Clavicle fracture: causes, symptoms, treatment in children and adults, first aid, with displacement

The clavicle is the only bone connecting the upper limb to the trunk. This is a tubular bone that has an S-shape, because of which in some northern regions of the country its old Russian name “flint” is still encountered. The absolute length of the clavicle of an adult is 12.2-16.0 cm. The average length relative to growth in men is 8.8%, in women - 8.3%. The collarbone consists of the body (middle part) and two ends: acromial and sternal. The ends are somewhat thickened and form joints with the scapula and sternum.

The nature of the movements is determined by the shape of the joints and the direction of muscle traction. The acromioclavicular joint belongs to amphiarthrosis and is characterized by low mobility. The joint has a dense fibrous capsule, an acromioclavicular ligament is woven into it as if. Another, more durable ligament that holds the joint of the clavicle with the acromion is the coraco-clavicular, consists of two ligaments (trapezoidal and conical).

The sterno-clavicular joint is spherical in shape. Its fibrous capsule is strengthened by the anterior and posterior sternoclavicular ligaments. In addition, there are costal-clavicular and interclavicular ligaments that protect the articulating bones from separation. Five muscles are attached to the clavicle.

  • In the area of ​​the sternal end: from the upper outer edge there is the sternocleidomastoid muscle of the neck, from the lower front - the clavicular part of the pectoralis major muscle.
  • In the area of ​​the acromial end: the trapezius muscle is attached to the anteroposterior surface, and the deltoid muscle is attached to the anteroposterior edge.
  • The fifth muscle - subclavian - runs along the posterior surface of the clavicle in its middle part. It should be remembered that under this muscle are the subclavian artery, vein and nerves of the brachial plexus. Slightly more medially, at the level of the sternoclavicular joint, on the right are the brachiocephalic trunk and common carotid artery, on the left is the subclavian artery, on both sides is the vagus nerve.

From a physiological point of view, the clavicle is a kind of spring strut between the sternum and the shoulder joint, not allowing it to occupy a more medial position. The emphasis on the shoulder and mobility in the joints of the clavicle contribute to a significant amount of movement of the shoulder and shoulder girdle. An important role in the biomechanics of these movements is played by muscles attached to the clavicle. In addition, the clavicle protects the neurovascular bundle.

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Physical examination

Diagnosis of a collarbone fracture is not difficult, since the bone is located under the skin and is available for examination (however, the doctor is not immune to errors).

The patient’s appearance is characteristic: the head is turned and tilted towards the damage, the shoulder girdle is lowered and shifted anteriorly, and the medial edge of the scapula and its lower corner depart from the chest as a result of the lack of a “spacer”, which served as the clavicle. The shoulder is lowered, pressed to the body and rotated inward. The subclavian fossa is flattened. Usually in the area of ​​the clavicle, a swelling is visible due to the standing central fragment.

Palpation revealed a violation of bone continuity, it is possible (but not desirable!) To determine pathological mobility and crepitus.

Fracture of the clavicle is often accompanied by displacement of fragments, especially if the fracture line runs obliquely and passes through the middle of the bone. Due to the violation of the physiological balance of the muscles, the fragments move and animate the typical position. The central fragment, under the action of the sternocleidomastoid muscle, moves up and back, and the peripheral one - down, anterior and inside. The reason for the dislocation of the distal fragment is the disappearance of the support between the shoulder joint and sternum. The thrust of the deltoid muscle and its own mass of the limb displace the peripheral fragment down. The traction of the pectoralis major and minor muscles rotate the shoulder inwards, bring the limb closer to the trunk and not only increase the downward shift, but also shift the fragment inside. Fragments come one after another, the clavicle is shortened. Compounding the subclavian muscle aggravates the medial displacement of the peripheral fragment.

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Non-drug and drug treatment of clavicle fracture

The most common conservative treatment for clavicle fracture is the simultaneous reposition of fragments, followed by their fixation in the correct position for the period required for adhesion.

Local anesthesia. 10-20 ml of 1% procaine solution is injected into the fracture area, and after 5-7 minutes, manipulation is started. The purpose of the reposition is to bring the peripheral fragment to the central one by raising the shoulder girdle and leading it outwards and backwards. There are several ways to compare clavicle fragments.

