Sternoclavicular physeal fracture associated with adjacent clavicle fracture in a 14-year-old boy: a case report and literature review

Abstract

We report a very rare association of a physeal fracture of the medial clavicular growth plate with a fracture of the adjacent clavicle in a 14-year-old boy who fell on his shoulder while playing football. Clinical, radiographic and computed tomographic (with three-dimensional reconstruction) features are described. Open reduction, internal fixation of the lateral fracture (with a reconstructive plate) and suture of the periosteum were performed.

The operative outcomes of displaced medial-end clavicle fractures

“…Maintaining a stable closed reduction is often not possible with these fractures because of the counteracting deforming forces of the medial ligamentous complex and the cephalad pull of the sternocleidomastoid muscle on the lateral fracture fragment, combined with the often delayed presentation of these injuries (57% of patients in our series experienced a delay in diagnosis). 4,8,9,11 We used a transosseous suture technique for all physeal injuries, which avoids significant disruption to the physis and prevents the passage of sutures and instruments beyond the posterior cortex of the clavicle (near to the vital structures). It also avoids the insertion of hardware (such as metal sutures or Kirschner wires) and the possibility of metal ware irritation, migration, or the need for hardware removal with a second operation.…”

Fracture-décollement de l’épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature

“…Plusieurs modalités techniques sont proposées: 2 à 4 points de sutures trans-osseux de part et d’autre du foyer au fil d’acier pour Goldfarb [ 17 ] et Thomas [ 31 ] ou au fil non métallique pour Hofwegen [ 30 ]; 4 à 8 points entre d’une part l’os et d’autre part le tissu fibro-périosté au fil non métallique pour Tennent [ 16 ] et pour Nous. L’ostéosynthèse de la fracture-décollement associée à une fracture de la clavicule est réalisée aussi suivant différents moyens: La réduction-reposition du fragment avec: une ostéosuture transosseuse assurée par des points trans-osseux pour Lemire [ 26 ]; Un haubannage pour Falcone [ 23 ] ; Une ostéosynthèse par plaque vissée pour Segal [ 25 ] et Lampasi [ 24 ]. Les plaques vissées constituent une bonne butée contre la récidive, n’exposent pas au risque de migration dangereuse dans le médiastin, mais présentent l’inconvénient de la ré-intervention pour ablation du matériel.…”

Posterior sternoclavicular joint dislocation in a child: a case report with review of literature

“…22,24,26,34 As in our case, it is very difficult to distinguish between true posterior dislocation and posterior displacement of the medial clavicle physeal fracture from conventional radiograph or even CT scan. 16,22,32 The true nature of the injury can only be verified during open reduction 16,22,32,33,53 or retrospectively when new bone formation and bone remodeling is seen in follow-up CT scans. 34 This is why many of the reports do not make a clear distinction between these 2 injuries, especially when managed nonoperatively, and are generally reported and treated as posterior dislocations of the SCJ.…”

“…6 Some of these injuries can also be missed because they present in association with mid-clavicular fractures. 27,33 Therefore, initial diagnosis can be difficult, as physical findings can be misleading and plain radiographs are usually inconclusive. 1,6 Specialized views such as Hobbs', Rockwood's serendipity view, or Heinig's 20,22,24,25 may aid in diagnosis.…”