Lateral Clavicle Fracture



Elderly population

Less common in younger population


Lateral 1/3 Neer Classification


Type I


Lateral Clavicle Fracture Undisplaced


Fracture lateral to the CC ligaments

- does not extend into the ACJ

- non displaced

- most common 4:1


Type II


Lateral Clavicle Fracture



- medial to CC ligaments

- CCL ligaments attached to lateral fragment

- medial fragment displaced superiorly

- highest rate of non union



- between conoid and trapezoid

- conoid disrupted

- trapezoid remains attached to the lateral fragment

- more stable


Type III


Involves articular surface ACJ

- ligaments intact

- may present as late degenerative change


Type IV

- skeletally immature patient

- paediatric sleeve fracture

- ligaments attached to periosteum

- displacement of proximal fragment


Non Operative Management


Robinson JBJS Am 2004

- cohort of 100 displaced Type II fractures

- 20% asymptomatic non-union

- 14% of cohort required surgery

- recommended non operative treatment in middle aged / elderly


Operative Management


Operative Indications 

- Compound / skin compromise

- displaced fracture in young people

- non union




1.  Dorsal plate / locking wrist plate


Lateral Clavicle Plate


Case 1


Lateral Clavicle ORIFLateral Clavicle ORIF 2


The lateral clavice fracture has been cleaned and reduced

- held with K wire across ACJ

- high strength suture around clavicle and coracoid

- locking plate applied, reinforced with IM screw, and high strength tape around coracoid

- advantage: no need to remove hook plate


2.  Hook Plate


Lateral Clavicle Fracture Hook Plate PreopLateral Clavicle Fracture Hook Plate Post op


Halder et al J Should Elbow Surg 2006

- 22 patients treated with hook plate

- very limited ROM (90o flexion) until plates removed at 3-4 months

- 1 disengaged from acromion (should have used acromial screws)

- 1 disengaged from clavicle (should have used 6 not 4 hole plate)

- 1 clavicular fracture at end of plate

- 1 non union, 1 delayed union

- 1 infection

- most complications in patients > 60


Hook Plate Disengage


3.  Endobutton


Robinson et al JBJS Br 2010

- 16 patients under 60 with displaced type 2

- all treated under 3 weeks

- endobutton in coracoid, clavicle reduced, endobutton clavicle

- 1 symptomatic non union


Non Union


Lateral Clavicle Non unionLateral Clavicle Nonunion ORIF


Distal clavicle nonunionDistal Clavicle Nonunion




1.  Bone graft / ORIF


2.  Excise

- open

- arthroscopic