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Presentation, Evaluation, and Treatment of Clavicle Fractures in Preschool Children Presenting to an Emergency Department

Soto, Fernando MD*†; Fiesseler, Frederick DO*; Morales, Jaime MD*; Amato, Chris MD*

doi: 10.1097/PEC.0b013e3181bec7fc
Original Articles

Clavicle fractures are a common injury among pediatric patients. Few data exist regarding specific etiologies and their management in the preadolescent patient. Our objective was to determine the specific source of injury and treatment techniques used in the youngest patient population.

Methods: Study Design. A multicenter retrospective chart review study.

Setting. Twenty New Jersey and New York emergency departments from January, 2000 to February, 2007.

Subjects. Consecutive patients younger than 2 years with the primary or secondary diagnosis of "clavicle fracture" according to the International Classification of Diseases, Ninth Revision. A manual chart review was performed for specific data points.

Results: Two hundred twenty-eight patients met the inclusion criteria. Complete charts were available for 189 patients: 0 to 6 months (n = 14), 6 to 12 months (n = 41), 12 to 18 months (n = 53), and 18 to 24 months (n = 81). Males comprised 56% of the patients. The 3 most common etiologies of clavicle fractures were as follows: fall from bed/crib, 34%; playful activity, 17%; and fall not otherwise specified (NOS), 16%. Analgesic medications were reported in 32% of children while in the emergency department, and 51% were given a prescription on discharge. The most common immobilization technique was sling in 43% of patients. No immobilization was performed 37% of the time. Two patients (1%) were reported to the Division of Youth and Family Services.

Conclusions: In the youngest patient population, falling from a crib or bed is the most common etiology of clavicle fractures. Treatment for these injuries was found to be highly variable.

From the *Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ; and †Emergency Department, University of Puerto Rico Hospital, San Juan, Puerto Rico.

Reprints: Fernando Soto, MD, Emergency Department, University of Puerto Rico Hospital, PO Box 29207, 65th Infantry Station, San Juan, Puerto Rico 00929-0207 (e-mail:

Presented at the 4th Mediterranean Emergency Medicine Congress (MEMC-IV) at Sorrento, Italy, 2007.

© 2009 Lippincott Williams & Wilkins, Inc.