Posterior displacement of a proximal epiphyseal clavicle fracture

Posterior clavicle dislocations are uncommon injuries but are associated with serious complications based on their proximity to mediastinal structures. In children, the physis is the weakest point structurally, making a displaced Salter I fracture more common than a true sternoclavicular joint dislocation. This injury may be missed on exam and routine radiographs unless a high suspicion is maintained. A CT scan with contrast may be helpful for diagnosis of this injury and detection of complications to mediastinal structures. Emergent reduction is required in cases where there is vascular compromise.