Fracture-separation of the medial clavicular epiphysis: about 6 cases and review of the literature

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.