I. Overview Clavicle fracture is one of the common fractures, accounting for about 5% of all fractures in the body, and is more common in young children. It is classified by anatomical site: (1) medial 1/3 fracture, which is caused by direct violence and can be combined with Ⅱ anterior rib fracture; (2) middle 1/3 fracture; and (3) lateral 1/3 fracture. About 80% of clavicle fractures occur in the middle 1/3. The lateral 1/3 clavicle fracture can be divided into two types: (1) without displacement: the rostral clavicular ligament is not broken. (2) Displaced: the rostral collarbone ligament is broken. Diagnosis 1. Clinical manifestations (1) Typical manifestations: There is a clear history of trauma, and indirect violence is common. The fracture site is swollen, bruised, painful, and the affected shoulder and upper arm refuse to move. (2) Physical examination: the fracture site is swollen, bruised, and may have a sunken deformity in appearance, with palpable bone rubbing sensation and percussion pain in the clavicle. In young children, based on the history of trauma; during examination, the head tilts to the affected side, the chin turns to the healthy side, and a crying or painful face appears when the upper limb is held up or lifted from the axilla, suggesting a possible fracture. For suspected rostral ligament injury, the X-ray film of symmetrical weight-bearing can be added to determine the fracture and displacement, i.e., to take the orthogonal film of both shoulders with the weight of about 4kg held vertically by both hands. If the distance between the rostral process and the clavicle increases and the displacement of the fracture end increases, it indicates a rupture of the rostral collateral ligament. Treatment 1.Medial 1/3 fracture: Suspension of upper limb by triangular scarf for 4-6 weeks. 2. Middle 1/3 fracture (1) For children without displaced fracture, the outer layer of “8” bandage is reinforced with wide adhesive tape and fixed for 3-4 weeks. (2) If the fracture is displaced, it should be fixed with “8” plaster bandage for 4-6 weeks, and the fixation period should be extended for the elderly and comminuted fractures. The fracture of the middle 1/3 of the clavicle does not emphasize anatomical repositioning, even if the deformity heals, it does not affect the function of the upper limb. Multiple repositioning can produce bone nonunion. The indications for surgery of the middle clavicle fracture are: (1) open fracture; (2) vascular and nerve injury; (3) bone disjunction; (4) pursuit of aesthetics or early activity requiring surgical treatment. Internal fixation methods include intramedullary pin fixation and bone plate screw fixation. 3. The lateral 1/3 fracture can be divided into 3 types according to the relationship between the fracture line and the rostral ligament: Type I: the fracture is between the rostral ligament and the acromioclavicular ligament, the fracture is relatively stable, no displacement, and is the most common. The fracture is relatively stable without displacement and is most commonly treated with a triangular scarf suspension for about 6 weeks. Type II: The rostral collar ligament is separated from the proximal clavicle and the fracture is moderately displaced. Because the fracture segment is separated from the rostral clavicle ligament, the fracture displacement is not easily repositioned by manipulation, and in principle, incision and internal fixation treatment are considered. Type III: Articular surface fracture of the external end of the clavicle. Conservative treatment is generally adopted. If secondary traumatic arthritis occurs, the distal end of the clavicle can be surgically removed.