Distal Clavicle Classification

Type I

• distal to the coracoclavicular ligaments.
• Coracoclavicular ligaments remain intact,
• Displacement uncommon.
• Treatment = sling.

1. Conoid ligament
2. Trapezoid ligament
3. Coracoid process
4. Acromion
5. Clavicle

Type IIA

• medial to the coracoclavicular ligaments.
• Medial fragment frequently displaces superiorly.
• Nonunion is frequent.
• Treatment = ORIF. Consider hook-plate fixation (Haider SG, JSES 2006;15:419). Consider non-absorbable suture fixation. (Levy O, JSES 2003;12:24).

1. Conoid ligament
2. Trapezoid ligament
3. Coracoid process
4. Acromion
5. Clavicle

Type IIB

• Between the coracoclavicular ligaments.
• Medial fragment frequently displaces superiorly.
• Nonunion is frequent.
• Treatment = ORIF. Consider hook-plate fixation (Haider SG, JSES 2006;15:419). Consider non-absorbable suture fixation. (Levy O, JSES 2003;12:24).

1. Conoid ligament
2. Trapezoid ligament
3. Coracoid process
4. Acromion
5. Clavicle

Depuy Clavicle Pin (T)

Synthes Clav Hook (T)

Synthes Small Frag set

Type III

• Intra-articular, frequently without ligament disruption.
• Generally little or no displacement.
• Frequently missed or misdiagnosed as acromioclavicular joint injuries.
• May lead to AC arthritis.
• Treatment = sling. Consider distal clavicle excision for patients who are symptomatic at 6-12 months after injury.

1. Conoid ligament
2. Trapezoid ligament
3. Coracoid process
4. Acromion
5. Clavicle