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Medial Clavicle Physeal Fractures

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Topic updated on 03/27/16 6:50am
Introduction
  • Suspect in any young individual (< 25 yrs) with a medial clavicle or sternoclavicular injury
  • Usually Salter-Harris Type I or II
Imaging
  • Radiographs
    • difficult to visualize on AP
    • obtain serendipity views ( beam at 40 deg cephalic tilt)  
      • anterior dislocation/fxs - affected clavicle is above contralateral clavicle
      • posterior dislocation/fxs - affected clavicle is below contralateral clavicle
  • CT scan
    • is study of choice
    • can differentiate from sternoclavicular dislocations
    • can visualize mediastinal structures and injuries
Treatment
  • Nonoperative
    • observation
      • controversial 
        • most asymptomatic injuries will remodel and do not require intervention
    • closed reduction in operating room under anesthesia
      • indications
        • anterior displaced physeal fx
          • indications are not well established
        • posterior displaced physeal fx
          • hoarsness
          • blunt or direct trauma to subclavian vessels
          • thoracic outlet syndrome
          • pneumothorax
      • technique
        • approach
          • thoracic surgeon available
        • reduction
          • traction and abduction of arm, while applying direct pressure
          • posterior displaced fractures usually require sterile towel clip for manipulation
        • convert to open
          • if irreducible by closed means, consider open approach
      • postreduction
        • immobilization
          • figure of 8 harness for 3-4 weeks (anterior displaced)
  • Operative
    • open reduction
      • indications
        • rarely needed
        • unreducible and symptomatic in a patient > 23 yrs old
 

 

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