Clavicle fracture (peds)

This page is for pediatric patients; see clavicle fracture for adult patients

Background

  • Newborn
    • Usually result from birth injury (0.5% normal deliveries; 1.6% breech deliveries)
  • Fracture in <2 year-old should raise possibility of abuse

Clinical Features

Newborn

  • Upper extremity palsy (brachial plexus injury)
  • "Pseudoparalysis" secondary to pain
  • Callous at clavicle during first 2-3wk of life

Non-Newborn Presentation

  • Swelling, deformity, and tenderness overlying the clavicle
  • Affected arm may be supported by the contralateral arm

Associated Injuries

  • Type I (middle)
    • Subclavian artery/vein injury
    • Nerve root and/or brachial plexus injury
  • Type II (lateral)
    • Coracoclavicular ligament injury
    • AC joint dislocation/subluxation
  • Type III (medial)
    • Intrathoracic injury
    • Rib fracutre
    • Sternal fracture

Differential Diagnosis

Thoracic Trauma

Evaluation

Workup

  • Assess distal pulse, motor, and sensation
  • X-ray
    • May be seen on chest x-ray, shoulder x-ray, or dedicated clavicle films (preferred)
  • If high suspicion and no fracture on plain films, consider CT

Allman Classification

  • Type I: Middle third
  • Type II: Lateral third
  • Type III: Medial third

Management

Newborn

  • No treatment necessary

Non-Newborn

  • Pain management
  • Place the affected extremity in a sling or shoulder immobilizer
  • Orthopedic surgery consultation in the ED for:
    • Displaced fracture with skin tenting
    • Open fracture
    • Neurovascular compromise

Disposition

Newborn

  • Discharge home

Non-Newborn

  • Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)

Speciality Care

  • For <12 years of age, almost all fractures are treated nonoperatively (due to high remodeling potential)

See Also

This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.