Clavicle fracture (peds): Difference between revisions
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===Non-Newborn=== | ===Non-Newborn=== | ||
* | *Pain management | ||
* | *Place the affected extremity in a [[Sling and swathe splint|sling]] or shoulder immobilizer | ||
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*Orthopedic surgery consultation in the ED for: | |||
**Displaced fracture with skin tenting | |||
** | **Open fracture | ||
* | **Neurovascular compromise | ||
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==Disposition== | ==Disposition== | ||
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===Non-Newborn=== | ===Non-Newborn=== | ||
* | *Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above) | ||
==Speciality Care== | |||
*For <12 years of age, almost all fractures are treated nonoperatively (due to high remodeling potential) | |||
* | |||
==See Also== | ==See Also== | ||
Latest revision as of 17:38, 13 June 2020
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
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
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
- Almost all may be discharged with orthopedic surgery follow-up (if no indications for immediate surgical management; see above)
Speciality Care
- For <12 years of age, almost all fractures are treated nonoperatively (due to high remodeling potential)