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Schwachman Syndrome
Joseph Junewick, MD FACR
over 7 years ago
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ARSt Case Repository

Clavicle Fracture

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 8 years ago
Updated: over 8 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

3 year old with supraclavicular mass.


Case Images


Diagnosis

Clavicle Fracture

Clinical Notes

Negative radiographs of the clavicle 1 week prior.

Findings

US – Mildly comminuted fracture of the clavicle with periosteal new bone (hematoma).

XR – Radiograph after US confirms fracture with callous formation.

Discussion

Clavicle fractures are frequent in children and adults. Because of the complex shape and location, orthogonal imaging is not possible. Typical imaging protocol includes an AP and an AP with 15 degrees of caudo-cranial angulation; ipsilateral rotation may also be added. Fractures are most common at the junction of the middle and distal thirds near the transition of the anterior arc and posterior arc. Angulation and displacement at the fracture often occur because of muscle imbalance.

In pre-school children fractures may be occult because of higher incidence of incomplete fractures (increased osseous flexibility since the matrix is less mineralized and more hydrated) and less developed shoulder and neck musculature (decreased distraction and angular deformity of the fracture).

Ultrasound is an effective means to diagnose radiographically silent fractures in pediatrics.

Reference

Graif M, et al. Sonographic Detection of Occult Bone Fractures. Pediatric Radiol 1988; 18:383-385.



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