1. Clavicle Fractures
Similar fractures in adults usually result from greater violence, are much slower to unite, and demand more care.
Classification 3 groups:
Mid-third, 80%
Distal or inter-ligamentous, 15%
Proximal-third 5%

2. Clavicle Fractures
Among the most common fracture occurring in children.
In children usually heal without problems (the saying goes that if you put two ends of a fractured clavicle in the same room [pediatric] they will heal).

3. Clavicle Fractures
Ideal method of management has not yet been developed.
Over 200 methods have been described.
Most do well with nonoperative management.
It may take at least 3 months for adults to resume heavy activities.

4. Clavicle Fractures

5. Clavicle Fractures

6. Clavicle Fractures
Distal clavicle fractures more problematic if involving the coracoclavicular ligaments.
fracture
without wts.
with wts.

7. Clavicle Fractures
Distal clavicle plate

8. Clavicle Fractures
ORIF
Displaced

9. Clavicle Fractures
IM Rod

10. Acromioclavicular Joint

11. AC Separations
MOI- direct force that occurs from a fall on the point of the shoulder.
Major deformity is the downward displacement of the shoulder.

12. AC Separations Classification:6 types of separation.
Types I-III most common.
Grade I - mild forces, Grade 6 - occurs with major forces.

13. AC Separation
Stress X-rays to differentiate between Grade I and Grade 3.
Gr. III has upward displacement % compared to the normal.

14. AC Separation Treatment Grade I-III is usually conservative.
Sling for comfort.
Early ROM.
Grade IV-VI is usually surgical.
Grade II injuries can develop DJD.
Grade III injuries can be repaired in a young laborer who performs overhead work.

15. The Elbow Little Leaguer’s elbow
Osteochondritis dissicans of the capitellum
Panner’s disease-osteochondrosis of the capitellum

16. Little Leaguer’s Elbow
A term used to describe a number of overuse conditions about the elbow associated with repetitive throwing that affects the skeletally immature elbow
MOI is valgus extension overload, which leads to traction stress on the medial aspect of the elbow, the medial collateral ligament, and the medial epicondyle

17. Little Leaguer’s Elbow
Valgus extension overload also results in compression stresses on the lateral aspect of the joint, leading to osteochondritis dissicans of the capitellum, loose bodies, and radial head overgrowth
The extension component can cause repetitive irritation of the olecranon in the olecranon fossa, which can lead to impingement & loose bodies

18. Little Leaguer’s Elbow
Symptoms
Medial pain
Diminished throwing effectiveness
Decreased throwing distance

19. Little Leaguer’s Elbow
Examination
Tenderness
Swelling over medial epicondyle
Elbow flexion contraction > 15 degrees
X-ray- fragmentation and widening of the epiphyseal lines

20. Little Leaguer’s Elbow

21. Little Leaguer’s Elbow
Treatment
Rest ( 4-6 weeks)
No throwing
Ice
NSAID’s
May strengthen when pain free (>6wk)

22. Osteochondritris Dissicans Of The Humeral Capitellum
Represents an island of subchondral bone and its articular cartilage that begins to separate from the rest of the humerus
Symptoms include lateral pain, which is dull and worsens with motion, which locks and catches

23. Osteochondritris Dissicans Of The Humeral Capitellum
Etiology is unclear
Repetitive stress most likely cause
May have genetic predisposition
Between ages 10-15
Common in throwers and gymnasts

24. Osteochondritris Dissicans Of The Humeral Capitellum
Examination
Radiocapitellar tenderness
Flexion contracture
Crepitation
Effusion

25. Osteochondritris Dissicans Of The Humeral Capitellum
Radiology
Crescent shaped region of sclerotic subchondral bone at the humeral capitellum
Possible loose bodies

26. Osteochondritris Dissicans Of The Humeral Capitellum
Treatment
If no evidence of separation then rest, ice, ROM, and analgesics
Repeat X-ray check for healing
Surgery if locking, loose bodies, fragment separation or failure of conservative management

27. Panner’s Disease Osteochondrosis of the humeral capitellum
Repetitive valgus stress causes compressive stress across the radiocapitellar
Occurs between 7-12 years of age ( peak incidence at 9 years)
May be susceptible at this time due to limited blood supply

28. Panner’s Disease Pathophysiology Unknown
May be similar to Legg-Calve`-Perthes disease

29. Panner’s Disease Symptoms Fairly sudden pain Deep and dull achiness
Worsened with throwing
No mechanical symptoms (locking or catching)

30. Panner’s Disease Physical exam
Tenderness and swelling over the lateral elbow
Mild to moderate flexion contractures (usually from 5-20 degrees)

31. Panner’s Disease Radiology
Fragmentation of the capitellum, with alternating area of sclerosis and rarefaction and an irregular joint surface

32. Panner’s Disease Treatment Conservative
Complete rest from throwing until symptoms subside and ROM is normal
Repeat X-rays to monitor remodeling
May return when X-rays and exam is normal
Long term disability is rare

33. The Wrist
Gymnast wrist
Torus fractures
Wrist fractures

34. Gymnast Wrist
Chronic overuse injury occurring at the physis if skeletally immature gymnasts
Presents with wrist pain
Usually due to repetitive hyperextension and overuse
Arms are used as weight bearing devices
Salter-Harris type I injury

35. Gymnast Wrist

36. Gymnast Wrist
Gymnast’s wrist frequently show physeal irregularities and bony sclerosis on X-ray
If untreated can result in permanent radial deformity and shortening due to growth arrest
Rest relieves symptoms
Extension splints can prevent recurrence

37. Gymnast Wrist