Clavicle fracture (peds): Difference between revisions
 
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==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]]


==Evaluation==
==Clinical Features==
*Newborn  
[[File:Clavicle fracture 1.jpg|thumb|Right clavicle fracture.]]
**Upper extremity palsy (brachial plexus injury)  
[[File:IMG 3824.jpg|thumb|Right clavicle fracture.]]
**"Pseudoparalysis" secondary to pain  
===Newborn===
**Callous at clavicle during first 2-3wk of life  
*Upper extremity palsy ([[brachial plexus injury]])  
*Middle Third fracture
*"Pseudoparalysis" secondary to pain  
**Most common
*Callous at clavicle during first 2-3wk of life
*Medial clavicle fracture
 
**Rare
===Non-Newborn Presentation===
**If displaced anterior: tenderness and palpable protrusion of distal end
*Swelling, deformity, and tenderness overlying the clavicle
**If displaced posterior: compression of trachea/esophagus possible
*Affected arm may be supported by the contralateral arm
*Distal clavicle fracture
 
**Rare
===Associated Injuries===
**Due to direct trauma
*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==
==Differential Diagnosis==
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==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
 
**Arm [[sling]] x 3-4wk
===Non-Newborn===
***Adequate even for displaced and overlapping fracture
*Pain management
*Medial
*Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer
**Anterior displacement: ORIF
 
**Posterior displacement: emergent reduction by ortho or trauma
*Orthopedic surgery consultation in the ED for:
*Distal
**Displaced fracture with skin tenting
**Minimal displacement: [[sling]]
**Open fracture
**Significant displacement: ORIF
**Neurovascular compromise


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


==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

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