The Clavicle – small, S-shaped curved tubular bone, one end of which connects with the sternum (sternoclavicular joint) and a second end with the acromion process of the scapula (acromioclavicular joint). Traditionally in the clavicle there are three parts: the sternal end of the diaphysis (middle part) and the acromial end.
A clavicle fracture can occur anywhere, but most often the fracture is localized in the region of the diaphysis, at least in the region of the acromial end of the clavicle, and more rarely – in the area of the sternal end (of 20.8 and 1 case per 100 000 population per year respectively).
Anatomy of clavicle
Sometimes fractures of the acromial end of the clavicle can be combined with dislocations (about 2% of all cases), which is possible with the simultaneous rupture of ligaments. In addition, fractures of the clavicle can be combined with fractures of the scapula.
Under the collarbone are major nerves and blood vessels, which, fortunately, in fractures of the clavicle are almost never damaged.
Causes of fracture
A typical cause of clavicle fracture – trauma (direct blow or fall on the hand). Fractures of the clavicle is a common injury in children and athletes. Many newborns are born with is broken during passage through the birth canal of the clavicle. Maximum strength gains collarbone to 20 years.
What are the fractures?
As we have already noted that fractures are different in localization (fractures of the diaphysis, the acromial end and the sternal end). Additionally, the fractures are comminuted, megascolecidae, with perpendicular or oblique fracture lines, etc. This division is very important, as the type of fracture affects the choice of optimal method of treatment and its success.
As to the clavicle are attached strong muscles, the fracture in most cases is the displacement of fragments.
Symptoms of fracture of the clavicle
- Offset shoulder anteriorly and down
- Inability to lift the arm because of pain
- Feeling of crunching (crepitus) when trying to lift up the hand
- Deformation or an irregularity in the collar bone area
A clavicle fracture is most often characterized by there are a number of symptoms as a fracture. the main symptom of fracture of the clavicle is a sharp pain in the affected area, which over time does not pass, but only intensified. However, the pain may be due to simple injury, so it is important to distinguish a fracture from a simple injury. A characteristic feature of the fracture of clavicle is the inability to lift the arm, as well as the presence of a strong swelling and swelling. When the fracture is possible damage to the blood vessels and nerves – to determine this, you need to check whether sensitive and movable fingers and wrist
As a rule, fracture of the clavicle with displacement is more prominent, therefore, to detect and, as a consequence, first aid can even faster. In such cases, it is visually evident that the longer hand, and the shoulder joint extends significantly below a healthy joint. In this type of fracture the patient usually instinctively holding a hand over a forearm or pressing it to the trunk.
Video: Clavicle fracture
Diagnosis of fracture
Careful pressure in the fracture site causes pain. Sometimes you may hear a crunch when the victim tries to raise his hand. Although fragments rarely penetrate the skin through, they can put it in the form of tents. The doctor carefully and gently examined the shoulder, to make sure that the vessels and nerves are not damaged.
Usually the deformation or unevenness in the projection of the fracture so obvious that the diagnosis of a fracture the doctor is not in any doubt. However, the survey does not provide information on the exact nature of the fracture: for this purpose necessary x-ray examination. As we have noted, the nature of the fracture determines the optimal treatment option.
Treatment fracture of clavicle
Principally fractures of the clavicle can be treated by conservative and surgical means.
If conservative treatment is immobilization, i.e., immobilize the arm for several weeks (usually 3-7 weeks depending on the severity of the fracture and patient’s age).
Variants of immobilization of the left gusset bandage, right – rings, Delbe (pull shoulders to the side and backwards, restoring the length of the clavicle)
The basic principles of immobilisation in the conservative treatment are: the long reconstruction of the clavicle by eliminating the displacement of bone fragments, immobilization of the arm for the time required for clinical fusion.
In the conservative treatment of clavicle almost always heals, but unfortunately, it does not always eliminate the displacement of fragments and a shoulder girdle may be deformed and shortened at the expense of the long not restored the clavicle.
Significant thickening of the clavicle at the site of fracture indicates the fusion process (callus). Usually with time, the callus is reduced, but small thickness, typically remain.
The deformation of the clavicle is not completely eliminated due to displacement of fragments after conservative treatment.
Currently it is considered that if there is displacement of the clavicle after reduction (i.e., the physician tries to eliminate the offset) by more than the width of the bone or more than 2 cm in length, needs surgery – osteosynthesis.
Displacement of bone fragments in clavicle fracture width and length, requiring surgery.
As the indication for surgery can be considered as the patient’s unwillingness to have even a minimal deformation of the shoulder girdle for aesthetic reasons.
