Neer describes the pathologic anatomy and treatment of fractures lateral to the coracoid tubercle. He divides distal clavicle fractures into two types based on whether the coracoclavicular ligaments stay attached to the proximal fragment. The paper addresses why some of these fractures fail to unite and how to manage them.
When you see a distal clavicle fracture, your first question is whether the coracoclavicular ligaments still hold the medial fragment. That single anatomic fact separates a benign injury from a problem fracture. Type I is stable and heals in a sling. Type II is unstable, prone to nonunion, and often needs a hard look at fixation.
Don't trust a supine AP film in Type II. Displacement occurs mostly in the AP plane, so get erect stress and oblique views to see the true gap. Neer's key teaching point still holds: preserve the distal fragment rather than excise it. Its ligamentous attachments to the coracoid and acromion allow bone-to-bone healing, something you lose entirely if you resect it like an AC separation.
This paper is the origin of the Neer classification you will be tested on repeatedly, and it frames the modern debate over which unstable distal clavicle fractures actually need surgery.
Neer describes the pathologic anatomy and treatment of fractures lateral to the coracoid tubercle. He divides distal clavicle fractures into two types based on whether the coracoclavicular ligaments stay attached to the proximal fragment. The paper addresses why some of these fractures fail to unite and how to manage them.
When you see a distal clavicle fracture, your first question is whether the coracoclavicular ligaments still hold the medial fragment. That single anatomic fact separates a benign injury from a problem fracture. Type I is stable and heals in a sling. Type II is unstable, prone to nonunion, and often needs a hard look at fixation.
Don't trust a supine AP film in Type II. Displacement occurs mostly in the AP plane, so get erect stress and oblique views to see the true gap. Neer's key teaching point still holds: preserve the distal fragment rather than excise it. Its ligamentous attachments to the coracoid and acromion allow bone-to-bone healing, something you lose entirely if you resect it like an AC separation.
This paper is the origin of the Neer classification you will be tested on repeatedly, and it frames the modern debate over which unstable distal clavicle fractures actually need surgery.