore, GW (Eds), Churchill Livingstone, New York 1996. p.219.