Rockwood Children CH19

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

Intra-articular disk ligament

Figure 19-23.  A: Schematic demonstrating the technique of medial clavicular resection arthro- plasty. B: Intraoperative photograph of a patient with recurrent anterior sternoclavicular instability with resultant pain due to a deformed and irre- ducible clavicular head. C: Intraoperative photo- graph following medial clavicular head resection and intramedullary passage of the intra-articular disk ligament. (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.)

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high-energy mechanisms cause sternoclavicular injuries, asso- ciated damage to critical mediastinal structures can occur, and therefore, a thorough evaluation is necessary to avoid missing an associated life-threatening injury. The majority of anterior dislocations can be treated with immobilization alone, whereas acute posterior injuries are typically treated with operative intervention yielding excellent results.

SUMMARY, CONTROVERSIES, AND FUTURE DIRECTIONS RELATED TO STERNOCLAVICULAR FRACTURE–DISLOCATIONS

Although sternoclavicular joint injuries are relatively rare, they do occur, even in the pediatric and adolescent populations. As

Annotated References Reference

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Lee JT, Nasreddine AY, Black EM, et al. Posterior stenoclavicular joint injuries in skeletally immature patients. J Pediatr Orthop . 2014;34(4);369–375. Shannon SF, Hernandez NM, Sems SA, et al. High-energy pediatric scapula fractures and their associated injuries. J Pediatr Orthop . 2017. doi: 10.1097/BPO.0000000000000969. Tepolt F, Carry PM, Heyn PC, et al. Posterior sternoclavicular joint injuries in the adolescent population: a meta-analysis. Am J Sports Med . 2014;42(10):2517–2524.

Retrospective case series of 48 patients treated for a posterior sternoclavicular joint injury.

This is the largest series of pediatric scapula fractures that investigates the associated injuries, the morbidity, and the mortality.

Meta-analysis reviewing associated injuries and outcomes of posterior sternoclavicular joint injuries in the adolescent population.

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