Clavicle and Shoulder Injuries in Children

Clavicle FracturesClavicle Fractures

Clavicle fractures may occur through bone or through proximal or distal growth plates.

Diaphyseal fractures are common in the midclavicle. Unless open or with neurovascular compromise, manage closed. Less is best. Place the affected arm in a sling until the pain has subsided. The common figure-eight strapping is uncomfortable and unnecessary. Shortening and malunion are rarely problems.

Physeal fractures are sometimes difficult to differentiate from dislocation of the sternoclavicular or acromioclavicular joints. Physeal fractures usually occur in younger children and show tenderness over the physis rather than the joint. Physeal fractures are less serious, requiring only sling mobilization and no reduction. Remodeling and recovery of normal function occur with time.

Sternoclavicular Dislocations

These injuries are rare but do occur in children. The dislocation may be anterior or posterior. To differentiate from physeal fractures and to plan management, order a CT scan. Reduce by shoulder retraction or by traction on the medial clavicle with a towel-clip.

A-C Separation

Separations occur after the age of 13 years. Sometimes the separation is minimal, with slight swelling and tenderness over the joint. Manage separations as done for adults. The challenge is to differentiate A-C separation from physeal fracture. Order comparative spot radiographs of the the A-C joint using a soft tissue technique.

Scapular Fractures

These fractures are rare in children. Manage closed except for those of the glenoid fossa that have significant displacement.

Shoulder Dislocations

Shoulder dislocations are rare in children, and recurrence occurs in the vast majority. Reduce dislocations and immobilize in a sling until comfortable. Inform the family that recurrent dislocation is probable and that operative correction is likely. Posterior dislocation is sometimes associated with brachial plexus palsy in infancy and joint laxity in adolescence.

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