Background: We compared five classification systems for clavicle fractures. The aim of the study was to evaluate the prognostic value of each system.

Methods: Over a twelve month period we reviewed all new radiographs of the shoulder region and identified 227 clavicle fractures. Each radiograph was classified using five classification systems. We reviewed all subsequent x-rays and clinical records until patient discharge. We assessed each classification system’s prognostic value in predicting delayed/non-union.

Results: Our data shows that 80% of clavicle fractures occur in the middle third, 18% lateral third and 2% medial third. The overall prevalence of delayed/ non-union was 7.7%, with 3.9% requiring operative management and 3.8% developing asymptomatic non-union. The prevalence of non-union in the lateral third was 15%, all were asymptomatic. Craig’s classification had the greatest prognostic value for lateral third fractures, Robinson’s classification had the greatest prognostic value for middle third fractures.

Conclusions: Clavicle fractures are common injuries but non-union is an uncommon occurrence. Non-union is more common in the lateral third but we found these to be asymptomatic. Middle third fractures should be classified according to Robinson’s classification system and lateral third fractures according to Craig’s classification. We did not assess sufficient medial third fractures for the data to be significant.