Clavicle Fracture

A clavicle fracture is also known as a broken collarbone. The collarbone is located between the ribcage (sternum) and the shoulder blade (scapula); this connects the arm to the body. (Orthoinfo) The clavicle is a long bon and most breaks occur in the middle. On very rare occasions, it will break where it attaches at the ribcage of shoulder blade. (Orthoinfo) Although it lies above several important nerves and blood vessels, injuries are rare to these nerves and blood vessels even if during the break the ends of the bone shift. (Orthoinfo) A collarbone fracture can occur in people of all ages. Most of these fractures occur in men younger than the age of 25, it’s not as common in women at all. (Pecci) When it comes to clavicle fractures in children the odds are much different. Younger children have a high risk of this fracture because their bones have not completely hardened yet and are still growing, causing the increase in susceptibility. (Atanda) Usually this fracture takes place in a contact sport such as football, wrestling, rugby, lacrosse, and hockey. (Atanda) But, there is a few non-contact sports where this injury can also occur; such as, biking, skiing, snowboarding, and skateboarding. (Atanda)

Although you can’t control whether you have a direct collision with someone there are safety precautions you can take. If your sport has optional or required protective gear, use it at all times. (Atanda) Learning the proper techniques of your sport can benefit you if it comes to a situation where you need to get out of the scene quickly to save yourself. (Atanda) Maintaining strong bones by eating a well-balanced diet will decrease the possibility of a fracture if you are hit. (Atanda) Participating in strength training and stretching will help build more flexible muscles to that during a collision your body has room to twist and turn. (Atanda) Proper and supportive footwear that best fits your foot and sport is one of the biggest things you can do to prevent any injury. (Atanda) By wearing proper and supportive foot wear, it can allow you to sufficiently get out of a situation where this injury could occur by being able to make good plants with your feet to get you moving. (Atanda)

Usually, the main cause of a clavicle fracture is by a direct blow to the shoulder, it can also happen during a fall of a car collision. (Orthoinfo) On very rare occasions, it can occur in babies while passing trough the birth canal. (Orthoinfo) A clavicle fracture has a numerous amount of symptoms, usually associated with pain and the immobility of the arm on the side of the break. Once the collision has occurred and you have a fracture, you should notice having a sagging shoulder. (Orthoinfo) Normally it will sag downward and forwards. (Orthoinfo) You will notice a grinding sensation on attempts to raise or move your arm. (Orthoinfo) If you run your fingers across the break, you can feel a deformity or “bump.” Vary rarely; a fragment of the collarbone will break through the skin, causing the skin to form a “tent” formation. This fracture is also associated with bruising, swelling, and tenderness over the collarbone. (Orthoinfo)

If you experience a clavicle fracture, it is in your best interest to be taken to an emergency room immediately. After arriving, the Doctor will begin to ask you question about the injury and how it happened. (Orthoinfo) Next, he does a physical exam your vital signs, your shoulder, neck and spine. (Orthoinfo) Normally the Doctor will know right away where the initial break is because the “bump” is located right on top of where the fracture is. (Orthoinfo) X-rays of the entire shoulder are used to pinpoint the exact location and severity of the break, the x-ray also can tell the Doctor if there are any additional injuries. (Orthoinfo) If it is discovered that other bones are broken, you will most likely get a computed tomography scan, also known as a CT scan or a CAT scan. (Orthoinfo)

A computed tomography scan can see the details of even the smallest fracture or crack. (Orthoinfo) While looking at the results from your scans, they use Allman’s Classification to decipher where the fracture is. (Orthoinfo) This classification divides the clavicle into thirds; midshaft, lateral (distal), and medial (proximal). (Orthoinfo) The midshaft is the middle of the entire clavicle bone. (Orthoinfo) Next, the lateral (distal) is the part of your collarbone toward your shoulder side. (Orthoinfo) Lastly, the medial (proximal) portion is the part of the bone closest to the neck. (Orthoinfo) Less than 5% of clavicle fractures occur in the medial (proximal) portion. (Orthoinfo) Coming in second, 15%-25% happen in the lateral (distal) portion of the collarbone. (Orthoinfo) Being the most common origin of fracture, 75%-80% of fractures occur in the midshaft. (Orthoinfo)

