clinicians must be attentive to injuries to the medial and lateral aspects of the clavicle which may include dislocations and physeal injuries FIGURE 111.7 Radiograph of the pelvis and femur of an 18-month-old girl with osteogenesis imperfecta There is a healing fracture of the right femur (large arrow ), as well as an acute fracture of the left femur (small arrow ) CLINICAL PEARLS AND PITFALLS Clavicle fractures in children less than years old (excluding the newborn period), particularly of the lateral end of the clavicle are uncommon, and should raise concern for possible nonaccidental trauma The newborn or preverbal child who cries upon being picked up under the arms should be evaluated for possible clavicular fracture Patients with sternoclavicular fractures and dislocations following bluntforce trauma to the chest, may present with referred pain to the shoulder and neck Posteriorly displaced sternoclavicular fractures may cause damage to the underlying neurovascular and airway structures Current Evidence The clavicle is the most frequently fractured bone in children, and management considerations vary by the location of fracture (medial, shaft, or lateral), age of patient, and degree of displacement Clavicle fractures may occur in newborns as a result of birth trauma, and in ambulatory children and adolescents secondary to a fall onto the shoulder or an outstretched hand, or from