  • The first way. The patient is laid on his back on the edge of the table with a high roller between the shoulder blades. The arm on the side of the fracture is hung from the table. After 10-15 minutes, the surgeon’s assistant becomes at the head of the patient and, grabbing the patient’s armpits with his hands, shifts his shoulders up and back. The surgeon, standing facing the patient, fixes the shoulder joint with one hand, the second sets and holds fragments.
  • The second method is similar to the first, but it is performed when the patient is upright, who is seated on a low stool. The assistant surgeon becomes behind the victim, in front captures his armpits and, resting his knee on the patient’s back, raises and spreads his shoulders as much as possible. The surgeon performs reposition directly at the fracture site.
  • The third method is used in the absence of an assistant. Nearby put two stools. On them side by side the patient and the surgeon sit down. The doctor puts his forearm into the armpit of the patient, at the same time with his chest holds the shoulder and elbow joint of the victim in the adduction position. Then, with his forearm, he lifts the patient's upper arm and, acting as a lever, takes him back. With his free hand he compares the fragments.

Performing any of the described methods of reposition, one should not, as is advised in some teaching aids, take the shoulder of the victim, since the pectoralis major muscle is stretched, the shoulder joint is brought in, which makes it difficult to compare fragments.

At the end of the manipulation, without loosening the traction, it is necessary to fix the shoulder girdle and shoulder on the affected side in the position achieved by reposition. This is best done with a plaster cast. Of the many proposed dressings, the dressing proposed in 1927, M.P. Smirnov and V.T. Vanstein. Carrying out immobilization, it is necessary to put a cotton-gauze roller in the armpit.

Another device that creates reliable fixation of fragments is the SI bus. Kuzminsky. In case of failure during simultaneous reposition, this bus can be used for the gradual (within 2-3 days) comparison of fragments. Correct installation of body segments and correction of traction by moving belts allow you to use the tire as a reponing device.

Previously proposed by Beler (Bohler, 1928), H.D. Rakhmanov (1949), M.K. Tikhomirov (1949), M.I. Chizhin (1940) currently has no special tires and they have only historical significance.

Good results when used correctly give method A.V. Titova (1950), based on the use of a certain size and shape of the "oval", placed in the armpit of the patient. Hand hang on a scarf. Prescribe early functional treatment.

Soft-tissue dressings are unsuitable for fixing fragments of the clavicle: the 8-shaped dressing and Delbe rings do not raise the shoulder girdle, but only divert it posteriorly, the kerchief, the Deso and Velpo dressings do not fix the fragments in the right position. In addition, after 1-2 days, the bandage tours, as a rule, weaken, as a result of which the bandage ceases to fulfill the fixing role. However, as an exception, the listed dressings can be used in children (with subperiosteal fractures) and in the elderly.

Fracture of the clavicle is often an integral part of polytrauma, then the listed methods of treatment become unacceptable due to the forced lying position of the patient. We believe that in such situations, the Cuto method, which is as follows, should be included in the arsenal of disaster medicine. The patient lies on his back, closer to the edge of the bed with his arm hanging for 24 hours. Then, the arm bent at the elbow joint is placed on a low side stool for 14-21 days. UHF, massage, exercise therapy for the elbow joint and fingers are prescribed.

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Surgical treatment of clavicle fracture

Surgical treatment of clavicle fracture is performed according to strict indications: damage to the neurovascular bundle, open fracture, multi-fragmented fracture with the threat of damage to blood vessels and nerves, interposition of soft tissues, the threat of perforation of the skin with an acute fragment. If a fragment with a sharp edge will stand for a long time, and the skin at the place of protrusion is anemic (white), one should not wait for an open fracture to occur - the patient must be operated on. The operation makes it possible to make an incision in the desired projection and in aseptic conditions.

Surgical treatment of clavicle fracture consists in exposure of fragments, open reduction and fixation of bone fragments in one of the ways. The most commonly used intraosseous osteosynthesis with a metal pin. The latch can be inserted from the side of the central fragment or retrograde when the pin is pierced into the peripheral fragment before leaving the acromion, and then, after matching bone fragments, the pin is inserted into the central fragment, moving it in the opposite direction.

Bone methods of fixation using plates, cerclages, bone homotransplants, which block the fracture line, are also possible. To avoid bias, the graft is attached to the collarbone with screws or wire. Immobilization is carried out using a plaster thoracobrachial dressing.

Currently, researchers use external fixation devices, as a rule, of their own design for the treatment of clavicle fractures.

Regardless of the method of treatment and the type of locking device, immobilization should last at least 4-6 weeks. From the 3-4th day, UHF to the fracture area and exercise therapy for non-immobilized joints is necessary. On the 7-10th day, static contractions of the muscles of the forearm and shoulder are started. From day 18-21, electrophoresis of calcium and phosphorus preparations is prescribed for the fracture area.

At the end of the immobilization period, the plaster cast is removed and radiography is performed. If consolidation has begun, rehabilitation treatment is started: exercise therapy for joints of the upper limb, shoulder and shoulder massage, ozokerite and electrophoresis of procaine, calcium chloride on the shoulder joint, laser therapy, hydrotherapy in the pool, etc.

