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Distal Clavicle Physeal Fractures

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Topic updated on 08/17/15 11:04pm
Introduction
  • Rare injury accounting for only 5% of clavicle fractures in children
    • considered a childhood equivalent to adult AC separation
  • Pathoanatomy
    • periosteum usually remains intact with injury
    • clavicle displaces away from physis and periosteal sleeve, both of which remain attached to the AC and CC ligaments
Classification
  • None
Presentation
  • Symptoms
    • pain, dysfunction, ecchymosis in older children
  • Physical exam
    • pseudo-paralysis of the affected ipsilateral extremity may be present in newborns 
      • reflexes remain intact following isolated clavicle fractures, which can help differentiate from brachial plexus injuries
Imaging
  • Radiographs
    • obtain AP and serendipity view to help define injury 
Treatment
  • Nonoperative 
    • sling management 
      • indicated in most cases, especially if periosteum is intact 
        • a new clavicle will form within the intact periosteal sleeve, and the displaced clavicle will typically reabsorb with time and growth
  • Operative
    • surgical reduction
      • indications (rarely indicated)
        • open fractures
        • severly displaced fractures in older patients with near closed physis

 

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Qbank (2 Questions)

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(OBQ10.94) A 6-year-old patient sustains an injury to his shoulder after falling from his bicycle. A radiograph is shown in Figure A. What is the preferred treatment in this patient? Topic Review Topic
FIGURES: A          

1. Closed reduction and pinning of the fracture
2. Open reduction and plating
3. Sling immobilization
4. Coracoclavicular ligament reconstruction
5. Open reduction and suture fixation

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