0 Item(s)
Options for Management of Distal Clavicle Fractures and Acromio-clavicular Joint Separation
Distal clavicle fractures are classified on the basis of their relationship to the coracoclavicular (CC) ligaments in the Neer classification and the Craig subclassification (Figure 1). Type I fractures occur lateral to the CC ligaments and typically have minimal displacement because the trapezoid and conoid ligaments remain intact. Type II fractures are characterized by detachment of the CC ligaments from the medial segment. These fractures are subdivided into type IIA fractures, which occur medial to the intact CC ligaments, and type IIB fractures, which occur between a disrupted conoid ligament and an intact trapezoid ligament. The trapezoid ligament remains attached to the lateral clavicular fragment. Type II fractures are often characterized by substantial clavicular displacement (>100% of the width of the clavicle) and instability because the medial fragment is pulled superiorly and posteriorly by the trapezius muscle while the lateral fragment is drawn distally by the weight of the arm and medially via scapular rotation and the pull of the pectoral and latissimus dorsi muscles. Type III fractures extend into the acromioclavicular (AC) joint and typically have minimal displacement because the CC ligaments remain intact.