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Clavicle fracture

Clavicle fracture
ICD-10S 42.0 42.0
ICD-9810 810
MedlinePlus001588
eMedicineorthoped / 50

Clavicle fracture - a pathological condition, manifested by a violation of the anatomical integrity of the clavicle. Most often, fractures occur in the middle third at the border of the outer and middle third of the clavicle, on its most curved and thinned part. The most common ones are oblique and comminuted.

Radiography

It accounts for 2.6-12% of the total number of fractures, 44-66% of fractures of the shoulder girdle. In 80% of cases, a fracture occurs in the middle third, 15% of the fracture of the acromial end of the clavicle, 5% of the sternal (sternal).

Injury mechanism

Falling on the lateral surface of the shoulder, on an outstretched arm, a direct blow to the clavicle, birth injury. Secondary collarbone fractures are very rare due to muscle contraction caused by cramps.

Clinic

Local soreness, swelling, deformation, hemorrhage and shortening of the shoulder girdle, the shoulder is lowered and shifted anteriorly. A peripheral fragment along with the upper limb, under the influence of its severity and contraction of the pectoralis and subclavian muscles, moves down, forward and inward. The central fragment, under the influence of the sternoclavicular muscle, moves up and back. Fragments come together and go one on top of another.

Damage to the neurovascular bundle and pleura dome with closed fractures of the clavicle is possible, but is very rare

The patient holds with his healthy hand the forearm and elbow of the injured limb, pressing it to the body. movements in the shoulder joint are limited due to pain. On palpation of the fracture site, pathological mobility and crepitus of the fragments can be determined.

Radiography

X-ray is performed in the direct and lateral projections.

General information

Clavicle fractures account for up to 12% of the total number of fractures and up to 66% of fractures of the shoulders. In 80% of cases, damage is localized in the middle third of the clavicle, the acromial end suffers in 15%, and the sternal end in 5% of cases. Most often occur in childhood and adolescence. In children, the collarbone usually breaks like a "green branch" (while maintaining the integrity of the periosteum). In adults, fractures with a shift are often observed.

Most often, damage develops as a result of an accident at home or on the street. The following mechanisms are possible:

  • In direct injury (a blow to the clavicle), oblique, transverse and comminuted fractures of the clavicle usually occur. Observed during fights using sticks, bats and metal rods, the fall of a heavy object, a collision with the protruding part of the structure: the production mechanism, a children's town, etc.
  • In indirect injury (falling onto an outstretched arm, elbow or shoulder), oblique and oblique fractures form. The cause of the fall is usually adverse weather conditions, less often - alcohol or drug intoxication.
  • In some cases, a fracture of the clavicle is provoked by a sharp contraction of the muscles. Similar injuries can be detected after a generalized epileptic seizure.

The collarbone is a small, slightly curved tubular bone located above the upper rib and connecting the sternum to the scapula. It serves to strengthen the shoulder girdle, is a support for the scapula and bones of the upper limb. Protects nerves and large vessels of the axillary region.

The location of the fracture is largely determined by the anatomical features of the bone. Most often, the clavicle breaks in the middle third closer to the acromial end - in the thinnest and most curved section. Other factors affecting the location of damage are the direction and point of application of the traumatic force.

The most common are comminuted and oblique fractures. Under the influence of muscle traction and limb weight, the peripheral clavicle fragment moves down, inwards and anteriorly. At the same time, the sternoclavicular muscle “drags” the central fragment down and back. As a result, the shoulder girdle is shortened. Sometimes the end of the peripheral fragment moves into the area of ​​the neurovascular bundle, this is dangerous because of the threat of nerve damage and bleeding.

Classification

In modern traumatology and orthopedics, a systematization of clavicle fractures is used, taking into account several factors:

  • localization: damage to the outer, middle and inner third of the clavicle,
  • by the nature of the fragments: transverse, oblique, oblique, comminuted and S-shaped,
  • by type of damage: open and closed fractures.

Clavicle injuries are possible without displacement and with displacement of fragments.Fractures with displacement can be accompanied by damage to the pleura located near nerves and blood vessels.

Symptoms of a clavicle fracture

The patient is concerned about the pain at the fracture site. Hand movements on the damage side are sharply limited. The shoulder girdle is edematous, shortened. The shape of the clavicle is changed. The shoulder is lowered, its displacement in and out is observed. With a healthy hand, the patient holds the injured limb by the elbow or forearm and presses it to the body.

