https://upload.orthobullets.com/topic/4122/images/distal clavicle physeal xray.jpg
https://upload.orthobullets.com/topic/4122/images/peds clavicle fx periosteal sleeve.jpg
https://upload.orthobullets.com/topic/4122/images/healing distal clavicle fracture pediatric.jpg
https://upload.orthobullets.com/topic/4122/images/healing distal clavicle fracture pediatric2.jpg
  • Epidemiology
    • rare injury accounting for only 5%-10% of clavicle fractures in children
  • Pathophysiology
    • mechanism
      • Fall onto an outstretched extremity or the side of the shoulder.
      • Direct blow
    • pathoanatomy
      • considered a childhood equivalent to adult AC separation
      • 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
  • Clavicle osteology
    • is an S-shaped bone whose medial end is connected to the axial skeleton via the sternoclavicular joint and lateral end is connected to the scapula via the acromioclavicular joint
  • Clavicle ossification
    • overview
      • first bone to ossify in the fifth week in utero
    • central clavicle
      • initial growth (<5 years) occurs from the ossification center in the central portion of the clavicle (Intramembrenous Ossification)
    • distal clavicle
      • continued growth occurs at the medial and lateral epiphyseal plates
      • lateral epiphysis does not ossify until age 18 years
    • medial clavicle
      • approximately 80% of clavicular growth occurs at the medial physis
      • does not begin to ossify until 18 to 20 years
      • last physis to close in body (20-25yrs)
        • sternoclavicular dislocations in teenagers/young adults are usually physeal fracture-dislocations
Type I  • Minimally displaced with intact AC and CC ligaments.
Type IIA  • Clavicle displaced superiorly with fracture medial to CC ligament.
Type IIB  • Clavicle displaced superiorly with tear of Conoid ligament.  

  • Symptoms
    • pain
    • dysfunction
    • ecchymosis in older children
  • Physical exam
    • Tenderness and deformity at the distal clavicle
    • Skin tenting may be present
    • 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
  • Radiographs
    • recomended views
      • obtain AP and Zanca view to help define injury 
    • findings
      • Intact periosteal sleeve forms a "new" lateral clavicle inferior to the superiorly displaced medial fragment.
  • Nonoperative 
    • sling management 
      • indications
        • 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 and controversial)
        • open fractures
        • severly displaced fractures in older patients with near closed physis
        • some Type II fractures

Please rate topic.

Average 3.0 of 21 Ratings

Questions (4)
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase

(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? Review Topic

QID: 3182

Closed reduction and pinning of the fracture




Open reduction and plating




Sling immobilization




Coracoclavicular ligament reconstruction




Open reduction and suture fixation



Select Answer to see Preferred Response

Topic COMMENTS (7)
Private Note