|Beitragstitel||Epiphysiolysis type Salter I of the medial clavicle. A case report|
Epiphysiolysis type Salter I of the medial clavicle. A case report
Ramadani Fatos, Barbier Geoffrey, Vial Philippe, Gautier Emanuel
Department of Orthopaedic Surgery, HFR-Fribourg, Hôpital cantonal
Epiphysiolysis of the medial clavicular end or dislocation of the sterno-clavicular joint (SCJ) are rare lesions during childhood. The clavicle is the last bone to ossify at its medial part at the age of 17 to 20 years of age. The osseous fusion of the growth plate takes place at the age of 23 to 25 years. On standard radiographs it is difficult to distinguish between a true SCJ dislocation and a displaced medial epiphysiolysis type Salter I or II.
A 13 year old boy presents in the pediatric emergency room with upper thoracic pain. He indicated a fall during a soccer play and a severe compression injury to his thorax when another player felt on him. Clinically, no neuro-vascular troubles or dyspnea were present. Conventional radiographs showed a posterior dislocation of the medial clavicle, confirmed by a CT-scan. Intraoperatively, an epiphysiolysis type Salter I of the medial clavicle was found. Open reduction was performed and the medial end of the clavicle stabilized with a figure-of-eight Fibertape. The patient was immobilized with a posterior figure-of-eight bandage for 6 weeks.
At 12 weeks, the patient was asymptomatic, the range of shoulder mobility was symmetric, the body-cross test was negative, and radiographs revealed healing in correct length of the clavicle and correct position of the medial epiphysis.
Epiphysiolysis of the medial end of the clavicle or posterior SCJ dislocation is a major lesion which can be complicated by additional vascular injury. Closed reduction attempts are unsuccessful. Thus, open reduction and fixation with trans-osseous sutures should be performed. The aim of the fixation is to obtain an anterior traction of the medial clavicle avoiding a posterior re-dislocation.