Non-surgical Management of a Displaced Distal Clavicular Fracture

Case Diagnosis: Non-surgical management of a displaced distal clavicular fracture in a 12-year-old

Case Description or Program Description: A 12-year-old presented with complaints of left shoulder pain after a fall onto the lateral aspect of his shoulder while skiing. Evaluation in the ED revealed a deformity of the distal clavicle and significant pain. X-ray showed a displaced fracture of the distal clavicle with elevation of the medial fragment and mild acromioclavicular (AC) and coracoclavicular (CC) separation. Treatment included supportive care with a sling and referral for surgery.

He was seen a few days later in the orthopedic clinic and non-operative treatment was recommended. He utilized a sling for four weeks followed by physical therapy. At three months, radiographs showed a healing left distal clavicle fracture with appropriate callus formation and decreased AC and CC separation. At five months, radiographs revealed complete remodeling of the distal clavicle, a normal physical examination, and complete return to all activities.

Setting: Pediatric orthopedic sports clinic

Assessment/Results: A distal clavicular fracture associated with CC ligament disruption can be categorized as a Type IIb fracture (Neer classification). Though typically treated operatively in adults, the pediatric patient was successfully treated non-operatively and returned to sporting activities at three months.

Discussion (relevance): Displaced distal clavicular fractures are quite rare in the pediatric population. In this case, the decision was made to proceed with non-surgical management given the patient’s age and potential for healing. A structured rehabilitative program allowed appropriate healing of the fracture and full return to activities without restrictions.

Conclusions: Direct impact to this point on the shoulder typically causes AC joint disruption in adults, but results in distal clavicular fractures in children. While surgical management is reserved for those with severe superior, posterior, or inferior displacement, it may not always be indicated for superiorly displaced distal clavicular fractures in children.