Clavicle Fracture Classification

Allman Classification (Allman FL, JBJS 49A;774:1967)

• Group I-middle 1/3=69%-85%
• Group II-lateral 1/3=12%-28%: See Distal Clavicle Fracture.
• Group III-medial 1/3=3%-6%

Group I - Middle 1/3 Clavicle Fracture

• 69%-85% of clavicle fractures.
• 0.13%-13% non-op nonunion rate overall
• Generally treated non-oeratively
• No difference between sling and figure-8 (Stanly, Injury 19;162:1988)
• Closed reduction not helpful (Hill, JBJS 79B;537:1997)
• 31% of non-op patients report shoulder weakness, fatigue, paresthesias and asymmetry.
• Shortening >18 mm in males or >14 mm in females is associated unsatisfactory result. (Lazarides S, JSES 2006;15:191)
• Operative indications=open fx, NVI, displaced fx with impending skin compromise, shortening >20mm, significant comminution, scapulothoracic dissociation.  Consider for neurologic disorders, floating shoulder, bilateral fx, cosmesis, ipsiliateral UE fx.
• See Clavicle Fx ORIF Technique.

Group II - Lateral Clavicle Fracture

• Fracture in lateral 1/3 of the clavicle
• 12%-28% of clavicle fractures
• See Distal Clavicle Fracture.

Group III-Medial Clavicle Fracture

• Fracture in the medial 1/3 of clavicle
• 3%-6% of clavicle fractures