title: Fracture and retrosternal dislocation of the medial clavicle in a 12-year-old child--case report, options for diagnosis, and treatment in children.
abstract: We report a retrosternally displaced epiphysiolysis in a 12-year-old child and discuss options for the most appropriate diagnostic and therapeutic approach. If a standard anteroposterior view of the shoulder girdle shows abnormalities or if appropriate clinical suspicion is present, we strongly favor an magnetic resonance imaging study for further workup instead of a computed tomographic scan, which is currently the diagnostic method of choice in clinical algorithms. Radiation exposure is thereby limited and maximum information about possible mediastinal soft tissue complications is obtained using a single diagnostic tool. If open reduction is indicated, retention of the joint or approximation of physeal fracture or treatment of ligamentous injury should be performed without metal devices. These suggestions for future management of these patients should further reduce the use of x-rays in children. In addition, applying a suture instead of using metal for stabilization can avoid the extensively described complications in literature that can potentially result from metal devices. In addition, sutures circumvent the need for a second operation for metal removal.
authors.affiliation: Department of Trauma, Hand-, and Reconstructive Surgery, Hospital of the J.W. Goethe-University, 60590 Frankfurt/Main, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Lehnert
authors.forename: Bernd
authors.initials: B
authors.lastname: Maier
authors.forename: Heike
authors.initials: H
authors.lastname: Jakob
authors.forename: Marcus
authors.initials: M
authors.lastname: Maier
authors.forename: Helmut L
authors.initials: HL
authors.lastname: Laurer
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
mesh_terms: D000058:Accidental Falls; D000465:Algorithms; D002648:Child; D002968:Clavicle / Q000293:injuries*; D003937:Diagnosis, Differential; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005596:Fractures, Closed / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D016059:Range of Motion, Articular; D013536:Suture Techniques; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy