A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like) in Children: A Case Report and Literature Review Study

Abstract

Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients). Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed) of the fracture is the recommended treatment.

A rare case of acromioclavicular joint injury in a 16-year-old girl

“…Conservative treatment is primarily used for distal clavicle fractures in teenagers with an incomplete fusion of the epiphyseal cartilage, 5 , 7 although invasive therapy using Kirschner wire may be required depending on the degree of the distal clavicular translocation. 4 In our case, because the patient was 17 years old with skeletally immature and there was a history of repeated injuries, epiphyseal damage, and rupturing of both coracoclavicular ligaments, we performed the arthroscopic conoid ligament reconstruction procedure, as reported by Takase et al. 8 Although the subjects of the report were adults, bone union was achieved in all cases after approximately 3 months with functional training starting after around 2 weeks of external fixation.…”

Acromioclavicular Joint Pseudo-dislocations with Lateral end Clavicle Fracture: A Rare Injury and Proposed Technique of Fixation

“…Due to the remodelling potential of children, distal clavicle fractures are often managed conservatively with successful outcomes [ 2 , 5 ]. However, there is some consensus in the literature that there are cases in which operative management of these injuries should be considered, particularly Dameron and Rockwood type IV–VI distal clavicle fractures [ 4 , 6 , 9 , 10 ]. In patients nearing skeletal maturity, there is limited remodelling potential and these fractures if not managed surgically, can lead to residual deformity of malunion, as reported previously in the literature.…”

“…In patients nearing skeletal maturity, there is limited remodelling potential and these fractures if not managed surgically, can lead to residual deformity of malunion, as reported previously in the literature. Various methods of fixation have been used in the literature including open tension band repair using absorbable sutures [ 9 ], temporary Kirschner wire fixation and suture repair of periosteum with [ 6 ] or without cerclage fixation around the coracoid process [ 5 , 6 , 8 , 9 , 11 , 12 ], and coracoid transposition [ 4 ]. Reported complications of surgery include K wire migration requiring early removal/revision fixation [ 5 ], discomfort, scar dissatisfaction and skin/soft tissue irritation by K wire [ 8 ].…”

“…However, consensus appears to be that in paediatric patients nearing skeletal maturity, when significant clinical deformity is present, reduction and fixation of the fracture are recommended [ 1 , 2 , 6 ]. There is reduced remodelling potential in this population.…”

Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series

“…Clavicle fractures are common injuries in children, representing about 15% of all pediatric fractures, with more than 90% of these fractures located in the midshaft. [1][2][3] Traditionally non operative treatment has been the gold standard treatment in children, as the clavicle has excellent remodeling potential due to late medial and lateral physeal closure. Another reason for popularity of non operative treatment is that non union is extremely rare in pediatric patients, with only few case reports in the pediatric literature.…”