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Clavicle Fractures
The
Anatomy:
The clavicle is the
first bone in the in the human skeleton
to ossify.
It serves as the only
bony connection between the arm and
the trunk, articulating distally with the acromion
and proximally with the
sternum.
Neonatal
Period
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.
The presence of a
fracture may be recognized by an asymmetric Moro
reflex; pseudoparalysis
(refusal to move the extremity because of pain); or
crepitus may be felt over
the fracture site.
5% of clavicle
fractures are associated with brachial plexus
injuries.
Treatment
o Reassurance and
informing the parents that a bump will be felt along
the clavicle.
Toddlers
and Older Children
Most fractures are
secondary to falls with the arm outstretched or
falling on the tip of the
shoulder
Rarely is there a
complete fracture and there may be up to a 2 cm.
overlap.
The clavicle may also
have a greenstick fracture that is overlooked by a
radiograph. Comparison views
may be necessary to diagnose the fracture.
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.
A radiograph may not
be necessary if the mechanism of injury and physical
examination are consistent
with a fractured clavicle.
Treatment
o Since
significant growth remains for young children,
clavicle fractures rarely require surgery.
o Most
clavicle fractures heal very well with minimal
treatment.
o A
sling or a shoulder strap can be used for comfort
and to keep the ends of the
bone from moving.
o Analgesics can be
used for pain
o Ice initially to
decrease swelling
o Inform parents that
the callous formation will cause the presence of a
bump that will eventually be
remodeled and unnoticeable.
Non-healing and
neurovascular compromise are very rare with
fractures of the clavicle.
Clavicle
fractures generally heal in 3-6 weeks. There
may be a residual bump left
at the fracture site after healing is
complete.
Reference
1.
Huurman, Walter. and Ginsburg, Glen.
Musculoskeletal Injury in
Children. Pediatrics
in Review. December 1997
2.
Brown, Llyod and Miller,
Lee. Orthopedics.
Board Review
Series Pediatrics. Baltimore:
Lippincott Williams and Wilkins, 2005. 506-507
3.
Uptodate.com “Clavicle Fractures”
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