• Clinical science

Clavicle fracture


Clavicle fractures are common fractures that usually affect children and adolescents and typically occur from a direct fall onto the shoulder. Clavicle fractures are classified according to the fracture location with the use of the Allman classification. More than two-thirds of cases are due to a fracture in the middle third of the clavicle (group I of the Allman classification). Patients usually present with nonspecific symptoms such as swelling, focal tenderness, and reduced movement of the arm in some cases, more specific signs such as shortening and drooping of the shoulder can occur. Clinical presentation and physical exam help confirm the diagnosis. X-ray is routinely performed to confirm the diagnosis. Further testing may be necessary in certain cases (e.g., arteriography in the case of potential vascular injury). Treatment depends on the location of the fracture and includes conservative and/or surgical measures.


  • Common (account for approx. 2.6% of all fractures)
  • Most commonly occurs in children and adolescents


Epidemiological data refers to the US, unless otherwise specified.


  • Direct fall onto the shoulder, e.g., while cycling (∼85% of cases)
  • Direct blow (∼5% of cases)
  • Indirect trauma, like falling onto an outstretched hand (∼5% of cases)



Allman classification system

Group Location of fracture
I Midshaft fracture/middle third (∼ 69% of cases)
II Lateral/distal third
III Medial/proximal third


Clinical features





Midshaft (group I) fractures

  • Mostly conservative treatment (e.g., simple shoulder sling) for 4–6 weeks
  • Exception: excessively shortened or displaced fractures (require surgery)

Lateral (group II) fractures

  • Stable fractures
    • Conservative treatment (e.g., simple shoulder sling)
  • Unstable fractures
    • Surgical fixation (e.g., tension banding, clavicular plate) is typically indicated
    • If needed, ligament repair

Medial (group III) fractures



  • Malalignment with cosmetic abnormalities
  • Nonunion

We list the most important complications. The selection is not exhaustive.

last updated 04/22/2020
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