Clavicle fracture (peds)

This page is for pediatric patients; see clavicle fracture for adult patients

Background

• Newborn
  • Usually result from birth injury (0.5% normal deliveries; 1.6% breech deliveries)
• Fracture in <2 year-old should raise possibility of abuse

Clinical Features

Right clavicle fracture.

Right clavicle fracture.

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
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Evaluation

Left clavicle fracture on xray.

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

Allman Classification

• Type I: Middle third
• Type II: Lateral third
• Type III: Medial third

Management

Newborn

• No treatment necessary

Non-Newborn

• Pain management
• Place the affected extremity in a sling or shoulder immobilizer

• Orthopedic surgery consultation in the ED for:
  • Displaced fracture with skin tenting
  • Open fracture
  • Neurovascular compromise

Disposition

Newborn

• Discharge home

Non-Newborn

• Type I (middle)
  • Routine follow up with primary care provider
    • Adequate even for displaced and overlapping fracture
• Type II (lateral)
• Depends on degree of displacement (routine follow up vs consult)
  • Significant displacement: ORIF
• Type III (medial)
• Ortho consult

See Also

• Fractures and dislocations (peds)