What are the types of distal clavicle fractures?

Updated: Jan 14, 2019
  • Author: Benjamin P Kleinhenz, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Neer made a significant revision to the Allman classification scheme. Group II (distal clavicle) fractures were further divided into 3 types, based on the location of the clavicle fracture in relation to the coracoclavicular ligaments. The reason for this modification was that distal clavicle fractures behave differently depending on the exact location of the injury. The designations are as follows (see Clinical Presentation and Workup) [14] :

  • Type I fractures: Minimally displaced and occur lateral to an intact coracoclavicular ligament complex; these fractures may be treated nonoperatively and symptomatically (see the image below)

  • Type II fractures: Occur when the medial fragment is separated from the coracoclavicular ligament complex; the medial fragment is displaced cephalad by the pull of the sternocleidomastoid muscle, and the distal fragment is displaced caudally by the weight of the upper extremity, with the intact coracoclavicular ligament complex; the resulting deformity leads to marked displacement of the fracture ends, predisposing this fracture type to a higher prevalence (up to 30%) of nonunion

  • Type III injuries: Minimally displaced or nondisplaced and extend into the acromioclavicular (AC) joint; as with type I fractures, these injuries can be treated symptomatically; the development of late AC degenerative changes can be treated with distal clavicular excision

    Type I fracture of the distal clavicle (group II). Type I fracture of the distal clavicle (group II). The intact ligaments hold the fragments in place.
    A type II distal clavicle fracture. In type IIA, b A type II distal clavicle fracture. In type IIA, both conoid and trapezoid ligaments are on the distal segment, while the proximal segment, without ligamentous attachments, is displaced.
    A type IIB fracture of the distal clavicle. The co A type IIB fracture of the distal clavicle. The conoid ligament is ruptured, while the trapezoid ligament remains attached to the distal segment. The proximal fragment is displaced.

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