Refracture of the clavicle in an infant: case report and review of clavicle fractures in children

Pearls and Pitfalls of Thoracic Manifestations of Abuse in Children

Child abuse is a broad term that includes, but is not limited to, physical or emotional harm, neglect, sexual abuse, and exploitation. In 2018 in the United States, there were nearly 700,000 victims of such maltreatment, of which 1700 children died. The majority of deaths occur in infants and toddlers under 3 years of age. While clinical signs and symptoms may raise suspicion for inflicted injury, such as bruising in young infants, imaging often plays a central role in identifying and characterizing nonaccidental trauma. The purpose of this article is to discuss the array of inflicted traumatic injuries to the thorax in children. Rib fractures are among the most common and telling features of physical abuse, especially in infants. The locations of such fractures and differences in appearance while healing will be presented, along with potential mimics and pitfalls. Less typical fractures seen in abuse will also be reviewed, including those of the sternum, clavicle, spine, and scapula. Finally, uncommon injuries to the lungs, heart and esophagus will also be considered.

Posttraumatic pseudarthrosis of the clavicle in an 8-year-old girl

We describe an 8-year-old girl who developed a posttraumatic pseudarthrosis of the right clavicle. Despite the great periosteal regenerative potential in children, the fracture did not heal at 12 months with a classic conservative treatment. As a result of pain and functional limitations, surgical treatment was required. Excess bone of the hypertrophic nonunion was removed and an open reduction and internal fixation with a compression plate were performed. Cancellous bone chips from the iliac crest were packed into the fracture site. Good remodelling and consolidation was achieved 10 months after the operation. At that stage, the functional outcome was satisfactory.