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Closed reduction and pinning of the fracture
2%
43/1918
Open reduction and plating
1%
17/1918
Sling immobilization
92%
1768/1918
Coracoclavicular ligament reconstruction
16/1918
Open reduction and suture fixation
3%
65/1918
Select Answer to see Preferred Response
The history and radiograph depict a patient that has sustained an oblique fracture of the distal clavicle with superior displacement of the lateral fragment. The preferred treatment is sling immobilization. Distal clavicle physeal fractures are fairly rare in the pediatric population. The robust periosteum remains intact while the clavicle displaces. The regenerative capacity is high with an intact periosteum. The coracoclavicular (CC) ligaments remain attached to the periosteum and new bone fills any remaining bony gaps within the periosteal sleeve. Most of these injuries can be managed conservatively. Surgical intervention is rarely indicated, even with significantly displaced injuries. Nenopoulos et al. retrospectively reviewed 75 pediatric patients treated for distal clavicular injuries. The majority of patients (63/75) were treated conservatively. They indicate that results from conservative measures yielded excellent outcomes. Surgical intervention could be considered in patients greater than 8 years, to optimize cosmetic results. Incorrect Answers Answers 1, 2, 4, 5: Operative intervention is rarely indicated for distal clavicular injuries in the pediatric population.
4.3
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