Surgical management of a medial clavicle physeal fracture following blunt trauma

Abstract text (incl. references and figure legends)

Case history

Medial clavicle physeal fractures, also known pseudodislocation of the sternoclavicular joint, are rare injuries to the medial physis of the clavicle in children. Treatment is generally nonoperative management but rarely, surgical management might be indicated.

We present a case of a 6-year-old male who suffered a head and shoulder trauma following a box falling onto himself.

Clinical findings, Investigation/Results and Diagnosis

He presented to the emergency department with a epicranial haematoma and a right shoulder and chest oedema and tenderness. Radiographs and CTscans revealed no head or cervical spine injuries but showed a medial clavicle physeal fracture with significant cranial and slight anterior dislocation.

Therapy and Progressions

He was subsequently admitted to the operating room where he was submitted to an open reduction and fixation with transosseous sutures using a direct medial clavicle approach, achieving anatomic reduction.In the immediate post-operative period, he was immobilized with a velpeau-like sling which he maintained for 3 weeks.He evolved with anatomic bone healing of the fracture and no range of motion limitation at the 6-month follow-up.

Comments

Non-operative treatment is usually indicated in most asymptomatic injuries, anterior and posterior displacement (if no injury to mediastinal structures). Stable reduction is often difficult to maintain and an open reduction may be required.

Even though, in the present case, there was not a mandatory surgical indication per se, we found the huge cranial displacement and clinical skin tenting to be of too great significance for a non-operative management. The patient evolved with anatomic healing and great shoulder function with no pain. In the light of the aforementioned, we therefore believe this approach to have been a successful application of surgical treatment in this rare pattern of fracture.

References

DOI: 10.1155/2018/4986061 , 10.1016/j.ijscr.2021.105656

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