UMEM Educational Pearls

Title: Midshaft Clavicle Fractures

Category: Orthopedics

Posted: 12/13/2025 by Brian Corwell, MD (Updated: 12/14/2025)
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Midshaft Clavicle Fractures

Have been in the sports headlines over the last several months

About 3 - 3.5% of all adult fractures

Typical patient is young and active, usually males < 30 years old

Most clavicle fractures (up to 80%) involve the middle third

Mechanism: Typically direct impact or FOOSH

“S” shaped bone with thinnest & narrowest segment at junction between middle and distal third

Upright AP
15° (or greater) cephalic tilt (improved clavicle visualization by eliminating overlapping scapula )

Appearance: 2/3 non-displaced

Displaced fractures

Medial fragment pulled posterior and superior by SCM muscle
Lateral fragment pulled inferior and medial by the pectoralis muscle and weight of arm

Because of the effects of gravity, attempt to get clavicle series in upright position

Otherwise supine view may underestimate degree of displacement

What to look for on plain film

Displacement

Measure as a percent relative to width of clavicle
- >100% displacement has high risk of nonunion
Shortening
- Measure the distance between the corresponding ends of the medial and lateral fragments
  - Shortening >2cm associated with decrease shoulder strength and endurance
  - http://www.orthopaedicsone.com/wp-content/uploads/2024/06/379191374.png
  - https://jsesinternational.org/cms/10.1016/j.jseint.2020.03.005/asset/2a9033e8-0d2f-4569-8bac-d545d7d69e75/main.assets/gr1.jpg
  - Also consider chest film and use this to compare the lengths of the injured and uninjured clavicles
    - https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQWTcfPHOXEADmMgzQ46GKUalTN-0mJT9hm6A&s