Neer classification of clavicle fractures

Last revised by Dr Daniel J Bell on 29 Apr 2022

The Neer classification of clavicular fractures along with the AO classification system is one of the more frequently used classification systems when assessing clavicular fractures.

Classification

The classification system, broken into five categories communicates both the stability and treatment recommendation of the fracture focusing on the relationship of the fracture to coracoclavicular ligaments and the acromioclavicular joint.

Type I

Considered a stable fracture requiring non-operative treatment

  • minimally displaced fracture line sits lateral to the coracoclavicular ligaments
  • trapezoid and/or conoid ligament intact
Type IIa

Considered an unstable fracture requiring operative treatment

  • fracture is medial to the coracoclavicular ligament with significant displacement of the medial portion
  • conoid ligament intact
  • trapezoid ligament intact
Type IIb

Considered an unstable fracture requiring operative treatment

  • fracture occurs between the coracoclavicular ligaments resulting in a torn conoid ligament and intact trapezoid ligament
  • displacement of the medial clavicle
Type III

Considered a stable fracture requiring non-operative treatment

  • intra-articular distal clavicular fracture extending into the acromioclavicular joint
  • conoid ligament intact
  • trapezoid ligament intact
Type IV

Salter-Harris type I physeal fracture considered stable fracture requiring nonoperative treatment

  • medial portion clavicle becomes displaced in the superior direction as the periosteal sleeve becomes avulsed from the inferior cortex
  • conoid ligament intact
  • trapezoid ligament intact
Type V

Considered an unstable stable fracture requiring operative treatment

  • comminuted fracture with medial clavicle displacement
  • inferior clavicle fragment attached to the coracoclavicular ligament
  • conoid ligament intact
  • trapezoid ligament intact

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