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

• PEM Currents
• Orthobullets
• Pediatric EM Morsels