Treatment of clavicle fracture without displacement
Faster and easier just fused clavicle in children up to three years, so you can use the simple broad bandage, which will fix the injured arm in a special position, and in addition, you can use bandage Dezo.
For children older than three years and adults this rapid coalescence will not occur, so instead will need a special cast that will provide rigid fixation, however, before applying this bandage will need to enter the patient pain medication to ease his position and to lessen the pain. Before applying the plaster bandage, you can apply a special tire, which for the first time will replace a bandage, however it is strongly recommended to apply the plaster.
Also need rehabilitation after clavicle fracture to restore the function of the hand and its full function – with long arm plaster will partially lose their ability.
Likely to occur when a broken collarbone for a long time does not want to heal – in such cases you will have to perform surgical intervention, during which the bone will be installed in the correct position, and the bone fragments will be extracted if possible.
Treatment of clavicle fracture with displacement
If the fracture has shifted the bones or bone fragments, we have to impose to the patient a bandage, which should be fixed using plaster. While bone fragments must be returned to its place, and it is made with a raised back and abduction of the shoulder, but do not forget that, as has been said, it is impossible to try to straighten them. If the debris is too much, then for correct healing use a special tire, which is obtained by linking two tires Cramer.
On severe cases, when conventional bandage when the clavicle fracture will not help, surgical intervention will be required, which is used most often because of damage to nerves and blood vessels or when there is a risk to damage them during the reduction of bone fragments.
Surgical treatment of clavicle fracture
The operation is performed in fractures of the clavicle is called osteosynthesis. During the operation, eliminate the displacement of fragments of bone and fasten metal construction, the choice of which is determined by the nature of the fracture.
Currently the most widely osteosynthesis plates and screws. If the fracture is localized in the diaphysis, the reconstructive a regular plate or a special S-shaped curved plate to the clavicle. But if the fracture of the fracture line affects the acromial end of the clavicle, may require more expensive construction: hook plates or specialized plates with locking screws.
LCP plate Osteosynthesis for fractures of the diaphysis of the clavicle
Plate Osteosynthesis by LCP S-A in fractures of the Clavicle acromial end of clavicle
Fixation hook plate hook plate with Pereloma-dislocations of acromial end of clavicle
In addition, the osteosynthesis can be performed with the aid of a pin, which is injected inside the bone or by using external fixation. The pins are locked and lock-free. The locking pins are additionally fixed in the bone screws, which are conducted through holes in the pin. Non-blocking fixed with bone pins with no screws, they come in smooth and threaded (pin Rockwood). Among the preferred non-blocking threaded pins, which provide more stable fixation.
Left – osteosynthesis locking pin, right – external fixation
Osteosynthesis of the clavicle threaded pin Rockwood
Apart from the fact that the operation allows to eliminate the displacement of bone fragments, it is characterized and disadvantages. In particular, the main complications of surgical treatment are:
- Nonunion of the clavicle (this is sometimes known as false joints, but it is not entirely accurate). Such complication may result novooskolskiy the nature of the fracture, inadequate selection of metallicity, excessive invasiveness of the surgery (extensive separation of the periosteum).
- Infectious complications – osteomyelitis. To prevent this complication it is necessary to comply with the requirements of asepsis, and the patient should receive prophylactic antibiotics (administered intravenously 30 minutes before surgery).
The incidence of these complications is about 1%
After the normal fusion of the bone fragments, the function of the shoulder joint is gradually recovering. Typically, residual effects are minor (some restriction of range of motion), unless the fragments were much displaced and the ends are not sold in by.
Exercises to increase range of motion and muscle strengthening can be started as soon as reduces pain. Sports should not begin until muscle strength recovered.
What questions should be discussed with a doctor for clavicle fracture?
- What are my individual risks of complications of surgical and conservative treatment? What method of treatment in my case will rely on the maximum success?
- How this injury will affect the function of the hand in later?
- Whether any of my individual factors to affect the outcome of treatment (co-morbidities such as diabetes, etc., habits)?
- What kind of implant for osteosynthesis optimal given the nature of the fracture?
- How I can serve myself after the operation?
- When will I be able to return to work, if my work involves … ?
- When you need to carry out check-UPS and x-ray examination?
Rehabilitation after clavicle fracture
With timely treatment to a qualified specialist term complete healing of a broken clavicle and reconstruction of the hand can reach up to eight weeks. After full recovery prescribe special exercises for clavicle fracture, help restore lost muscle mass and motor activity of the hands. Main effects when the clavicle fracture is a temporary loss of function of the hand, at the time of the rehabilitation period.
That’s all. All additions and questions about the broken collarbone you can ask us in the comments.
And remember – if you suspect a broken collarbone, you should immediately contact your doctor and x-rays.