There are two options of treatment for a clavicle fracture, surgical and non-surgical. If the broken bones have not shifted out of place and still line up correctly, surgery is only a possibility. (Orthoinfo) In some cases, broken collarbones can heal without surgery at all. (Orthoinfo) If you are not required to have surgery there are multiple other ways you can heal. (Orthoinfo) Icing your collarbone on a regular basis, will numb the spot and remove some of the pain and tenderness. (Orthoinfo) A simple arm sling or figure-of-eight wrap is usually used for comfort immediately after the break. (Orthoinfo) These are worn to support your arm and help keep it in position while it heals. (Orthoinfo) Medication, including acetaminophen, will be prescribed for you to also help deal with the pain and inflammation. (Orthoinfo) While you are wearing the sling, you are likely to lose muscle strength in your shoulder. (Orthoinfo) Once your bone begins to heal, the pain will decrease and your doctor will send you to physical therapy. (Orthoinfo)

The will start you off with just a few gentle shoulder and elbow exercises. (Orthoinfo) These exercises will help prevent stiffness and weakness during the healing process. (Orthoinfo) Eventually, you will begin more strenuous exercises as your bones heal and gain strength. (Orthoinfo) Physical therapy can benefit you greatly into you using your arm sooner than the Doctor expected. (Orthoinfo) It can even heal your collarbone quicker so that if you’re an athlete, you can return to your sport in a more efficient amount of time. (Orthoinfo) Doctor follow-ups will become a major part or your weekly routine. (Orthoinfo) You will need to see your doctor regularly until your fracture heals. (Orthoinfo) They will examine you and often take x-rays to make sure the bone is healing in a good position. (Orthoinfo) After the bone has healed, you will be able to gradually return to your normal activities. (Orthoinfo) In some surgery cases plates and screws will be used to put your collarbone back in place. (Orthoinfo) During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws or by attaching metal plates to the outer surface of the bone. (Orthoinfo)

After surgery, you may notice a small patch of numb skin below the incision; this numbness will become less noticeable with time. (Orthoinfo) Since there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin. (Orthoinfo) Plates and screws are usually not removed after the bone has healed, unless they are causing discomfort. (Orthoinfo) Problems with the hardware are usually not common, but sometimes, seatbelts and backpacks can irritate the collarbone area. (Orthoinfo) If this happens, the hardware can be removed after the fracture has completely healed. (Orthoinfo) Pins are also used to hold the fracture in good position after the bone ends have been put back in place. (Orthoinfo) The incisions for pin placement are usually smaller than those used for plates. (Orthoinfo) Pins often irritate the skin where they have been inserted and are usually removed once the fracture has healed. (Orthoinfo) Rehabilitation will be ordered by your Doctor after your surgery. Specific exercises will help restore movement and strengthen your shoulder. (Orthoinfo) Your doctor may provide you with a home therapy plan or send you to work with a physical therapist. (Orthoinfo)

Therapy programs typically start with gentle motion exercises, and then your doctor will gradually add strengthening exercises to your program as your fracture heals. (Orthoinfo) Although it is a slow process, following your physical therapy plan is an extremely important factor in returning to all the activities you enjoy. (Orthoinfo) Whether your treatment involves surgery or not, it can take several months for your collarbone to heal properly and completely. (Orthoinfo) It may take longer in diabetics or people who smoke or chew tobacco. (Orthoinfo) Most people return to regular activities within three months of the injury occurrence. (Orthoinfo) Your Doctor will tell you when your injury is stable enough to return to play. (Orthoinfo) Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. (Orthoinfo) This may require you to start your treatment from the very beginning. (Orthoinfo) Once your fracture has completely healed, you can safely return to sports activities. (Orthoinfo)

Works Cited

Orthoinfo. (2011, January). Retrieved from http://orthoinfo.aaos.org/topic.cfm/topic=a00072 Atanda, A. (2001, July). Clavicle Fracture. Retrieved from http://kidshealth.org/teen/diseases_conditions/bones/clavicle_fracture.html
Pecci, MD, M.,& Kreher, MD, J. B. (2008, Jan 1). Clavicle Fractures. Retrieved from http://www.aafp.org/afp/2008/0101/p65.html