Clavicle fractures are common in skeletally immature patients, but distal clavicle fractures are relatively rare, comprising only 10% to 20% of clavicle fractures in the growing population. Variations exist in this age group as chronological age may not correlate with skeletal age. Some children, specifically those whose age is greater than 15 years, may sustain an adult type of injury pattern. Knowledge of both skeletally mature and immature clavicle fractures is thus useful when caring for the adolescent population.
Displaced distal third clavicle fractures in children, as opposed to adults, retain the integrity of the coracoclavicular (CC) ligaments. The proximal attachment of the CC ligament to the periosteum and the distal attachment to the conoid tubercle of the coracoid are important intact attachments that allow for cortical button fixation in this age group. A displaced clavicle with a CC disruption, as in adults, concerns an orthopedic surgeon with not only a stable fixation of the clavicle but also the biological fixation of the CC ligament. The lack of stable biological fixation of the CC ligament in the skeletally mature patient has thought to be a source of failed repairs in these injuries. This is not the case in the pediatric patient with a similar injury who has intact CC ligaments with a disrupted periosteum and abundant innate biological healing capabilities.
A double-button suture fixation technique has been utilized to improve fixation, avoid the need for hardware removal, and allow earlier mobilization of adolescent patients with distal clavicle fractures. The purpose of this study is to describe a surgical technique for the management of adolescent distal clavicle fractures.
Full Article: Distal Clavicle Fixation in the Skeletally Immature