Clavicle fracture (peds)

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