On examination, hemorrhages, pathological mobility and crepitus of clavicle fragments can be detected. With open fractures, a small wound is visible in the shoulder girdle, often with the end of the bone fragment protruding from it. In case of violation of the integrity of the neurovascular bundle, numbness and weakness of the limb can be detected, general weakness and dizziness due to internal bleeding are possible. Pleural rupture is accompanied by shortness of breath and lack of air due to pneumothorax.

Complications

Complications of clavicle fractures are rare. The most common negative consequence is a wound of a vessel or nerve with an acute fragment of a bone. In case of violation of the integrity of nerves in the long term, disorders of sensitivity and movements of varying severity can be observed. Rupture of a large vessel is fraught with significant blood loss. Pneumothorax is rarely diagnosed; in the absence of medical care, it can be life threatening.

Diagnostics

Diagnosis of a collarbone fracture is carried out by a traumatologist in an emergency room or outpatient clinic. The following methods are used:

  • Objective examination. When examining the site of damage, the characteristic deformation of the clavicle, edema, pain, and sometimes crepitation of the fragments are determined. When conducting a general examination, attention is paid to the safety of sensitivity and movements in the upper limb, the absence or presence of signs of blood loss, breathing difficulties.
  • X-ray of the clavicle. In the photographs, the fracture zone and the direction of displacement of the fragments are usually clearly visible. In children, angular deformation is detected due to the displacement of fragments while maintaining the integrity of the periosteum.

If you suspect a nerve injury, you need to consult a neurologist, with signs of impaired vascular integrity, an examination of the vascular surgeon is indicated.

Clavicle Fracture Treatment

Therapeutic tactics are determined by the presence and nature of the bias. Children and adults with uncomplicated, well-repaired collarbone fractures without the risk of damage to nerve trunks or blood vessels do not require inpatient treatment. With the threat of complications, hospitalization in the trauma unit is indicated. In most cases, a good effectiveness of conservative treatment is noted, operations are rarely performed.

First aid

First aid consists in hanging a limb on a headscarf, bending it in the elbow joint and bandaging it to the body. You should not try to eliminate the displacement yourself by sharp jerks or movements of the affected limb - this can cause secondary displacement of the fragments, increase the risk of complications.

Conservative treatment

The main treatment is immobilization. The fixation period in children is 2-3 weeks, in adults - 1 month. In childhood, Delbe rings are usually sufficient to hold fragments. In adults, the Chizhin frame and other special dressings are used.

  • In case of fractures of the “green branch” type and damage without displacement, a fixation bandage is applied.
  • In case of a collarbone fracture with displacement of fragments, local anesthesia is performed with subsequent reposition and fixation with a soft or plaster cast.

After reposition, a control picture is taken, UHF is prescribed. With severe pain in the first days after the injury, it is recommended to take analgesics. After the termination of immobilization, the patient is sent for massage and exercise therapy.

Prevention

Prevention includes measures to reduce injuries. In the period of ice, it is necessary to choose stable shoes with non-slip soles to prevent falls. Since collarbone fractures are often found in children, important preventive measures are sufficient control when the child is on the street, the equipment of safe children's play complexes.

The structure and position of the clavicle

This bone is visible during a routine examination of a person with a thin or medium build. In obese people, clavicle can only be detected by palpating the shoulder girdle. It connects the upper part of the sternum (bone between the ribs) and the acromial end of the scapula. The main function is to maintain the correct position of the shoulder joint and help the hand cope with physical activity. That is why with a collarbone fracture, the first symptom is a shift in the shoulder, because of which the patient is forced to constantly support him.

The clavicle consists of 3 parts:

  • 2 epiphyses are the final parts of the bone that fix it to the sternum and scapula with the help of joints (sternoclavicular, acromioclavicular)
  • 2 metaphyses - a section of the clavicle, which is adjacent to the pineal gland and directly in contact with the capsules of the joints,
  • The diaphysis is the middle part of the clavicle.

Directly behind the bone are some of the largest vessels in the body - the subclavian artery and vein. Their damage is a dangerous complication of a fracture that can lead to death due to the rapid expiration of blood. It is impossible to stop bleeding without surgery, so you need to quickly recognize this pathology in order to avoid a tragic outcome.

All the nerves that control the muscles and sensitivity on the arm are also located behind the bones of the clavicle. This is important to know, since damage to their bone fragment can lead to complete / partial paralysis of the upper limb and loss of sensitivity. A timely operation, in most cases, helps to completely restore the innervation of the hand and restore the patient's previous quality of life.

An additional danger is also created by nearby tops of the lungs, damage to which leads to respiratory failure and a general deterioration of the patient's condition. How to suspect each of the listed complications and the nature of the fracture will be discussed below.

