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

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Haroon Shaukat MD
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