Distal clavicular physeal injury.

Fourteen patients with separation of the distal clavicular metaphysis from the epiphysis were reviewed. These injuries, especially in the older child and adolescent, mimic acromioclavicular separation. However, they are really growth-plate injuries in which the epiphysis and physis maintain their normal anatomic relation to the shoulder joint, while the distal metaphysis is displaced superiorly, away from the underlying structures. The periosteal sleeve is generally intact inferiorly, and the ligamentous structures connecting the clavicle to the coracoid usually remain attached to the periosteal sleeve. Depending on the degree of displacement, these patients may be treated by either closed methods or pin fixation. The periosteal sleeve is usually extremely osteogenic and will readily fill in any gap between the periosteum and metaphysis. In fact, in one patient this led to clavicular "duplication" and necessitated resection of the original distal clavicle. In the skeletally immature patient it is extremely important to recognize that these physeal injuries are discrete from acromioclavicular separation.