Causes of clavicle fracture

Most often, injuries result in a fracture of this bone - an excessive effect of force on a certain area. The most dangerous of them:

  • A strong blow to the collarbone or to the shoulder girdle,
  • Falling from a height equal to / exceeding one's own height. The support in this case can fall on the straightened arm, on the elbow or on the outside of the shoulder.

In addition to injuries, damage to the clavicle can occur due to a violation of its normal structure. In this case, a fracture occurs even with minimal impact on the bone (sudden movement of the hand, push in the shoulder girdle, etc.). Such an injury will be called a “pathological fracture.” It can lead to:

  • Clavicle osteomyelitis is an infection of the bone that develops when microbes enter its tissue. Risk factors are: operations on the collarbone and surrounding soft tissues, the presence of any chronic infection in the body (pyelonephritis, cholecystitis, sinusitis, etc.), immunodeficiency (HIV or blood cancer),
  • Malignant bone tumors / metastases - osteosarcoma, giant cell tumor, fibrosarcoma. All of them lead to the destruction of normal tissue of the clavicle and the growth of atypical "irregular" cells,
  • Clavicle tuberculosis - this bone is rarely affected in the tuberculosis process, but Koch bacteria can also settle in its tissues. They gradually destroy them from the inside, which leads to thinning of the walls of the clavicle,

Symptoms of damage to the clavicle appear almost identically with conventional and pathological fractures. The main difference is the severity of intoxication and the presence of signs of damage to other organs, so that these conditions can be distinguished during diagnosis.

Anesthetize with available means

At home, as a rule, there is access only to non-hormonal anti-inflammatory (NSAIDs) or combined painkillers. The most common representatives: Pentalgin, Ibuprofen, Citramon, Analgin.

Do not use a large number of drugs at the same time - just one or two tablets is enough. The first effect of taking can be expected in 15-30 minutes, depending on the patient’s body and the drug. The doctor / ambulance should definitely name the medicine that the patient took.

Lock shoulder

Any movement in the shoulder joint will cause pain and contribute to the displacement of a bone fragment. Therefore, it is necessary to immobilize this segment of the limb. It is quite simple to apply a bandage for a collarbone fracture - at home it is recommended to use the usual 8-shaped one.

How to apply it? You should start winding from the healthy side - several circular rounds are carried out through the armpit and shoulder girdle, after which the bandage is led along the back and wrapped in the same way to the affected side. The dressing should be tight enough to prevent further displacement of the parts of the clavicle.

If attempts to immobilize your hand were unsuccessful, wait for the ambulance to arrive or use a scarf that will allow you to temporarily fix your shoulder. For this, the forearm should be placed in the middle of the scarf, and its ends tied behind the neck. It is important to note that the outer end must be held behind the back - this will reduce the load on the neck muscles and the likelihood of further displacement of bone fragments.

Apply cold to the affected shoulder girdle

It is necessary to perform the procedure within 5-10 minutes after receiving an injury. Cold helps reduce swelling and pain. Recommended application time is 30 minutes.

The ambulance team, after arrival, will assess the quality of limb fixation and correct existing deficiencies. If the dressing has not been applied, the doctor / paramedic will independently immobilize the upper limb belt. The standard means for an ambulance are rings for a collarbone fracture. Soft elastic rings are put on the affected and healthy shoulders, which are pulled together on the back by a locking mechanism. This temporarily prevents the displacement of fragments and somewhat reduces pain. Tires are currently not used for collarbone fractures.

After the patient is delivered to the doctor, the method of further treatment of clavicle fracture and the need for hospitalization are selected. These points will depend on the type of fracture and the presence of complications.

Treatment of a traumatic fracture

The main goals of treatment are to achieve a comparison of bone fragments and fix them in the correct position. If these conditions were met, the clavicle will grow together without any additional therapy within 1.5 months. Otherwise, bone repair may not occur for an extended period.

Currently, two main methods of treating traumatic fractures are used: conservative and surgical. The first method involves matching fragments using a special procedure - a closed reposition, which should be performed only by a qualified traumatologist. The operation for a fracture of the clavicle (surgical method) is performed in the presence of complications, severe displacement or when the skin is torn by parts of the bone (open fracture).

Gypsum overlay

An important part of treatment is the application of gypsum during a fracture, which will fix the clavicle for a long time in the correct position. Most often, Vanstein's dressing is used, covering the chest, shoulder girdle and forearm from the injured side. Despite the fact that it significantly restricts the patient’s movement, it should not be removed without radiographic confirmation of the fusion.

On average, the recovery period lasts 1-1.5 months. During this time, it is necessary to monitor the patient's condition and the healing process of the clavicle. Signs that should alert the patient:

  • The reappearance and increase of edema,
  • Prolonged redness of the skin in the shoulder girdle (longer than 5-6 hours),
  • Local temperature increase above the fracture site,
  • Increased pain in the clavicle.

