Clavicle fracture (peds)

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

Middle Third fracture

Most common

Medial clavicle fracture

Rare
If displaced anterior: tenderness and palpable protrusion of distal end
If displaced posterior: compression of trachea/esophagus possible

Distal clavicle fracture

Rare
Due to direct trauma

Differential Diagnosis

Thoracic Trauma

Airway/Pulmonary
Cardiac/Vascular
- Cardiac injury
  - Blunt cardiac injury
    - Cardiac contusion
    - Commotio cordis
  - Penetrating cardiac injury
  - Cardiac tamponade
- Traumatic aortic transection
Musculoskeletal
Other

Evaluation

CXR

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)

See Also

Fractures and dislocations (peds)

References

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