The precise location of "Midshaft" clavicle fractures: Scrimmaging from the 42 yard-line.

Background: The realities of midshaft clavicle fracture distribution have not been described accurately. Consequently, a topographical depiction of midshaft clavicle fractures may help design implants that are more anatomically concordant with the fractured clavicle, leading to better outcomes and fewer complications. Methods: This is a retrospective cohort study. One-hundred sixty-six surgically treated midshaft clavicle fractures of four fellowship-trained shoulder surgeons were evaluated to determine the precise "location" of the fracture on standard radiographs. This location was determined by noting the lateral, central, and medial endpoint of each fracture, expressed as a percentage (0%-100%) of the distance from the lateral to the medial end of the clavicle. Results: Fractures on average began at the 36% line (SD = 6%), were centered at the 42% line (SD = 6%), and ended at the 48% line (SD = 7%). Ninety percent of fractures were centered lateral to the midpoint, and 64% were completely lateral to the midpoint. Thirty-two percent of midshaft fractures extended into the lateral third of the clavicle, but no fractures extended into the medial third. Conclusion: Midshaft clavicle fractures in skeletally mature individuals appear to occur predominantly within the lateral metadiaphyseal half of the clavicle, and rarely extend into the medial third. Industry professionals and surgeons alike should consider this when designing and selecting implants. To note, our study relied on two-dimensional radiographs, and future studies should work on fully capturing the complex three-dimensional anatomy of the clavicle. Level of evidence: IV.