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Clavicular Fractures in Children

- Clavicle Frx in Infants:
    - 95% of birth frxs involve the clavicle and are associated w/ breech deliveries;
    - diff dx:
           - congential pseudoarthrosis of clavicle:
           - brachial plexus injury
                 - pseudo-paralysis which follows clavicular frxs may be distinguished from brachial plexus injury, because reflexes remain intact following isolated clavicle fractures;
           - proximal humeral epiphyseal separation;
    - associated injuries:
           - brachial plexus injury
           - pneumothorax
           - vascular injuries;
    - clavicular birth fractures heal rapidly.

- Clavicle Frx in Children:
    - 80% of fractures occur in midshaft;
    - distal clavicular physeal separation:
           - childhood equivolent to adult AC separation;
           - clavicle is stripped away from physis and periosteal sleeve, both of which remain attached to the AC and CC ligaments;
           - a new clavicle will remodel from the periosteal sleeve whereas the displaced clavicle will be reabsorbed w/ time;
    - in young children most of bony prominence will be incorporated w/ growth;

- Treatment:
    - older children can be managed w/ sling or figure-eight dressing;
    - adolescents may be left w/ small bony prominence;
    - surgical intervention is rarely indicated

The apical oblique view of the clavicle: its usefulness in neonatal and childhood trauma.

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