# Medial Clavicle Physeal Fracture in a 15-Year-Old Male: A Case Report

## TL;DR

A 15-year-old athlete had a rare clavicle fracture near the sternoclavicular joint that was not visible on X-rays but was diagnosed with CT scans.

## Contribution

Highlights the diagnostic challenge of medial clavicle physeal fractures in adolescents and the importance of advanced imaging.

## Key findings

- Plain radiographs failed to detect a medial clavicle physeal fracture in a skeletally immature patient.
- CT imaging was necessary to confirm the diagnosis of a displaced physeal fracture.
- Physical exam and clinical suspicion are critical when radiographs are negative in adolescent trauma cases.

## Abstract

Sternoclavicular joint injuries are rare and potentially life-threatening injuries due to their proximity to vital mediastinal structures. In adolescents, skeletal immaturity can add complexity to the injury due to potential involvement of the physis. A physeal fracture with displacement can appear as a dislocation on imaging, also known as pseudo-dislocation. Additionally, this anatomic area is difficult to visualize with plain radiographs, which can result in misdiagnosis and delayed treatment.

We present a case of a 15-year-old male athlete who presented to the emergency department with severe right clavicular pain four hours after sustaining a football injury. Plain radiographs obtained at an outside facility as well as repeat plain radiographs at our facility showed no evidence of fracture or dislocation. The patient’s degree of pain and physical exam findings prompted further imaging with computed tomography (CT), ultimately revealing a physeal fracture of the medial right clavicle with posterior and superior displacement.

Sternoclavicular joint injuries in skeletally immature patients are complex and require immediate diagnosis and intervention. Plain radiographs are often unreliable in recognizing these injuries and, in our case, the physeal fracture with displacement was not radiographically apparent on two separate occasions. Advanced imaging with CT revealed the diagnosis, highlighting the importance of a detailed physical exam and for physicians to maintain a high index of clinical suspicion when evaluating adolescents with high-impact trauma, even in the setting of negative plain radiographs.