summary Distal Clavicle Physeal Fractures are rare injuries to the distal physis of the clavicle in skeletally immature patients. Diagnosis can be made with plain radiographs. Treatment is generally nonoperative management with a sling. Surgical management is indicated for open fractures or those associated with impending soft tissue compromise. Epidemiology Incidence rare injury login to view 1 more bullet Etiology Pathophysiology mechanism login to view 3 more bullets pathoanatomy login to view 4 more bullets Anatomy Clavicle osteology S-shaped bone medial clavicle is connected to the axial skeleton via the sternoclavicular joint lateral clavicle is connected to the scapula via the acromioclavicular joint Clavicle ossification overview login to view 2 more bullets central clavicle login to view 1 more bullet distal clavicle login to view 2 more bullets medial clavicle login to view 4 more bullets Coracoclavicular (CC) ligaments provide vertical stability composed of login to view 4 more bullets Acromioclavicular (AC) ligaments provide horizontal stability Classification Rockwood Classification Type Definition Image Type I Sprain of the AC ligaments, periosteal tube intact Type II Partial disruption of the periosteal tube Type III Large split in the periosteal tube with superior displacement Type IV Large split in the periosteal tube with posterior displacement of the lateral clavicle through trapezius Type V Complete disruption of the periosteal tube with displacement through the deltoid and trapezius Type VI Inferior dislocation of the distal clavicle below the coracoid Presentation Symptoms pain Physical exam common login to view 3 more bullets rare login to view 4 more bullets Imaging Radiographs initial views login to view 4 more bullets later findings login to view 1 more bullet Treatment Nonoperative sling management login to view 4 more bullets Operative surgical reduction login to view 11 more bullets Complications Laceration of subclavian artery or vein rare diagnosed by rapidly expanding hematoma thick periosteum usually protective treatment = vascular repair Nonunion rare seen after attempts at open reduction treatment login to view 1 more bullet Pin migration pin fixation around the clavicle should be avoided