Clavicle fracture (peds): Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Clavicle fracture 1.jpg|thumb|Right clavicle fracture.]] | |||
[[File:IMG 3824.jpg|thumb|Right clavicle fracture.]] | |||
===Newborn=== | ===Newborn=== | ||
*Upper extremity palsy ([[brachial plexus injury]]) | *Upper extremity palsy ([[brachial plexus injury]]) | ||
| Line 11: | Line 13: | ||
*Callous at clavicle during first 2-3wk of life | *Callous at clavicle during first 2-3wk of life | ||
=== | ===Non-Newborn Presentation=== | ||
* | *Swelling, deformity, and tenderness overlying the clavicle | ||
*Affected arm may be supported by the contralateral arm | |||
=== | ===Associated Injuries=== | ||
* | *Type I (middle) | ||
* | **Subclavian artery/vein injury | ||
* | **Nerve root and/or brachial plexus injury | ||
*Type II (lateral) | |||
**Coracoclavicular ligament injury | |||
* | **AC joint dislocation/subluxation | ||
* | *Type III (medial) | ||
**Intrathoracic injury | |||
**Rib fracutre | |||
**Sternal fracture | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 17:13, 13 June 2020
This page is for pediatric patients; see clavicle fracture for adult patients
Background
- Newborn
- Usually result from birth injury
- Fracture in <2 year-old should raise possibility of abuse
Clinical Features
Newborn
- Upper extremity palsy (brachial plexus injury)
- "Pseudoparalysis" secondary to pain
- Callous at clavicle during first 2-3wk of life
Non-Newborn Presentation
- Swelling, deformity, and tenderness overlying the clavicle
- Affected arm may be supported by the contralateral arm
Associated Injuries
- Type I (middle)
- Subclavian artery/vein injury
- Nerve root and/or brachial plexus injury
- Type II (lateral)
- Coracoclavicular ligament injury
- AC joint dislocation/subluxation
- Type III (medial)
- Intrathoracic injury
- Rib fracutre
- Sternal fracture
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Workup
- Assess distal pulse, motor, and sensation
- X-ray
- May be seen on chest x-ray, shoulder x-ray, or dedicated clavicle films (preferred)
- If high suspicion and no fracture on plain films, consider CT
Diagnosis
- Fractured segment:
- Type I: Middle third
- Type II: Lateral third
- Type III: Medial third
Management
Neonatal
- No treatment necessary
Middle Third
- Arm sling x 3-4wk
- Adequate even for displaced and overlapping fracture
Medial
- Anterior displacement: ORIF
- Posterior displacement: emergent reduction by ortho or trauma
Distal
- Minimal displacement: sling
- Significant displacement: ORIF
Disposition
Neonatal
- Discharge home
Middle third
- Routine follow up with primary care provider
Medial
- Ortho consult
Distal
- Depends on degree of displacement (routine follow up vs consult)