Fractures of the clavicle in the adult: Epidemiology and Classification

TLDR

The study aimed to create a new clavicle fracture classification based on radiographic assessment of fracture site, displacement, comminution, and articular involvement. A retrospective review of 1,000 adult clavicle fractures treated between 1988 and 1994 at the Royal Infirmary of Edinburgh provided the data for the classification. The classification showed good inter‑ and intra‑observer reliability; incidence was highest in young males and constant in females, with diaphyseal fractures common in young adults and distal fractures in the elderly; displaced diaphyseal (type 2B) and displaced distal (type 3B) fractures had higher non‑union rates, especially when comminution was extensive.

Abstract

From 1988 to 1994 a consecutive series of 1000 fractures of the adult clavicle was treated in the Orthopaedic Trauma Clinic of the Royal Infirmary of Edinburgh. In males, the annual incidence was highest under 20 years of age, decreasing in each subsequent cohort until the seventh decade. In females, the incidence was more constant, but relatively frequent in teenagers and the elderly. In young patients, fractures usually resulted from road-traffic accidents or sport and most were diaphyseal. Fractures in the outer fifth were produced by simple domestic falls and were more common in the elderly. A new classification was developed based on radiological review of the anatomical site and the extent of displacement, comminution and articular extension. There were satisfactory levels of inter- and intraobserver variation for reliability and reproducibility. Fractures of the medial fifth (type 1), undisplaced diaphyseal fractures (type 2A) and fractures of the outer fifth (type 3A) usually had a benign prognosis. The incidence of complications of union was higher in displaced diaphyseal (type 2B) and displaced outer-fifth (type 3B) fractures. In addition to displacement, the extent of comminution in type-2B fractures was a risk factor for delayed and nonunion.