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Steven Frick, MD
Most in middle
5% distal
<5% medial
Beware nutrient
foramen- not a fx
Clavicle Fractures
Greenstick common
Typical Healing
Clavicle Birth Fxs
Large baby
Pseudoparalysis
Simple immobilization
If no BP palsy active
movement should return
early
Congenital Pseudarthrosis
of the Clavicle
Right side
Except with
dextrocardia
If symptomatic in older
child Excise,
tricortical graft, fixation
Clavicular Nonunion
Distal Clavicle Fx / AC Injury
11 yo female
Ped vs car
Initial XR
from front ------------from behind
Distal clavicle Coracoid
posterior
Acromion
Suture Fixation around Coracoid
POSTOP
PREOP
Final X-ray- Full Motion
Medial Clavicular Injuries
Medial clavicular
physis last to close
22-24 yo
Clavicle shaft usually
anterior
May displace
posteriorly
Serendipity view or
CT if suspect
CT Scan Posteriorly Displaced
Medial Clavicle Injury
Scapula Fractures
May be a sign of
significant trauma
Usually nonoperative
treatment
Growth centers may
be confused with
fracture
Axillary view often
helpful
Coracoid base fracture
Scapula Fractures - Classification
Can have fracture
through common
growth center of
coracoid and glenoid
Scapula Fractures - Classification
Body
Neck
Glenoid
Acromion
Coracoid
Intraarticular or
extrarticular
Glenohumeral Dislocations
Rare in children < 12 years old
High risk of recurrent instability when
initial dislocation occurs in childhood or
adolescence
Anterior, Posterior or Inferior direction
Traumatic or Atraumatic etiology
Glenoid Dysplasia
May predispose to
instability
May be primary or
secondary (after
brachial plexus palsy)
Traumatic Shoulder Dislocation
Gentle reduction
Immobilization for
approx 3 weeks
Shoulder rehabilitation
Surgical stabilization
/reconstruction
reserved for recurrent
instability
Atraumatic Instability
Often multiple joint
ligamentous laxity
Multidirectional
instability usually
present
May be voluntary
(discourage)
Rotator cuff
strengthening
Proximal Humerus Fxs
Birth injuries
0-5 yo Salter I
5-11 yo metaphyseal
11 to maturity
Salter II
Others rare (III, IV)
Birth Fractures of the
Proximal Humerus
Often Salter I type
Great remodeling
potential
Simple immobilization
Proximal Humerus
Acceptable Alignment
Great remodeling potential 80% of
humeral length contributed by proximal
physis
Shoulder ROM compensatory
Age dependent? some studies state that
even older adolescents have acceptable
functional outcomes after nonoperative
treatment of prox humerus fxs
Neer Horowitz Classification-
Proximal Humeral Physeal Fractures
Grade I- < 5 mm
Grade II - < 1/3 shaft
width
Grade III - <= 2/3
shaft width
Grade IV - > 2/3 shaft
width
Metaphyseal Fxs
Remodeling over 6 Months
Pinning Proximal Humerus
Usually dont need to
Most recent studies quote high complication
rates (pin migration, infection)
If used leave pins long and bend outside
skin, consider threaded tip pins
Even in older adolescents remodeling
occurs
Few functional deficits
Percutaneous Pinning-
this technique may lead to pin migration
Pinning