Clavicle fracture (peds): Difference between revisions
| Line 62: | Line 62: | ||
==Disposition== | ==Disposition== | ||
=== | ===Newborn=== | ||
*Discharge home | *Discharge home | ||
=== | ===Non-Newborn=== | ||
*Routine follow up with primary care provider | *Type I (middle) | ||
**Routine follow up with primary care provider | |||
***Adequate even for displaced and overlapping fracture | |||
* | *Type II (lateral) | ||
*Depends on degree of displacement (routine follow up vs consult) | *Depends on degree of displacement (routine follow up vs consult) | ||
**Significant displacement: ORIF | |||
*Type III (medial) | |||
*Ortho consult | |||
==See Also== | ==See Also== | ||
Revision as of 17:20, 13 June 2020
This page is for pediatric patients; see clavicle fracture for adult patients
Background
- Newborn
- Usually result from birth injury
- 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
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
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
Diagnosis
- Fractured segment:
- Type I: Middle third
- Type II: Lateral third
- Type III: Medial third
Management
Newborn
- No treatment necessary
Non-Newborn
- Type I (middle)
- Arm sling x 3-4wk
- Adequate even for displaced and overlapping fracture
- Arm sling x 3-4wk
- Type II (lateral)
- Minimal displacement: sling
- Significant displacement: ORIF
- Type III (medial)
- Anterior displacement: ORIF
- Posterior displacement: emergent reduction
Disposition
Newborn
- Discharge home
Non-Newborn
- Type I (middle)
- Routine follow up with primary care provider
- Adequate even for displaced and overlapping fracture
- Routine follow up with primary care provider
- Type II (lateral)
- Depends on degree of displacement (routine follow up vs consult)
- Significant displacement: ORIF
- Type III (medial)
- Ortho consult