break of collarbone

Collarbone fracture: description

The clavicle (clavicle) is the only bony connection between the arm and trunk skeleton. It runs between the sternum and an appendix of the scapula (acromion).

The fractured clavicle (clavicle fracture) is one of the most common fractures with three to five percent of all fractures and about 45 percent of all shoulder injuries. About 60 out of every 100,000 people suffer a broken collarbone every year. Due to the changed leisure behavior, which is the trend for risky sports, the incidence of clavicle fracture is also increasing.

The fracture occurs mainly in young people in the first and second decades. Hereby, especially the male sex is affected.

Despite its frequency, the fractured collarbone is one of the most innocuous fractures. After fracture of the radius near the wrist (distal radius fracture), this fracture is the second most common adult fracture injury.

Clavicle fracture: symptoms

A typical symptom of a broken collarbone is pain. Any attempt to move the arm or chest is extremely painful. The sufferers therefore often take a restraint. An audible friction noise of the bone fragments when moving is also a sign of a fracture. Directly above the broken collarbone is usually a bruise and a swelling. If the fracture is postponed, it can often be seen in lean people, a stage in the course of the clavicle – especially in the page comparison. However, in obese (adipose) or multiple trauma patients (polytraumatized patients), staging is often overlooked.

If there is a break in the outer third of the clavicle, a so-called piano key phenomenon may occur. Here, a broken end is up and can be pressed down like a piano key.

Very rarely (in one to two percent of all patients) is the clavicle fracture open, that is, the bone fragments stick out of the skin.

A collarbone fracture can also happen at birth. In the affected babies, the above symptoms are often less pronounced.

Collarbone fracture: causes and risk factors

Cause of a broken collarbone is usually an indirect trauma. This includes above all a fall on the outstretched arm, for example when inline skating or cycling. In fact, cyclists find a fractured collarbone the most common form of bone fracture.

Rarely, a direct trauma from being hit or dropped on the front shoulder is the reason for a broken collarbone. In a motorcycle accident, the collarbone may break when the lower edge of the motorcycle helmet is pressed against the clavicle.

The collarbone breaks in an indirect trauma usually in the middle (90 percent) and in a direct trauma usually in the outer third of the bone.

Occasionally, a collarbone fracture occurs in the newborn during birth, namely when the infant’s shoulder girdle is narrowed as it passes through the maternal pelvis. This danger exists especially with big babies.

Collarbone fracture: examinations and diagnosis

If you suspect a fractured collarbone, you should consult a doctor for orthopedics and traumatology. This will ask you first about the accident and your medical history. Some questions from the doctor might be:

• Did you fall on the shoulder or outstretched hand?
• How did the accident happen?
• Can you still move the shoulder or the arm?
• Do you have pain?
• Did you have any complaints like pain, restriction of movement or a previous dislocation of the shoulder?

The description of the accident and the symptoms often enough already that the doctor considers a collarbone fracture into consideration. It becomes more difficult if the patient is unconscious due to multiple injuries (polytrauma) and other injuries are the first priority.

To clarify the suspected diagnosis of collarbone fracture, a closer examination is needed. The doctor examines the Schultereckgelenk (acromioclavicular joint) and the sternum Schlüsselbeingelenk (sternoclavicular joint). He also examines the large key trabeculae (arteria and subclavian vein) and checks to see if the nearby nerve plexus (brachial plexus) is intact.

It is also important to exclude concomitant injuries such as pneumothorax (air entry in the pleural space) or hematothorax (blood in the pleural space). In addition, blood flow, motor skills and sensitivity are checked on the affected arm.

In infants, the pediatrician recognizes a broken collarbone based on the restraint and by scanning the collarbone. X-rays are rarely taken in babies.

Imaging procedures

This is followed by an x-ray examination at various levels. This can be safely clarified whether a collarbone fracture is present and how the break is. If it is unclear whether further joints are affected, still images of the shoulder joint, the sternum-Schlüsselbeingelenks and the chest are made. For further clarification, an ultrasound examination of the shoulder and the Schultereckgelenks can be performed.

