Clavicle fracture (peds): Difference between revisions
 
(13 intermediate revisions by 3 users not shown)
Line 2: Line 2:
==Background==
==Background==
*Newborn  
*Newborn  
**Usually result from birth injury
**Usually result from birth injury (0.5% normal deliveries; 1.6% breech deliveries)
*Fracture in <2 year-old should raise possibility of abuse
*Fracture in <2 year-old should raise possibility of [[Child abuse|abuse]]


==Clinical Features==
==Clinical Features==
[[File:Clavicle fracture 1.jpg|thumb|Right clavicle fracture.]]
[[File:IMG 3824.jpg|thumb|Right clavicle fracture.]]
===Newborn===
===Newborn===
*Upper extremity palsy (brachial plexus injury)  
*Upper extremity palsy ([[brachial plexus injury]])  
*"Pseudoparalysis" secondary to pain  
*"Pseudoparalysis" secondary to pain  
*Callous at clavicle during first 2-3wk of life  
*Callous at clavicle during first 2-3wk of life


===Middle Third fracture===
===Non-Newborn Presentation===
*Most common
*Swelling, deformity, and tenderness overlying the clavicle
*Affected arm may be supported by the contralateral arm


===Medial clavicle fracture===
===Associated Injuries===
*Rare
*Type I (middle)
*If displaced anterior: tenderness and palpable protrusion of distal end
**Subclavian artery/vein injury
*If displaced posterior: compression of trachea/esophagus possible
**Nerve root and/or brachial plexus injury
 
*Type II (lateral)
===Distal clavicle fracture===
**Coracoclavicular ligament injury
*Rare
**AC joint dislocation/subluxation
*Due to direct trauma
*Type III (medial)
**Intrathoracic injury
**Rib fracutre
**Sternal fracture


==Differential Diagnosis==
==Differential Diagnosis==
Line 27: Line 33:


==Evaluation==
==Evaluation==
*CXR
[[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
 
===Diagnosis===
====Allman Classification====
*Type I: Middle third
*Type II: Lateral third
*Type III: Medial third


==Management==
==Management==
===Neonatal===  
===Newborn===
*No treatment necessary
*No treatment necessary


===Middle Third===
===Non-Newborn===
*Arm [[sling]] x 3-4wk
*Pain management
**Adequate even for displaced and overlapping fracture
*Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer


===Medial===
*Orthopedic surgery consultation in the ED for:
*Anterior displacement: ORIF
**Displaced fracture with skin tenting
*Posterior displacement: emergent reduction by ortho or trauma
**Open fracture
**Neurovascular compromise


===Distal===  
==Disposition==
*Minimal displacement: [[sling]]
===Newborn===
*Significant displacement: ORIF
*Discharge home


==Disposition==
===Non-Newborn===
*Neonatal
*Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)
**Discharge home
 
*Middle third
==Speciality Care==
**Routine follow up with primary care provider
*For <12 years of age, almost all fractures are treated nonoperatively (due to high remodeling potential)
*Medial
**Ortho consult
*Distal
**Depends on degree of displacement (routine follow up vs consult)


==See Also==
==See Also==

Latest revision as of 17:38, 13 June 2020

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.
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

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)

See Also

References

Retrieved from "https://www.wikem.org/w/index.php?title=Clavicle_fracture_(peds)&oldid=258176"