Review Question - QID 6955

This patient has sustained a physeal distal clavicle fracture. The next best step would be sling immobilization.

The radiograph reveals a distal clavicle physeal fracture. In children, a periosteal sleeve will remain attached to the intact coracoclavicular ligament along the inferior clavicle, and as such, remodeling can be expected. Further investigations are not required and nonsurgical management with a sling is preferred. Surgical treatment is not necessary in these children.

Bishop et al. reviewed pediatric shoulder trauma. They state that lateral clavicular physeal injuries are rare and almost exclusively treated non-operatively. However, they stress the importance of history and physical examination of shoulder as the concern of posterior sternoclavicular dislocations should be always be considered with any clavicle injury.

Figure A shows a minimally displaced distal physeal fracture.

Incorrect Answers:
Answer 1: Stress radiographs would be painful and unnecessary immediately after injury. With a minimally displaced fracture, this would not provide any clinical benefit or change the initial management plan in this child.
Answer 2,3: Surgical treatment is not required in children, even elite athletes.
Answer 5: Associated injuries are rare in children. A shoulder MRI would unnecessary.