| 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 |
- Based on relationship of fracture line to CC ligaments and AC joint
|
| Type I fractures |
Minimally displaced and occur lateral to the CC ligaments but spare the AC joint, stability is conferred by the residual soft-tissue attachments |
| Type II fractures |
Less stable than Type I and Type III fractures, proximal fragment is detached from CC ligaments, distal fragment is attached to scapula via the AC joint |
| Type III fractures |
CC ligamentous attachments are intact, but fracture extends into AC joint, typically stable |
| Type IV fractures |
Most common type in pediatric patients and are associated with displacement at the junction of the metaphysis and physis; the physis and epiphysis remain attached to the AC joint |
| Type V fractures |
Similar to Type II injuries, distal and proximal fragments are not in continuity with CC ligaments, however, free boney piece may remain connected |
|
| 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
|