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the body to close and is rarely visible radiographically before age 18 years old.
Therefore, special views (e.g., the cephalic tilt view) or advanced imaging with
CT may be necessary for the identification of posteriorly displaced
sternoclavicular fractures ( Fig. 111.10 ). Radiologic examination in these cases
aims to identify any orthopedic injury as well as potentially lethal complications
of trauma to the mediastinal structures that lie posteriorly, including the aorta and
trachea. Initial imaging for suspected AC joint injury should allow for
comparison of the joints either through a single anteroposterior view, which
includes both AC joints, or separate radiographs of each AC joint to allow for
comparison. Sensitivity for detecting injuries is increased if the x-ray is taken
with the arm in internal rotation; however, stress views are no longer
recommended.
Most clavicle shaft fractures and nondisplaced fractures of the lateral end of the
clavicle in children are treated with nonoperative management due to the ability
of pediatric bones to remodel. Treatment of shaft fractures typically involves
immobilization in either a sling and swathe or a simple sling for 3 weeks and
gradual return to daily activities depending on age and risk of repeat trauma.
Return to contact sports should be delayed until solid bony union occurs
(typically between two to four months). The figure-of-eight splint, an alternative
method of immobilization, can be more uncomfortable and cumbersome and has
not been demonstrated to have superior outcomes. For newborns and toddlers, the
child can be put into a long-sleeved shirt with the distal sleeve of the injured side
pinned to the shoulder area of the shirt of the contralateral side.