Fractures of the clavicle are common in pediatrics.

1. Clavicle fractures occur in 3% of live births. Most are unrecognized and may be diagnosed weeks later during healing when the presence of a hard lump is felt along the clavicular shaft.
   
2. The presence of a fracture may be recognized by someone present at the delivery hearing a pop, the feeling of crepitance at the fracture site, and an unequal Moro reflex.
   
3. 5% of clavicle fractures are associated with brachial plexus injuries.
   
4. Treatment is reassurance and informing the parents that a bump will be felt along the clavicle .

1. Most fractures are secondary to falls with the arm outstretched or falling on the tip of the shoulder
   
2. Rarely is there a complete fracture and there may be up to a 2 cm. overlap.
   
3. The clavicle may also have a greenstick fracture that is overlooked by a radiograph. Comparison views may be necessary to diagnose the fracture.
   
4. Clinically, the child will present with pain, swelling at the fracture site, the arm dangling, and the shoulder depressed. The medial aspect of the fracture is often elevated by the sternocleidomastoid muscle.
   
5. A radiograph may not be necessary if the mechanism of injury and physical examination are consistent with a fractured clavicle.
   
6. Treatment
   
   1. Immobilization with a figure eight bandage or sling. This will keep the child from using the extremity and prevent other children from running into the child.
      
   2. Immobile toddlers for 10 days, young children for 2-3 weeks, and older children 3-4 weeks.
      
   3. Analgesics
      
   4. Ice initially to decrease swelling
      
   5. Inform parents that the callous formation will cause the presence of a lump that will eventually be remodeled and unnoticeable.
      
7. Non-healing and neurovascular compromise are very rare with fractures of the clavicle.

1. Huurman, Walter. and Ginsburg, Glen. Musculoskeletal Injury in Children. Pediatrics in Review. December 1997