Pediatric Clavicle

Posted on: January 9, 2020, by :

Introduction:  

  • Medial: Rare injury to medial physis, considered childhood equivalent to adult sternoclavicular separation.
    • Anterior Displacement – patients head may be tilted towards affected side
    • Posterior Displacement – innominate artery and vein, internal jugular vein, phrenic and vagus nerves, trachea, and esophagus may be injured
  • Distal: Rare injury to distal physis, considered childhood equivalent to adult acromioclaviclular separation.
  • Shaft: common, mostly traumatic but occasionally from birthing deliveries.
    • associated injuries are rare but include neurovascular or brachial plexus injuries


Complications:

  • Exceedingly rare:
    • Persistent instability/nonunion (1-5%)
    • Laceration of subclavian artery or vein


Alternative Diagnosis:

  • Acromioclavicular (AC) Separation
    • traumatic injury to the AC joint with disruption of the acromioclavicular ligaments and/or coracoclavicular ligaments. (NOT A FRACTURE)
    • Consider obtaining bilateral views and compare displacement of contralateral shoulder

Treatment:

  • Nonoperative: brief sling immobilization, rest, ice, physical therapy with early ROM
  • Operative: only in severe tears with skin tenting or severe shoulder droop that does not improve with shrugs

 Other Helpful Resources

Haroon Shaukat MD

Pediatric Emergency Medicine Attending at Children's National Health System
I was born and raised in Silver Spring, Maryland, but with very little knowledge of all things DC. “Crabs and football, that’s what Maryland does”, unfortunately I could only partake in one of those. I grew up with a crab allergy so blue crabs are a make believe creature to me, much like the lochness monster. I decided to take the leap of faith and attend medical school abroad but family and home could not keep me away for too long. Residency took me to New Jersey where I began to cultivate my love for medical education and low tolerance for poor pain control. Did I mention I also learned that I outgrew my crab allergy in NJ! Alas, to the DMV I return! Hopefully to contribute to medical education and quality improvement while feasting on a Maryland blue crab or two.
Haroon Shaukat MD

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