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Ortho Hors D'oeuvres (Prompt):

Patient is a 5 year-old boy presenting after an unwitnessed fall while playing on the playground. Reportedly was on the monkey bars when he fell onto his right side.

On examination, there is prominence of the distal clavicle of the right shoulder. There is significant tenderness from the clavicle to the acromion. Exam, including distal neurovascular status, is otherwise intact.

X-rays show:

Questions:

1) What is the injury? What is the most common cause of this type of injury?

2) What other testing or imaging is needed?

3) What is the appropriate initial management of this injury?

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