If these symptoms appear, you should consult a doctor - he will examine the patient and determine the further treatment tactics.

Skin Care While Wearing Plaster

Patients are often concerned about skin irritation that occurs shortly after casting. How to prevent or alleviate it? To do this, remember a few simple rules:

  • Do not wet the gypsum - this will lead to its softening and adversely affect the skin. If moisture has got on or near an immobilized limb, it is necessary to allow the liquid to evaporate naturally. You can speed up the process with a regular hair dryer,
  • Protect the plaster from bumps and scuffs - wear only loose clothing on it and do not lean on the plaster during sleep,
  • If itching bothers you, do not try to “comb” the skin under the plaster with knitting needles, rulers, etc. Do not pour lotions or other liquids into the cast. This will only increase discomfort. To reduce discomfort, use a hairdryer, directing cold air into the gypsum.
  • Antihistamines also have antihistamines (Cetirizine, Cetrin, Claritin, Suprastin).

What to choose surgery or therapy?

In some cases, the traumatologist may offer the patient (or his parent) the choice of treatment tactics - to perform an operation or wait for an adhesion in a cast. What is better to choose in this case? As a rule, this does not affect the result - if the doctor provides several options, then he is confident in their success. Surgery differs from conservative treatment in only two main points.

The first is treatment time. After surgery, the patient can move his hand for 2-3 days, the bandage is removed after 2 weeks. Plaster must be worn for at least a month, which gives the patient significant discomfort.

The second is the consequences of treatment. Wearing a bandage / cast is a safe method for healing fractures. Of its possible complications, slow fusion or improper location of fragments (which can be easily prevented by regularly performing x-rays) are most often encountered. The operation with the application of bone plates or the insertion of a spoke into the collarbone is a serious interference with the normal functioning of the body. It is impossible to exclude the possibility of developing an infection, in this case. It is also important to remember that young patients must undergo a second operation after fusion - the removal of fixing devices. And this is an additional risk.

Each treatment method has its advantages and disadvantages. If there is a choice, doctors prefer the conservative method. However, the final decision rests with the patient.

Features of treatment of clavicle fracture in children

Clavicle fracture is one of the most common injuries of children aged 12-17 years. When treating young patients, in most cases, doctors prefer surgical tactics. If possible, an open reduction is performed under regional anesthesia - an anesthetic drug (novocaine, lidocaine) is administered next to the brachial plexus, which completely eliminates the sensitivity in the operated area.

Unlike adults, children are more likely to perform intramedullary osteosynthesis - a small knitting needle is inserted into the collarbone for a period determined by the traumatologist.The fusion of parts of the clavicle occurs earlier, since the child has a more abundant blood supply to the tissues. After the operation, it is recommended to wear a 1-1.5 week fixation bandage, which will prevent re-displacement of the fragments.

What can not be done after a fracture of the clavicle?

The end of treatment does not mean complete restoration of the clavicle. The resumption of stress on the arm and damaged shoulder girdle should occur gradually to avoid the development of repeated injuries.

Immediately after removing the plaster / dressing, you can not exercise and heavily load the upper limb. It is not recommended to carry a bag or briefcase on the damaged side, lean on your shoulder for a long time and extend your arm. During this period, muscles that have weakened after treatment should be gradually developed and strengthened. To do this, you can use the following exercises:

  • Slowly raise your hand above your head and gradually lower it. If you feel pain at the same time - do not be alarmed. The doctor would not allow the plaster or bandage to be removed if he were not sure of the successful fusion. As a rule, unpleasant sensations are associated with the occurrence of contracture - a temporary restriction of movements in the joint, due to changes in muscles and tendons. Overcome pain very carefully, slowly (over the course of days and weeks) increasing the amplitude of movements,
  • Take your hand away from the body and slowly bring it back. In the process, tighten the muscles to restore their tone and restore their former strength,
  • Try to perform circular movements in the shoulder joint, gradually increasing the swing of the arm.

Not earlier than 1.5-2 months after the removal of the gypsum, you need to add load on the arm and collarbone. To do this, you can use lightweight dumbbells (1-3 kg) or just carry a shopping bag on the damaged side. It is also recommended to use shoulder expanders and certain groups of simulators (“Butterfly”, “Boat”, etc.) with small weights (up to 5 kg). The load should be gradually increased.

You can actively engage in sports after 5-6 months after removing the bandage or plaster. It was at this time that the collarbone takes on the same structure and strength, and the muscles take on tone and strength.

