Clavicle Fractures Classification - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes clavicle fractures and explains Allman classification in a simple and easy way that helps you understand all you need to know.

The Allman classification is based on the anatomical location of the fracture. Clavicle fractures are traditionally treated conservatively and there is more evidence that conservative treatment is not ideal for displaced clavicle fractures. Conservative treatment may result in a higher incidence of malunion, nonunion and permanent shoulder dysfunction.
Three groups in the Allman classification:
Group I: Fracture involving the middle third of the clavicle. Accounts for approximately 80% of clavicle fractures. As a general rule, when the fracture is less than 100% displaced, then it is treated conservatively with a sling. When it is more than 100% displaced, the fracture is treated with surgery. When there is displacement, the medial fragment is usually elevated and the distal fragment is displaced downward due to gravity and the weight of the arm.
Group II: Fracture in the lateral third of the clavicle which accounts for about 10-15% of all clavicle fractures. Neer classification is applied to fractures in the lateral third of the clavicle.
Type I (Neer) – Fracture occurs lateral to the coracoclavicular ligaments, which remain intact to the medial segment.
Type II – Type IIA (Neer) – Both conoid and trapezoid remain attached to the distal segment. Fracture occurs medial to the intact ligaments. The medial clavicle is unstable and the nonunion rate is high without surgery.
Type II – Type IIB (Neer) – Fracture may occur either between the ruptured conoid and an intact trapezoid or fracture may occur lateral to both ligaments that are torn. The medial segment is unstable with conoid torn. Nonunion is high without operative treatment. Fracture will require surgery!
If the fracture occurs lateral to the ligaments the medial clavicle remains stable.
Type III (Neer) – Extension of the fracture into the AC joint. Intraarticular extension fracture that is stable. The patient may develop post-traumatic arthritis.
Group III: Fractures involving the medial third of the clavicle. Accounts for 5% of clavicular fractures. Displacement and nonunion is rare. Treatment of this fracture type is usually nonoperative and the fracture is rarely symptomatic.

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