Clavicle fracture (peds): Difference between revisions

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==Background==
== Background ==
*Fx in <2yo should raise possibility of abuse
 
*Newborn
*Fx in &lt;2yo should raise possibility of abuse  
*Newborn  
**Usually result from birth injury
**Usually result from birth injury


==Diagnosis==
== Diagnosis ==
*Newborn
 
**Upper extremity palsy (brachial plexus injury)
*Newborn  
**"Pseudoparalysis" 2/2 pain
**Upper extremity palsy (brachial plexus injury)  
**Callous at clavicle during first 2-3wk of life
**"Pseudoparalysis" 2/2 pain  
*Middle Third Fx
**Callous at clavicle during first 2-3wk of life  
**Most common
*Middle Third Fx  
*Medial clavicle Fx
**Most common  
**Rare
*Medial clavicle Fx  
**If displaced anterior: tenderness and palpable protrusion of distal end
**Rare  
**If displaced posterior: compression of trachea/esophagus possible
**If displaced anterior: tenderness and palpable protrusion of distal end  
*Distal clavicle Fx
**If displaced posterior: compression of trachea/esophagus possible  
**Rare
*Distal clavicle Fx  
**Rare  
**Due to direct trauma
**Due to direct trauma


==Treatment==
== Treatment ==
*Neonatal
 
**No treatment necessary
*Neonatal  
*Middle Third
**No treatment necessary  
**Arm sling x 3-4wk
*Middle Third  
***Adequate even for displaced and overlapping fx
**Arm sling x 3-4wk  
*Medial
***Adequate even for displaced and overlapping fx  
**Anterior displacement: ORIF
*Medial  
**Posterior displacement: emergent reduction by ortho or trauma
**Anterior displacement: ORIF  
*Distal
**Posterior displacement: emergent reduction by ortho or trauma  
**Minimal displacement: sling
*Distal  
**Minimal displacement: sling  
**Significant displacement: ORIF
**Significant displacement: ORIF


==Disposition==
== Disposition ==
*Neonatal
 
**D/c home
*Neonatal  
*Middle third
**D/c home  
**Routine f/u w/ PMD
*Middle third  
*Medial
**Routine f/u w/ PMD  
**Ortho consult
*Medial  
*Distal
**Ortho consult  
*Distal  
**Depends on degree of displacement (routine f/u vs consult)
**Depends on degree of displacement (routine f/u vs consult)


==Source==
== Source ==
 
Tintinalli
Tintinalli


[[Category:WikEM]]
[[Category:Ortho]]
 
[[Category: Peds]]

Revision as of 22:09, 7 July 2011

Background

  • Fx in <2yo should raise possibility of abuse
  • Newborn
    • Usually result from birth injury

Diagnosis

  • Newborn
    • Upper extremity palsy (brachial plexus injury)
    • "Pseudoparalysis" 2/2 pain
    • Callous at clavicle during first 2-3wk of life
  • Middle Third Fx
    • 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

  • Neonatal
    • No treatment necessary
  • Middle Third
    • 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

  • Neonatal
    • D/c home
  • Middle third
    • Routine f/u w/ PMD
  • Medial
    • Ortho consult
  • Distal
    • Depends on degree of displacement (routine f/u vs consult)

Source

Tintinalli