Features of a collarbone fracture in newborns

One of the obstetric complications is a fracture of the clavicle of the newborn. This condition can occur for four main reasons:

  • Large fruit - the weight of the child is more than 4 kg,
  • Anatomical narrow pelvis of the mother - if the dimensions of the bony walls of the pelvis are insufficient for the fetus to pass through the birth canal, obstetricians perform a cesarean section. If another tactic was chosen, the child may be injured,
  • Weak labor - if fetal promotion spontaneously stops in the birth canal, doctors use obstetric forceps or a vacuum to remove the baby. In this case, the possibility of injury to the clavicle
  • Forced labor - an active period of labor, normally lasts 12-14 hours. When accelerating this process (up to 4-6 hours), the child may be injured during the rapid passage of the birth canal.

According to statistics, a fracture of the right clavicle is more common than the left. Identifying the injury is quite simple - in children under one year of age, damage to this bone is visible during external examination, a pronounced edema and redness appear in the region of the shoulder girdle. The child is constantly in pain, expressing it with angry crying. The hand on the injured side does not move in the shoulder joint, as this enhances the pain.

Fracture, most often, occurs as a “green branch”, which significantly speeds up the healing process. The treatment tactics are mainly conservative - a bandage is applied to the newborn for 6-7 days, provide peace and regular breastfeeding (if possible). Any consequences of the fracture are extremely rare.

How to care for a child with a collarbone fracture?

Despite the fact that the fracture heals quickly enough, at this time the child should be provided with proper care. First of all - you cannot re-injure the collarbone. Since fragments, most often, are connected only by a thin strip of periosteum, it is very easy to break it. Within a week, after applying the bandage is prohibited:

  • Pull the handle on the damaged side,
  • In any way, injure the child’s shoulder / shoulder girdle,
  • Press on the area of ​​the clavicle.

Swaddle the baby should be as before - without additional effort or reduce the contraction of the diaper. When motion sickness, it is recommended to put the small patient on the healthy side, gently holding (but not squeezing) the handle on the damaged side. During sleep, the child should be on his back.

For any baby, the presence of milk in the mother is extremely important - this is the optimal food product that the mother's body created for her baby. With a collarbone fracture, the value of breastfeeding increases further, since milk serves as a source of “building materials” for bone restoration. It is recommended to feed the child "on demand", which he expresses by hungry crying.

Clavicle fracture is a common trauma, especially among young people. It is quite easy to suspect, thanks to the characteristic symptoms. If available, call an ambulance or contact your nearest emergency room / surgical hospital. Doctors will establish a final diagnosis, and then determine the optimal treatment tactics. Rehabilitation after a fracture occurs relatively quickly - an average of 1.5 months. Complications develop extremely rarely, which allows patients to fully restore their previous quality of life.

How can I break a collarbone?

The structural features of the bone do not provide for a rigid protective surface, so the collarbone can be broken in several ways. One of the most common is a dislocation of the acromial end (ICD code S42.0). This can happen as a result of a blow to the shoulder joint, when falling on the elbow or bruised arm in a traffic accident. Fractures of a pathological nature that occur when a malignant neoplasm affects a bone are rarely seen. Also, a crack in the clavicle sometimes forms with a sharp contraction of the muscles.

Signs of a clavicle fracture

Typical clinical signs indicating deviations from the natural state of the bone are a direct indicator of the presence of the disease. The main symptoms of a clavicle fracture are directly related to severe pain in the affected area, which the patient experiences after receiving an injury. Attempts to make any movement with the injured limb will be doomed to failure, as severe pain will not allow the victim to even raise his hand. In addition, edema or swelling will appear on the forearm, which clearly indicates a bruise.

Clavicle fracture surgery

Surgical intervention is far from necessary in all cases, however, if the patient does not want to have visible deformations on the body, therapeutic massage will not help here. During the operation, when the collarbone is fractured, the bone is fastened with a special metal structure, which eliminates the displacement of fragments. Osteosynthesis can be performed using screws or plates, the choice is made by the attending physician based on the nature of the fracture (open, closed).

Clavicle splint splint

Clavicle fracture is a complex trauma, the treatment of which requires a special approach, since it is not possible to splint directly the paired humerus. For this reason, the tire in case of collarbone fracture is superimposed with an elastic bandage or dressing. The success of the event will depend on how effectively it is possible to fix the arm and immobilize the shoulder girdle. It is equally important to press the shoulder to the body as much as possible by placing a cotton swab under the arm.

Plaster for collarbone fracture

Proper therapy always involves the application of gypsum due to the exclusion of complications in the healing process. In the absence of gypsum during a collarbone fracture, there is a risk of damage to nerve trunks, muscles or a group of vessels, which will inevitably lead to improper bone fusion. A broken collarbone requires urgent immobilization, if appropriate measures are not taken, the patient risks permanently being disabled. Modern materials for the treatment of fractures have several advantages:

  • availability,
  • strength,
  • high plastic properties
  • cheapness.

