Rockwood Children CH19

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SECTION TWO • Upper Extremity

A

B

Figure 19-8.  A: Intraoperative photograph depicting the mid-diaphyseal malunion. B: Intraoperative photograph showing the osteotomy has been performed in the plane of maximal deformity. C: Intraoperative photograph following reduction and plating of the malunion. (Reprinted with permission from Waters PM, Bae DS, eds. Pediatric Hand and Upper Limb Surgery: A Practical Guide. 1st ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.)

C

with the arm typically held in an adducted position. The force is transmitted from the acromion across the AC joint to the distal end of the clavicle.

Distal Clavicle Fractures

INJURIES ASSOCIATED WITH DISTAL CLAVICLE FRACTURES

INTRODUCTION TO DISTAL CLAVICLE FRACTURES

Common injuries associated with distal clavicle fractures include additional fractures about the shoulder girdle includ- ing proximal humerus and scapular fractures, thus constitut- ing a floating shoulder-type injury. In addition, rib fractures, lung injuries including contusions, and brachial plexus inju- ries may occur concomitantly. Finally, cervical spine injuries must be ruled out in collision or high-energy mechanisms of injury. Patients who sustain distal clavicle fractures present with pain about the involved shoulder especially with any attempt at movement of the arm. Paresthesias may be present if a concom- itant brachial plexus injury has occurred. Physical examination should begin by observing for obvious swelling, ecchymosis, and/or bony prominence or skin tenting, which may be present if there is a completely displaced fracture with superior displacement of the medial fragment and droop- ing of the unsupported shoulder girdle due to disruption of the strut function of the clavicle. The area posterior to the AC SIGNS AND SYMPTOMS OF DISTAL CLAVICLE FRACTURES

Distal clavicle fractures account for 10% to 30% of all clavi- cle fractures, thus making it the second most common site for a clavicle fracture, after midshaft clavicle fractures. 130 Minimal studies exist regarding the treatment and outcomes of these fractures for pediatric and adolescent patients. Therefore, the information presented here will mainly be extrapolated from the adult literature and our experience.

ASSESSMENT OF DISTAL CLAVICLE FRACTURES

MECHANISMS OF INJURY FOR DISTAL CLAVICLE FRACTURES

Akin to midshaft clavicle fractures, distal clavicle fractures are typically the result of a direct blow to the shoulder girdle or a fall onto the distal aspect of the clavicle. 130,140 Direct blows typi- cally occur in adolescents involved in collision-type sports such as football or lacrosse. When a fall is the mechanism of injury, direct contact from the ground is made against the acromion