Management controversies of fractures of the Lateral Third of the Clavicle: About 38 patients

Introduction: Clavicle fractures are a common condition, accounting for approximately 2.6 to 5% of all fractures in adults. Among these, fractures of the distal third, although less common than those of the middle third, present specific diagnostic and therapeutic challenges due to their anatomical and biomechanical complexity
Materials and Methods: A retrospective study was conducted in the Department of Orthopedic Trauma Surgery (AILE 4) at Ibn Rochd University Hospital in Casablanca to analyze fractures of the distal third of the clavicle and evaluate diagnostic and therapeutic approaches, as well as their clinical and radiological outcomes, in 38 patients admitted to the department between January 2018 and September 2024. 
Results: The mean age was 37 years, with a large male predominance (81.6%).
All patients, or 100%, presented with symptoms typical of upper extremity trauma, including total functional impairment, as well as pain upon the slightest palpation of the distal part of the clavicle and the acromioclavicular joint.
No vascular or nerve injuries were observed in our patients.
The cases were distributed as follows: Type I (11%), Type II with subtypes
IIA (42%) and IIB (39%), and Type III (8%).
In our series, the clavicle fracture was isolated in 77% of cases, whereas in 23% of cases we dealt with patients with multiple trauma.
Surgical treatment was the most common therapeutic approach, accounting for 86% of patients, while orthopedic treatment was used in 14% of cases. Orthopedic immobilization was performed using an elbow-to-body brace in all patients.
The average healing time was 12 weeks.
The results were good or excellent in 90% of cases, fair in 7%, and poor in only 3%.
Discussion: Our study, consistent with the literature, showed generally satisfactory results but also highlighted the importance of appropriate management and rigorous postoperative monitoring to minimize complications. Finally, advances in surgical techniques and rehabilitation protocols, combined with a better understanding of biomechanics, continue to improve long-term outcomes for these complex fractures.
Conclusion: Multidisciplinary management combined with informed treatment decisions remains the key to a favorable prognosis, with priority given to restoring function and ensuring patient comfort.