Retrosternal displacement of the clavicle after medial physeal fracture in an adolescent

Abstract

Retrosternal displacement of the medial clavicular metaphysis after a medial physeal fracture is a rare and potentially fatal injury because of possible damage of neurovascular structures, trachea and oesophagus. As the medial clavicular epiphysis does not ossify until 18-20 years of age and the medial clavicular physis is the last to close, around 22-25 years of age, this injury is difficult to demonstrate with plain radiographs in younger patients and is often mistaken for a sternoclavicular joint dislocation. We report on a 16-year-old boy with a fracture of the medial clavicular physis with retrosternal displacement of the metaphysis that was diagnosed with MRI, and discuss the diagnostic tools and treatment options in this rare injury.

Successful Nonsurgical Management of a Posteriorly Displaced Medial Clavicular Physeal Fracture in an Adolescent Athlete: A Case Report

“…4 Physeal fractures can remain occult on plain radiographs and CT. 1 The recent literature recommends MRI because of its ability to provide adequate visualization of the medial clavicular epiphysis, ligamentous complex, and other thoracic pathology. 4 A lack of consensus exists in the current literature of the most optimal treatment modality for physeal fractures of the medial clavicle with posterior displacement of the metaphysis. For the asymptomatic patient, several authors recommend closed reduction; however, the success rate is highly variable with a tendency for redisplacement.…”

“…4 Physeal fractures can remain occult on plain radiographs and CT. 1 The recent literature recommends MRI because of its ability to provide adequate visualization of the medial clavicular epiphysis, ligamentous complex, and other thoracic pathology. 4…”

“…2,3 As the weakest point in the SCJ, the physis is more prone to injury than the ligamentous complex. 4 Thus, in adolescent athletes, medial clavicular injuries are readily misdiagnosed as SCJ dislocations, when in fact Salter–Harris I or II physeal fractures are more common. 2,3…”

“…2,3 As the weakest point in the SCJ, the physis is more prone to injury than the ligamentous complex. 4 Thus, in adolescent athletes, medial clavicular injuries are readily misdiagnosed as SCJ dislocations, when in fact Salter-Harris I or II physeal fractures are more common. 2,3 Accurate diagnosis may prove challenging secondary to rarity of injury, subtle physical examination findings, and radiograph misinterpretation.…”

Epifisiólisis de clavícula medial tipo Salter 1 con desplazamiento posterior agudo en el esqueleto inmaduro

“…Existen múltiples publicaciones sobre luxación esternoclavicular posterior en adultos, pero relativamente pocas sobre epifisiólisis de clavícula medial con desplazamiento posterior en pacientes con esqueleto inmaduro, siendo la mayoría reportes de casos o series con pocos pacientes. 2,6,7,8,9,16,17,18,19,20,21,22,23,24,25,26,27,28,29 La baja frecuencia de esta lesión, asociada a la sutil presentación clínica y radiografías de hombro normales, explican el alto índice de errores diagnósticos y que su tratamiento siga siendo controvertido.…”