Clavicle fracture (peds)

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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