This five-year old boy was sitting in the bleachers watching his mom play tennis, when he fell off the third level onto the ground. Hospital radiographs revealed a complete oblique fracture through the distal third of the clavicle, with inferior displacement of the distal fragment (Figures A & B).
The boy was placed in a clavicular (figure of eight) sling for six to seven weeks.
The fracture healed completely with a small residual cosmetic bump.
Some points to remember about clavicular fractures:
• over 60 per cent occur in children under 10
• most frequently fractured bone in children (usually at junction of middle and distal third)
• sternoclavicular or acromioclavicular dislocation is very rare in children
• must be clinically cognizant of the underlying subclavian vessels and brachial plexus
• tends to be incomplete (greenstick) in infants and toddlers, complete in older children
• when the fracture is complete, muscle forces maintain the deformity; the glenohumeral joint pulls the lateral fragment downward and inward (due to pectoralis muscle pull anteriorly and part of the trapezius posteriorly)
• in contrast, the medial portion is pulled upward and backward by sternocleidomastoid
• in general, children under six do not require formal reduction; massive callus formation usually remodels and disappears within six to nine months•
Ogden, JA. Skeletal Injury in the Child. Philadelphia: Lea & Febiger, 1982.
The X-Files: October 2006
This five-year old boy was sitting in the bleachers watching his mom play tennis, when he fell off the third level onto the ground.
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