Clavicle fracture dressing

Plaster and splint for the treatment of clavicle fractures are integral parts of the therapy process. However, the use of other attributes of medical practice is often required. Often, the immobilization of a collarbone fracture involves the use of dressings during the provision of first aid, but they are also indispensable at the stage of patients undergoing rehabilitation therapy. The most famous dressings for treatment in medical circles are:

  • blindfold Delbe
  • Kuzminsky’s tire,
  • eight-shaped soft dressing,
  • Seira's dressing,
  • oval Titova.

Delbe's rings for a collarbone fracture

There is another no less effective method of applying a bandage that restores the length of the clavicle - these are Delbe rings. According to the rules of desmurgy, the rings for a collarbone fracture should be prepared as follows: two rings are formed of cotton wool wrapped in gauze, the holes in which are slightly larger than the diameter of the shoulder of the victim. The resulting design is put on through the hands, stretching to the muscle hollows, after which the rings are tied to the patient’s back with a special rubber tube.

8-shaped bandage

An eight-shaped bandage on the clavicle is one way of immobilization. It is superimposed only after the acute fragments have been repaired by a doctor, it is contraindicated to do this when providing first aid, otherwise the injury will heal for a very long time. The main objective of this dressing is to prevent the displacement and extension of bone fragments, so it is imposed very tightly. In the case when it is not possible to eliminate the bias in this way, a surgical procedure is performed to reposition.

How to sleep with a collarbone fracture

After receiving medical care, the patient should adhere to certain rules for a speedy recovery. Safety measures are aimed at providing the injured area with the most favorable conditions for rehabilitation, so sleep with a collarbone fracture is allowed only on the back or healthy side. Doctors recommend removing the bandage for the night and straightening the arm where there is a fracture of the clavicle. If necessary, you can buy special dumbbells for muscle development.

Consequences of fracture

No treatment process can give a 100% guarantee of the healing of the resulting injury, so the consequences of a collarbone fracture can be very different. And although in most cases this ailment resolves quickly, some patients have noted complications such as slow healing during therapy. In addition, with a multi-fragmented fracture, the following can occur:

  • arthrosis of the joints
  • violation of the ratio of soft tissues,
  • risk of rupture of the skin,
  • neurovascular bundle damage,
  • bone infections or growths.

Smirnov-Weinstein bandage

A bandage for treatment is used very rarely, especially if the collarbone is broken. This decision is explained by the need for surgical intervention when a patient receives a fracture. The position of the injured bone affects the choice of the method of therapy, therefore, in some cases, special means are used, such as the Weinstein dressing. By the principle of overlapping, it is similar to Velpo or Deso dressings, however, it has its own nuances:

  1. The arm is bent at right angles to the elbow joint.
  2. The shoulder is lifted at an angle of 45 degrees and slightly retracted.
  3. A roller is placed in the axillary region.
  4. A cotton-gauze dressing is applied to the shoulder girdle of the opposite side.
  5. The shoulder girdle is fixed with smoothed longs.
  6. The spacers are fixed with a plaster bandage.

Deso Bandage for Clavicle Fracture

Using this dressing, you can immobilize a certain part of the patient’s body, it is mainly used for injuries of the humerus or collarbone. In addition, this dressing can be done during the rehabilitation period or after operations. The Deso bandage for a collarbone fracture is applied only to reposition the dislocation, if any. Before the procedure, it is important to examine the muscle cavity for maceration of the skin. To apply the dressing you will need a cotton swab, pin and wide bandages.

Clavicle fracture recovery

Exercise therapy after an injury includes three main stages, each of which is an important component of the recovery process for any patient, whether an adult or a child. First, the patient undergoes immobilization using bandages, it includes simple exercises for the hand and fingers. The second stage of recovery after a fracture of the clavicle is carried out using special gymnastic sticks. During this period, the patient needs to develop the shoulder joint. After removing the gypsum, physiotherapy exercises are added, including additional procedures:

  • amplipulse therapy,
  • high frequency magnetotherapy,
  • remote shock wave therapy,
  • mineral water,
  • low frequency magnetotherapy,
  • hydrogen sulfide baths,
  • Erythema doses of UV radiation
  • UHF therapy
  • ultrasound therapy
  • physiotherapy
  • physiotherapy
  • sodium chloride baths,
  • electrophoresis of painkillers,
  • electrophoresis of vasodilator drugs.

Watch the video: Johns Hopkins All Childrens Sports Medicine - Clavicle Fractures (January 2020).