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clinicians must be attentive to injuries to the medial and lateral aspects of the
clavicle which may include dislocations and physeal injuries.

FIGURE 111.7 Radiograph of the pelvis and femur of an 18-month-old girl with osteogenesis
imperfecta. There is a healing fracture of the right femur (large arrow ), as well as an acute
fracture of the left femur (small arrow ).

CLINICAL PEARLS AND PITFALLS
Clavicle fractures in children less than 2 years old (excluding the
newborn period), particularly of the lateral end of the clavicle are
uncommon, and should raise concern for possible nonaccidental
trauma.
The newborn or preverbal child who cries upon being picked up under
the arms should be evaluated for possible clavicular fracture.
Patients with sternoclavicular fractures and dislocations following bluntforce trauma to the chest, may present with referred pain to the
shoulder and neck. Posteriorly displaced sternoclavicular fractures may
cause damage to the underlying neurovascular and airway structures.
Current Evidence. The clavicle is the most frequently fractured bone in children,
and management considerations vary by the location of fracture (medial, shaft, or
lateral), age of patient, and degree of displacement. Clavicle fractures may occur
in newborns as a result of birth trauma, and in ambulatory children and
adolescents secondary to a fall onto the shoulder or an outstretched hand, or from