The clavicle is the strut connecting the upper limb to the axial skeleton, transmitting upper limb forces to the sternum through the SC joint. Its S-shaped curve and tubular cross-section distribute loads efficiently. The middle third is the weakest point — the most common fracture site (80% of clavicle fractures). The clavicle has the first ossification centre to appear in the embryo (5-6 weeks) and the last epiphysis to fuse (medial physis at 22-25 years).
Midshaft clavicle fractures with greater than 2 cm shortening, complete displacement with no cortical apposition, or associated neurovascular injury require surgical fixation (plate or intramedullary pin). Non-operative management in a sling produces malunion in 15-25% of completely displaced fractures. Distal clavicle fractures associated with CC ligament rupture (Type II) require fixation.
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