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FIGURE 111.10 Three images of a patient with sternoclavicular dislocation. A: Apparent
normal anteroposterior (AP) view of the clavicle. B: Serendipity view demonstrating
asymmetry of the right sternoclavicular joint indicative of a posterior dislocation. C: CT scan
showing posterior sternoclavicular dislocation on the right. (Reprinted with permission from
Waters PM, Bae D, eds. Pediatric Hand and Upper Limb Surgery: A Practical Guide .
Philadelphia, PA: Lippincott Williams & Wilkins; 2012.)

Indications for consultation with an orthopedic surgeon include open fractures,
impending open fractures secondary to skin tenting, sternoclavicular dislocation,
any fracture to the medial one-third or 100% displaced fractures of the lateral
one-third, neurovascular compromise, multitrauma patients, and floating shoulder
injuries. Relative indications for urgent orthopedic consultation include
comminuted fractures, displacement ≥2 cm in the midshaft, and shortening ≥1.5
cm, particularly if the adolescent is of advanced skeletal age.
Management of AC joint injuries varies by severity. Typically, types I to III are
nonoperative and patients are treated with rest, ice, analgesics, and support or
immobilization with a sling; however operative repair of type III separations may
be indicated to improve functional outcomes in children and adolescents. Types
IV to VI are severe and require orthopedic evaluation and surgical treatment;
emergent evaluation is required in the setting of neurovascular compromise.
Disposition. The majority of children with clavicle fractures or injuries to the AC
joint can be discharged home. Fractures or injuries requiring operative
intervention as described above should be seen by orthopedics for possible
admission.