Clavicle fracture (peds): Difference between revisions

Latest revision as of 10:25, 22 March 2026

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

Right clavicle fracture.

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

Airway/Pulmonary
Cardiac/Vascular
- Cardiac injury
- Traumatic aortic transection
Musculoskeletal
Other

Evaluation

Left clavicle fracture on xray.

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

Diagnosis

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)

References

Authors:

@@ Line 1: / Line 1: @@
-== Background ==
+''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 [[Child abuse|abuse]]
+==Clinical Features==
+[[File:Clavicle fracture 1.jpg|thumb|Right clavicle fracture.]]
+[[File:IMG 3824.jpg|thumb|Right clavicle fracture.]]
+===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
-*Fx in &lt;2yo should raise possibility of abuse
+==Differential Diagnosis==
-*Newborn
+{{Thoracic trauma DDX}}
-**Usually result from birth injury
-== Diagnosis ==
+==Evaluation==
+[[File:Clavicle Fracture Left.jpg|thumb|Left clavicle fracture on xray.]]
+===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
-*Newborn
+===Diagnosis===
-**Upper extremity palsy (brachial plexus injury)
+====Allman Classification====
-**"Pseudoparalysis" 2/2 pain
+*Type I: Middle third
-**Callous at clavicle during first 2-3wk of life
+*Type II: Lateral third
-*Middle Third Fx
+*Type III: Medial third
-**Most common
-*Medial clavicle Fx
-**Rare
-**If displaced anterior: tenderness and palpable protrusion of distal end
-**If displaced posterior: compression of trachea/esophagus possible
-*Distal clavicle Fx
-**Rare
-**Due to direct trauma
-== Treatment ==
+==Management==
+===Newborn===
+*No treatment necessary
-*Neonatal
+===Non-Newborn===
-**No treatment necessary
+*Pain management
-*Middle Third
+*Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer
-**Arm sling x 3-4wk
-***Adequate even for displaced and overlapping fx
-*Medial
-**Anterior displacement: ORIF
-**Posterior displacement: emergent reduction by ortho or trauma
-*Distal
-**Minimal displacement: sling
-**Significant displacement: ORIF
-== Disposition ==
+*Orthopedic surgery consultation in the ED for:
+**Displaced fracture with skin tenting
+**Open fracture
+**Neurovascular compromise
-*Neonatal
+==Disposition==
-**D/c home
+===Newborn===
-*Middle third
+*Discharge home
-**Routine f/u w/ PMD
-*Medial
-**Ortho consult
-*Distal
-**Depends on degree of displacement (routine f/u vs consult)
-== Source ==
+===Non-Newborn===
+*Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)
-Tintinalli
+==Speciality Care==
+*For <12 years of age, almost all fractures are treated nonoperatively (due to high remodeling potential)
-[[Category:Ortho]]
+==See Also==
+*[[Fractures and dislocations (peds)]]
-[[Category: Peds]]
+==References==
+[[Category:Orthopedics]]
+[[Category:Pediatrics]]