Proximal clavicle physeal fracture with posterior displacement: diagnosis, treatment, and prevention.

Posterior sternoclavicular fracture displacement can present as a posterior sternoclavicular joint dislocation and is rare in the pediatric population. This article provides an algorithm for evaluation and management.A 14-year-old boy with a previously undiagnosed posterior sternoclavicular displacement presented with persistent 7/10 shoulder pain extending into his neck after undergoing nonoperative treatment for an unconfirmed diagnosis at another emergency department. Plain radiographs revealed a displacement of the right medial clavicle, and the position of the clavicular head indicated advanced imaging. Computed tomography showed the posterior portion of the clavicular head butting against the left braciocephalic vein at its confluence with the superior vena cava. The patient underwent open reduction and internal fixation. After exposing the sternoclavicular joint, a Salter-Harris I fracture with no evidence of vascular injury was confirmed. The fracture was reduced and stabilized using figure-eight #5 Ethibond sutures (Ethicon, Somerville, New Jersey), and the patient was placed in an immobilizer for 1 week. At 1 year postoperatively, the patient regained full range of motion and was completely healed.Posterior clavicle displacements are potentially devastating injuries that are difficult to diagnose. Coordinating operative treatment with orthopedic and general surgery is indicated to manage the fracture or displacement and potential vascular injury. Due to difficulties in maintaining a closed reduction, open reduction and internal fixation is the preferred mode of treatment for the reduction of all posterior clavicular fracture displacements.