Clavicular fractures in the mid range can sometimes not be assessed by a single X-ray. In this case, a computed tomography (CT) may be necessary. In the severely injured polytraumatized patient, CT is also usually performed.

Concomitant injuries of the collarbone fracture such as capsule ligament injuries of the shoulder can be assessed by magnetic resonance imaging (MRI).

Collarbone fracture: treatment

Collarbone fracture treatment aims to relieve the pain and restore a strong and stable bone at an early stage. Depending on fracture type can be treated conservatively or surgically.

Collarbone fracture: conservative treatment

About 90 percent of all collarbone fractures can be successfully treated conservatively. The patient first gets painkillers and the affected side is immobilized with a backpack or sling bandage. This conservative treatment is particularly suitable for a non-shortened and little or no shifted collarbone fracture. Pain and mobility of the shoulder and arm provide information about the success of the treatment.

The backpack bandage is put on a break in the middle and middle part of the body of the clavicle. It must be checked regularly whether the dressing is correct, otherwise there is a risk that the fragments will be moved. As a rule, adults must wear the backpack for three to four weeks and children for ten days.

If there is a fracture in the lateral third of the clavicle, a Gilchrist bandage is created.

Collarbone fracture: surgery

Collarbone fracture surgery is applicable for displaced fractures, interfragment fractures (z-shaped switch fragment), polytraumatized patients, open fractures or additional vascular and nerve injuries.

In a fractured collarbone with two fragments, nails are used, such as Prevot or TEN nails. For more complex fractures having more than two fragments, angular stable or non-angular plate systems are used. If a collarbone fracture is present in the outer third of the bone, Kirschner wires (flexible wire) can be used with cerclage (thread or wire) or, in special cases, a hook plate.

After the fractured collarbone surgery, the patient usually gets painkillers such as acetaminophen or ibuprofen. To protect the arm, an arm sling is created.

The shoulder joint should then be gently moved for six weeks to a maximum of the horizontal plane. Only after X-ray control, if a stable bone has been detected, shoulder-straining sports may be exercised. However, this should begin at the earliest after twelve weeks.

Collarbone fracture in children

In children, it is usually a closed shaft fracture. It is treated in small children with the sling and in larger children with the backpack. In case of injury to the outer third of the clavicle, surgery may be required. The break is temporarily stabilized with a Kirschner wire.

Collarbone fracture: disease course and prognosis

The collarbone fracture basically has a good prognosis. However, patients often underestimate how much the movement is restricted by the fracture.

Collarbone fracture: complications

The following complications can occur in a collarbone fracture:

• Absence of bone healing
• Bone can not be realigned
• Shortening of the clavicle
• Pain
• Swelling in the arm
• Ant walking (tingling paresthesia)
• Arm and shoulder can not be moved as originally

Surgery always involves certain risks such as inflammation. However, these occur only rarely. The following complications may arise in connection with the operation:

• wound healing
• infection
• Implant fails, breaks or wanders
• scarring
• numbness

Collarbone fracture: healing time

Duration and course of healing in a collarbone fracture vary depending on the type of fracture.

The prognosis is usually very good for a conservative treatment of a collarbone fracture. A slight shortening or misalignment of the collarbone after the end of treatment usually has no negative effect on the function of the shoulder joint.

After about three weeks, you can raise the arm to the horizontal. At the earliest after six weeks, a callus (newly formed bone tissue) is visible during X-ray inspection. At this time, you should have regained almost free mobility and be largely painless. Sports that strain the shoulder should resume after the twelfth week.

In an operative therapy, the patient is usually a little faster again fully resilient. An inserted implant is removed at the earliest after three months. In case of severe fractures, it should be maintained for at least six months, even in the case of an uncomplicated healing process.

In the long-term, 30 percent of affected individuals with collarbone fractures do not achieve optimal esthetic or functional results.

In children, a fractured collarbone usually heals after four weeks, forming a strong callus. The bone then rebuilds for years. One break of collarbone, which occurs at birth, usually heals without complications.