Clavicle Fracture

A 28-year-old male construction worker falls from a 6-foot scaffolding onto his left shoulder. He presents to the emergency department with severe left shoulder pain, inability to abduct the arm, and a visible deformity over the clavicle. On examination, there is marked swelling and crepitus over the lateral third of the clavicle. X-ray shows a displaced fracture of the lateral third of the clavicle with superior displacement of the distal fragment. What is the most appropriate initial management?

A 42-year-old woman falls directly onto her right shoulder while playing badminton. She presents with right shoulder pain, swelling, and a visible step deformity at the acromioclavicular joint. X-ray confirms a fracture of the distal clavicle with displacement of the distal fragment superiorly by 8 mm, and there is widening of the acromioclavicular joint space. The proximal fragment remains in normal position. What is the most likely diagnosis and the key factor determining surgical intervention?