Clavicle fracture (peds)

Background

• Newborn
  • Usually result from birth injury
• Fracture in <2yo should raise possibility of abuse

Diagnosis

• Newborn
  • Upper extremity palsy (brachial plexus injury)
  • "Pseudoparalysis" 2/2 pain
  • Callous at clavicle during first 2-3wk of life
• Middle Third Fx
  • Most common
• Medial clavicle Fx
  • Rare
  • If displaced anterior: tenderness and palpable protrusion of distal end
  • If displaced posterior: compression of trachea/esophagus possible
• Distal clavicle Fx
  • Rare
  • Due to direct trauma

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

Diagnosis

• CXR

Treatment

• Neonatal
  • No treatment necessary
• Middle Third
  • Arm sling x 3-4wk
    • Adequate even for displaced and overlapping fx
• 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 PMD
• Medial
  • Ortho consult
• Distal
  • Depends on degree of displacement (routine follow up vs consult)