This document summarizes a study of fractures of the distal clavicle in pediatric patients. It describes 10 patients ages 5-11 who presented with these fractures. Nine were treated conservatively with plaster casting, while one patient with a more severe fracture was treated surgically with K-wire fixation. All fractures healed without complications. The document concludes that fractures of the distal clavicle in children are rare but can generally be treated conservatively with good results and that surgery is only occasionally needed for more severe fractures.
2. Introduction
• Fracture of the clavicle, especially those of the middle third, are
very common among patients with an immature skeleton
• Rare injuries in the distal region
• 10-20 % of all fractures of the clavicle
• Caused by direct trauma on the shoulder, 85% result from injuries
during sport or recreational activites
• Few studies in the literature with long follow-ups on cases of
these injuries
3. Introduction
• Center of ossification of the distal epiphysis of the clavicle appears
after the age of 18 years
• Medial fragment of the clavicle may become avulsed from the
periosteum
• Significant shoulder deformity may develop in children
• Controversy continues to surround treatments for displaced fractures
• Conservative treatment remains more commonly indicated at this
age
• under exceptional conditions, surgical stabilization may be necessary
4. Material and Method
• The medical records and radiographs of 10 patients with fractureing of
the distal region of the clavicle between January 2000 and December
2010 were analyzed
• Ages ranged from 5 to 11 years
• Mean age 7,3
•
5. Material and Method
Inclusion Criteria
• 7 Male, Female
• 3 cases of falling from bicylce
• 3 cases of simple falls
• 2 cases of falls from height
• 2 cases of falls on stairs
Exclusion Criteria
• Patients with obstetric
trauma
• Previous fracture of the
clavicle
• Congenital or infectious
disease of the shoulder
• Mistreatment
6. Material and Method
• Patients who were treated
conservatively used a plaster cast
covering the chest and arm for six
weeks
• 1 patient who was treated
surgically underwent ORIF K-wire
between acromion and clavicle,
which was sufficient to provide
stability, followed by use of a
plaster cast covering the chest
and arm for six weeks
• Fractures were classified by
nenopoulos et al
7. Result
• All patients were treated in our
hospital
• Conservative treatment was used in
nine patients
• Three in IIIB
• Three in IIB
• Two in IIA
• One in IV
8. Result
• The only patient who was treated surgically
was an 11-year-old female
• Fracture in group IV
• Treated with a Kirschner wire
10. Discussion
• Literature of the clavicle in pediatric patients is of limites extent
with few cases or case reports
• Distal clavicle affected with large displacement occur,
conservative treatment is satisfactory in most cases.
• Figure of eight immobilization
• Use of arm sling
• Lateral growth plate only closes after the age of 19 years
• Surgical treatment is only indicated in rare cases among children
11. DIscussion
• Surgical indication for distal clavicle fracture :
• Exposed / open fractures
• Impact on soft tissues
• Risk of skin perforation
• Severe shortening of the scapular belt wih or without intermediate displacement of the
fragments
• Displaced fracture with a potential risk of injury ti structures of the neuromuscular
bundle or mediastinum
Group I – greenstick fractures
Group IIa – transverse fractures without displacement
Group IIb – displaced transverse fractures
Group IIIa – oblique fractures without displacement
Group IIIb – displaced oblique fractures
Group IV –comminuted fractures
Group V –acromioclavicular dislocation
