FRACTURE CLAVICLE

A 10 days old child presents with swelling rt clavicle?

how to proceed?

• The major causes of clavicular fractures are difficult deliveryof the shoulders in vertex presentations and extended arms in breech deliveries. Vigorous, forceful manipulationof the arm and shoulder usually has occurred. However, fracture of the clavicle may also occur in infants after apparently normal labor and delivery.51,72 It has been suggested that some fetuses may be more vulnerable to spontaneous birth trauma secondary to forces of labor,maternal pelvic anatomy, and in utero fetal position

• neonatal clavicular fractures are diagnosed at discharge or at the first follow-up visit.50 Complete fractures and somegreenstick fractures may be apparent shortly after birth; movement of the arm on the affected side is decreased or absent. Deformity and, occasionally, discoloration may be visible over the fracture site with obliteration of the adjacent supraclavicular depression as a result of sternocleidomastoid muscle spasm. Passive movement of the arm elicits cries of pain from the infant. Palpation reveals tenderness,crepitus, and irregularity along the clavicle. Moro reflex on the involved side is characteristically absent. Radiographs confirm the diagnosis of fracture

• should we expose a newborn  to radiation?. a linear probe usg can confirm the fractute. it can also look at the diaphragm for movement
• good biceps function and grasp reflex is reassuring ,so is normal pupil and normal respiratory excursion(d/d brachial plexus injury
• Differential Diagnosis

  A similar clinical picture of impaired movement of an arm with an absent Moro reflex may follow fracture ofthe humerus or brachial palsy. The fracture is confirmed by radiographs; palsy is accompanied by additional clinical findings. Rarely, an infant may present with a congenital pseudoarthrosis of the clavicle, which may be difficult to distinguish from a fracture. Pseudoarthrosis classically appears as a painless lump on the clavicle, with no associated tenderness or limitation of mobility of the shoulder and arm. Radiography reveals disruption of the affected clavicle, with enlargement of the end of the bone. The etiology is uncertain. Recommended treatment options include observation only or surgical excision of the cartilaginous cap at about 4 or 5 years of age, followed by alignment of bone fragments and, if necessary, bone grafting or internal fixation

• Treatment

  Therapy is directed toward minimizing the infant’s pain.The affected arm and shoulder should be immobilizedwith the arm abducted more than 60 degrees and the elbow flexed more than 90 degrees. A callus forms, and pain usually subsides by 7 to 10 days, when immobilization may be discontinued.

  Prognosis

  The prognosis is excellent, with growth resulting in restoration of normal bone contour after several months.