• Suspect in any young individual (< 25 yrs) with a medial clavicle or sternoclavicular injury
  • Usually Salter-Harris Type I or II
  • Delay in diagnosis 
  • Medial clavicle ossification center
    • appears during later teenage years
    • last physis to close in body (20-25yrs)
      • sternoclavicular dislocations in teenagers/young adults are usually physeal fracture-dislocations
  • Radiographs
    • difficult to visualize on AP, and radiographs usually unreliable to assess for fracture and degree of displacement
    • 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
  • Axial CT scan
    • is study of choice
    • can differentiate from sternoclavicular dislocations
    • can visualize mediastinal structures and injuries
  • Nonoperative
    • observation
      • indications 
        • controversial 
        • most asymptomatic injuries
          • will remodel and do not require intervention
        • anterior displaced physeal fracture
          • have good functional results treated nonoperatively
  • Operative
    • closed reduction in operating room under anesthesia
      • indications
        • controversial
        • acute posterior displaced physeal fx with
          • hoarsness
          • blunt or direct trauma to subclavian vessels
          • thoracic outlet syndrome
          • pneumothorax
      • contraindications
        • late presenting posterior dislocations
          • do not attempt closed reduction because medial clavicle may be adherent to vascular structures in mediastinum
      • failure to reduce
        • more difficult to reduce > 48 hours due to progressive callus formation in dislocated state
    • open reduction
      • indications
        • late presenting symptomatic posterior dislocations
        • unreducible and symptomatic
        • unstable after closed reduction
      • postreduction management
        • obtain CT to confirm stable
      • immobilization
        • figure of 8 harness or sling and swathe x 4 weeks (anterior displaced)
  • Closed reduction in operating room under anesthesia
    • approach
      • thoracic surgeon available
    • reduction  
      • traction and abduction of arm, while applying direct pressure
      • posterior displaced fractures usually require sterile towel clip for manipulation
      • if irreducible by closed means, consider open approach
  • Open Reduction
    • approach
      • horizontal incision over media clavicle
    • reduction
      • towel clip to reduce
    • fixation
      • wire/suture from medial clavicle to sternum/medial epiphysis
  • Persistent instability
    • increased risk with delay of reduction
  • Vacular Injury
    • do not attempt closed reduction in late presenting posterior dislocations because medial clavicle may be adherent to vascular structures in mediastinum

Please rate topic.

Average 2.9 of 28 Ratings

Topic COMMENTS (15)
Private Note