Orthopedics

Clavicle Fractures

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
  • 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
  • Since significant growth remains for young children, clavicle fractures rarely require surgery. 
  • Most clavicle fractures heal very well with minimal treatment. 
  • A sling or a shoulder strap can be used for comfort and to keep the ends of the bone from moving. 
  • Analgesics can be used for pain
  • Ice initially to decrease swelling
  • 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. 

 

References

  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”