[Distal clavicle fractures. Classifications and management]

Ben Ockert, E Wiedemann, F Haasters
Der Unfallchirurg 2015, 118 (5): 397-406

BACKGROUND: Fractures of the distal third of the clavicle represent 10-30% of all clavicle fractures . Frequently, these fractures result in instability due to a combination of bony and ligamentous injury. Thus, assessment of the stability is essential for adequate treatment of these fractures.

AIM: This article presents a review of the different classification systems for distal clavicle fractures with respect to anatomical and functional factors to allow for comprehensive assessment of stability. Furthermore, the different treatment options for each fracture type are analyzed.

RESULTS AND DISCUSSION: Fractures to the distal third of the clavicle without instability can be treated conservatively with satisfactory outcome. In contrast, instability may result in symptomatic non-union under conservative treatment; therefore, distal clavicle fractures with instability should be treated operatively with respect to the functional demands of the patient. Operative treatment with locked plating in combination with coracoclavicular fixation results in excellent functional results. Arthroscopically assisted fracture fixation may be beneficial in terms of a minimally invasive approach as well as assessment and treatment of associated glenohumeral lesions.

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