Fracture

Clavicle Fracture

Common fracture (2-5% of fractures). Middle third most affected (80%). Allman and Robinson classification.

The clavicle fracture is one of the most common fractures (2-5% of all fractures), particularly affecting athletes and young individuals. The mechanism is a fall onto the shoulder tip or directly onto the clavicle. The middle third is affected in 80% of cases (the thinnest area not protected by strong muscular attachments). The Allman classification distinguishes 3 groups by location (I: middle third, II: lateral third, III: medial third). Most fractures heal with conservative treatment, but displaced fractures with shortening > 2 cm are a surgical indication to prevent functional sequelae.

Characteristics

  • Shoulder and clavicle pain after trauma, palpable deformity of the clavicular contour (fragment protrusion), local bruising. Typical posture: arm supported by the opposite hand.
  • AP radiographs and 30° cephalic tilt view. Measurement of clavicular shortening (> 2 cm = risk factor for nonunion and poor functional outcome). CT scan if lateral third fracture to assess acromioclavicular involvement.
  • Associated risks: brachial plexus injury (rare), pneumothorax (displaced fractures), subclavian vessel injury (exceptional). Nonunion (5-15% of non-operated displaced fractures).
  • The acromioclavicular joint can be affected in lateral third fractures (Allman type II), requiring complete ligamentous assessment.

Medical and surgical management

  • Non-displaced or minimally displaced fractures: conservative treatment with arm sling or figure-of-eight brace for 4-6 weeks. Early shoulder mobilization under immobilization protection.
  • Displaced fractures with shortening > 2 cm: surgical fixation by superior plate (most common) or intramedullary pin. Early mobilization from day 1.
  • Lateral third fractures (type II): specific management depending on coracoclavicular ligament integrity. Fixation by hook plate, tension band or arthroscopic technique if ligament injury.

Physiotherapy rehabilitation

  • Early passive shoulder mobilization from day 7-10: pendular exercises, mobilization in flexion and external rotation below the pain threshold. Avoid abduction beyond 90° for 4-6 weeks.
  • Progressive muscle strengthening from 6 weeks: scapular stabilizers (trapezius, rhomboids, serratus anterior), deltoid and rotator cuff work.
  • Rehabilitation of posture and scapular kinematics: correction of shoulder protraction, posterior tilt training of the scapula.
  • Progressive return to sports from 8-12 weeks depending on radiographic consolidation. Contact sports after 3-4 months minimum.

Classification

  1. Allman I — Middle third

    Most common (80%). Conservative or surgical treatment depending on displacement.

  2. Allman II — Lateral third

    Higher risk of nonunion. Assessment of coracoclavicular ligaments essential.

  3. Allman III — Medial third

    Rare (5%). Beware of mediastinal complications. Usually conservative treatment.

  4. Displaced fracture

    A displaced fracture may require surgery.

Average duration

6 to 12 weeks of rehabilitation

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.