3, 4) In 1990, Craig 10) introduced a modified version of the Neer classification, which is more detailed and helpful in determining a treatment and prognosis. The Neer classification system is based on the fracture location in relation to the CC ligament on simple anteroposterior radiographs and its involvement. Robinson 9) proposed a more detailed classification system based on the fracture type (i.e., lateral fifth, medial fifth, and diaphyseal) and further divided each type of fracture based on displacement, angulation, intra-articular extension, and comminution in 1998 however, this approach is limited in that it does not have a specific category for distal clavicle fractures. 7) further classified clavicle fractures based on displacement and comminution of the fracture. 7, 9, 10, 11) In 1967, Allman 11) suggested classification of clavicle fractures based on anatomic location, an approach that does not consider treatment approaches and/or prognosis. Several classification systems for distal clavicle fractures have been introduced. In this article, we provide an overview of classification systems and treatment methods for distal clavicle fractures and discuss proper treatment strategies for distal clavicle fractures. Although appropriate treatment is needed to help ensure fracture healing and a rapid return to preinjury activities of daily living, definitive treatment strategies have not been established and a variety of techniques are used. Various strategies for surgical treatment of distal clavicle fractures have been reported, including precontoured locking plate fixation, hook plate fixation, coracoclavicular (CC) fixation (using a suture anchor, suture button device, or screw), tension band wiring fixation, transacromial Kirschner (K)-wire fixation, and arthroscopically assisted techniques. Importantly, however, conservative treatment of distal clavicle fractures may result in nonunion or pseudoarthrosis therefore, surgical treatment is recommended when these fractures are unstable. 3, 4, 5, 6, 7, 8) Distal clavicle fractures may be treated conservatively or surgically, and there is no gold standard or consensus in the field. Roughly 30%–45% of all clavicle nonunion fractures occur distally. 2) Distal clavicle fractures are less common than clavicle midshaft fractures and account for 10%–30% of all clavicle fractures. 1) An analysis of the frequency of distal clavicle fractures by age and sex has revealed that they occur most often in men between 30 and 50 years of age and secondarily in individuals (both men and women) over 70 years of age. The management of distal (lateral third) clavicle fractures can be challenging because of difficulty in distinguishing subtle variations in the fracture pattern, which may be suggestive of potential fracture instability.
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