The value of ultrasound in assessing displacement of a medial clavicular physeal separation in an adolescent

Abstract

We describe a case of medial clavicular physeal separation with posterior displacement of the metaphysis in a 13-year-old girl, focusing on the role played by ultrasound in the diagnosis, planning of treatment and post-reduction follow-up. On clinical examination and conventional radiography, the injury is essentially indistinguishable from a sternoclavicular dislocation or a fracture of the medial aspect of the clavicle; however, the pathogenesis is different, consisting in medial physeal separation and 'degloving' of the inner cancellous bone of the metaphysis from the surrounding periosteal collar with posterior metaphyseal dislocation. In our case, attempted closed reduction failed, and the injury required open reduction with relocation of the clavicle into the periosteal sleeve followed by suturing of the periosteal tear.

Posterior Sternoclavicular Joint Injuries in Skeletally Immature Patients

“…Ultrasound has previously been described as a means to assess physeal fractures pre-and postreduction and may be a possible alternative. 32 However, the current authors have no experience with this modality at their institution. For cases in which (1) the initial closed reduction is unsuccessful; (2) the patient presents for evaluation 48 hours or less after the initial injury; and/or (3) the patient presents with a major concomitant injury, the authors recommend ORIF with braided suture wire.…”

Functional Impact of Osteosuture in Medial Bilateral Clavicular Physeal Fracture in Teenagers

“…Clavicular physeal fracture is an uncommon pediatric fracture [1][2][3][4][5][6][7][8][9], especially bilateral. The lesion is not the same as in adults, who have a sternoclavicular disjunction.…”

“…The diagnosis, management and treatment totally differ in adults. These injuries mostly occur during sport activities [8], with high energy trauma, due to a direct force applied to the medial clavicle or an indirect force on the shoulder [1,3,6,9]. The clinical diagnostic might be obvious or difficult [8,10], pain and swelling in the sternoclavicular joint area [1], sometimes a deformity, focal tenderness and a clinical instability [2].…”

“…The clinical diagnostic might be obvious or difficult [8,10], pain and swelling in the sternoclavicular joint area [1], sometimes a deformity, focal tenderness and a clinical instability [2]. Therefore X-Ray and CT scan must be done in order to confirm the diagnosis [1,[3][4][5][6]10]. Three-dimensional reconstructed computed tomography scans may help to evaluate the lesions before surgery [2,3].…”

“…Therefore X-Ray and CT scan must be done in order to confirm the diagnosis [1,[3][4][5][6]10]. Three-dimensional reconstructed computed tomography scans may help to evaluate the lesions before surgery [2,3]. Several complications [8,10], such as tracheal or vascular compression [11,12], which are revealed by dyspnea, dysphagia or odynophagia [1,5], can be noticed.…”