What is a Clavicular Fracture?
Clavicular fracture is a condition where partial or complete break of the clavicle or collarbone occurs following a direct trauma. This shoulder injury is common in all ages, but its incidence increases in the newborns after a difficult delivery and in young adults who are into contact sports.
A broken collarbone almost completely heals well in children. In adults, healing of clavicular fractures could take some time with increased risks of complications.
Because of the clavicle’s proximity to the glenohumeral joint and its slender and curved shape, it is the most common fractured bone in the shoulder. In actuality, clavicular fractures comprise 5% of fractures seen in emergency departments in the United States.
The clavicle, one of the three bones that make up the shoulder girdle, is the only connection between the shoulder girdle and the trunk. Strong fibrous bands of tendons attach this slender and doubly-curved bone to the scapula, through the acromioclavicular joint, and to the trunk, through the sternoclavicular joint.
Maintaining the integrity of the clavicle is essential as it also protects the major vessels, the lungs and the brachial plexus, a meshwork of nerves that control and direct impulses from the spine to the shoulder and upper extremity.
Causes
A fractured clavicle is commonly caused by falls, most especially the ones where one lands on the point of the shoulder or on an outstretched hand, or by a direct blow to the collarbone. And so, this fracture type is frequently seen in athletes who are into contact sports, such as football and wrestling.
A broken collarbone is commonly seen in newborns after difficult or prolonged vaginal deliveries.
Signs and Symptoms
After a direct trauma to the clavicle, the injured complains of severe pain in the involved extremity, worsening with arm movements. Intense pain results in the inability to raise the arm. Signs of swelling, bruising and abrasions are commonly seen in this condition.
In closed collarbone fractures, a clavicular deformity is visibly observed. Audible grating sounds on the affected area strongly indicate that the integrity of the collarbone has been completely disrupted.
In a case of an open clavicular fracture, where the broken bone opens through the skin, bleeding is frequently reported.
Diagnosis
Diagnosis of clavicular fractures is based on the results of physical examination and on the data obtained from the medical history. The mechanism of injury is also determined.
An X-ray is usually ordered to assess the severity of the injury and to determine if the extent of damage. If complications are suspected, chest radiography or an angiography might be indicated.
Treatment
After the trauma, the affected extremity is immediately immobilized with a sling to prevent any arm movement that could aggravate the injury. An ice or cold pack is applied to the involved area.
The first goal of treatment is to realign the fractured bones since it is of utmost importance that they heal in the correct position. The clavicle and the arm are immobilized through a sling, using a figure-of-eight clavicular splint or a triangular bandage.
An Ace bandage is also used to wrap around the arm and trunk to limit any additional movement that can worsen the condition. An ice pack application for 15 to 20 minutes, at least three times a day, for the first 72 hours is recommended to decrease the swelling and the pain.
To alleviate the pain, non-steroidal anti-inflammatory medications are usually prescribed. In an open fracture, the bleeding is initially controlled. Afterward, prophylactic antibiotics and tetanus immunization are additionally administered.
A surgical procedure might be necessary if the clavicle and the surrounding structures are severely displaced. If the vessels, the lung or the brachial plexus is damaged, an immediate surgery is recommended to prevent the occurrence of neurological or vascular complications.
After the fractured bones have fused and completely healed, physical therapy exercises are prescribed. Initially, the program includes simple ranges of motion exercises, progressing to shoulder strengthening and flexibility exercises to restore full shoulder function.
A gradual return to normal activities is also recommended.
