Posterior Sternoclavicular Physeal Fracture Dislocation Treated Nonoperatively in an Adolescent: A Case Report

Posterior sternoclavicular (SC) injuries are clinically significant due to their proximity to vital mediastinal structures. Rapid diagnosis of these injuries is critical, yet challenging, as plain radiographs often fail to detect posterior displacement. Current guidelines call for immediate closed versus open reduction of SC injuries. However, there remains a paucity of literature reporting on outcomes following management in subacute presentations. In skeletally immature patients, most injuries involving the medial clavicle represent physeal fractures rather than true dislocations. This allows for greater remodeling potential, allowing for conservative management in select cases.

A 14-year-old male presented to the clinic 1 month after sustaining an injury to his left shoulder during a football tackle. On examination, the patient demonstrated a posterior step-off of the SC joint. Imaging was used to confirm the diagnosis of a medial clavicular physeal fracture with posterior displacement. The patient demonstrated clinical stability and a lack of progressive symptoms, and the decision was made to proceed with non-operative management with observation. The patient returned to activity without limitation.

This case highlights that subacute posterior SC physeal dislocations in adolescents may be managed nonoperatively with favorable outcomes.