A 15-year-old girl slipped on the ice and landed directly on her lateral shoulder. She had immediate pain and swelling in the middle of her clavicle. Her parents took her to the emergency room and a radiograph confirmed a displaced mid-clavicular fracture with considerable overlap (Figure 83-1). She was placed in a sling and saw her primary care physician the next day. In consultation with a sports medicine expert, she, her family, and her primary care physician decided on conservative treatment. A follow-up radiograph 4 months later demonstrated good healing. The bump on her clavicle is still palpable; but this does not bother her (Figure 83-2).
Midshaft clavicular fracture in a 15-year-old girl who slipped on the ice. (Used with permission from Emily Scott, MD.)
Healing callous after a midshaft clavicular fracture in the 15-year-old girl in Figure 83-1. (Used with permission from Emily Scott, MD.)
Clavicular fractures are common and are most often caused by accidental trauma. The clavicle most commonly fractures in the midshaft (Figures 83-3), but can also fracture distally (Figure 83-4). Most fractures can be treated conservatively. Refer patients with significant displacement or distal fractures for surgical evaluation.
A. Midshaft clavicular fracture with mild angulation but not overriding in 8-year-old child. Midshaft clavicular fracture with overlap in an 11-year-old child. B. Usually the proximal fragment is displaced superiorly from the pull of the sternocleidomastoid muscle. (Used with permission from Emily Scott, MD.)
Right distal clavicular fracture in an 8-year-old boy after he fell off the top bunk. (Used with permission from Emily Scott, MD.)
Accounts for 10 to 15 percent of fractures in children; 90 percent are midshaft fractures.1
Etiology and Pathophysiology
Ninety percent of clavicle injuries are caused by accidental trauma from fall against the shoulder as result of a direct blow to the clavicle or can be fall on an outstretched hand.2 However, stress fractures in gymnasts and divers have been reported.
Neonatal clavicular injuries are usually from birth trauma, commonly breech presentations.
In children under 2 years of age, a fall from the bed/crib is most common mechanism.3
Sports injuries are common in the adolescent population.
Physical assaults and child abuse can cause clavicular fractures and need to be considered (Figure 83-5).
Pathologic fractures (uncommon) can result from lytic lesions, bony cancers or metastases, or ...