Rockwood Children CH19

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CHAPTER 19 • Clavicle and Scapula Fractures and Acromioclavicular and Sternoclavicular Injuries

Postoperative Care Postoperatively, patients are placed in a sling 6 weeks. When suture-only fixation is pursued in the younger adolescent or pre- adolescent, a sling and swath is generally favored. When solid rigid plate fixation is achieved, immobilization is removed several times a day for pendulum exercises. Following union of the frac- ture, active shoulder range of motion and strengthening is initi- ated. Contact sports participation is usually avoided for 3 months.

additional stability (Fig. 19-10). Hook plates are uti- lized as a last resort in the setting of an older adolescent without adequate distal fragment bone to accommodate screws, as they require a second procedure for removal. However, all implant options are made available during all procedures, in case adequate fixation is unable to be obtained without them.

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Figure 19-10.  A and B: Preoperative AP and Scapula Y views of a displaced lateral clavicle fracture. C: Intraoperative photograph depicting the incision along Langer skin lines overlying the distal part of the clavicle and acromion. D: Intraoperative photograph showing fixation of the fracture utilizing interosseous suture. (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 D