Collarbone fracture or clavicle fracture is one of the most common, but at the same time the least dangerous fracture injuries. In a clavicle fracture, the clavicle (collarbone) breaks. This is the connecting bone between the shoulder blade and the chest connects. A fall on the extended arm or shoulder is the most common cause of this fracture injury.
What is a clavicle fracture?
A clavicle fracture is also commonly known as a collarbone fracture. A tubular bone, about the length of a hand, attaches the shoulder blade to the rib cage at the sternum. This bone is called the clavicle or collarbone. It is very common for this bone to break. Among bone fractures, only the radius fracture is more common. In most cases, children and adolescents are affected. The clavicle can break in different ways and in different places. Accordingly, clavicle fractures are classified into four types. Type 1 are stable fractures that are outside the ligaments. Type 2 are unstable fractures that are located between the outer ligaments and have the inner fragment protruding upward. In type 3, the fracture is outside the outer ligament attachments. In type 4, the outer and soft bone mantle is merely displaced but not severed. This type of clavicle fracture occurs only in children.
Causes
A clavicle fracture is always associated with some force. By far the most common causes are falls. Whereby most often a fall occurs on the shoulders or on an outstretched arm. Especially falls on the outstretched arm often occur in sports. In addition to falls, a fracture of the clavicle can also occur as a result of direct force. For example, blows to the front of the shoulder can cause a fracture. But fractures of the clavicle also occur in traffic accidents, because the seat belt exerts a strong pressure on the shoulder area during the impact. It is possible for an awkward position during birth to cause a fracture of the clavicle in babies.
Symptoms, complaints and signs
The symptoms of a clavicle fracture are very clear. For example, in most cases, the two ends of the fracture of the bone move against each other, resulting in a palpable step on the clavicle. In many cases, this is also visible. Hematoma formation and swelling often occur at the fracture site. More rarely, it is an open clavicle fracture. In this case, the ends of the bone have impaled the skin and open wounds and bleeding occur. There is pain when pressure is applied to the fracture site. In some cases, there is also pain when the head is turned because the head turn muscle is against a piece of the clavicle. There is always pain when the arm is moved on the side of the body with the fracture. Sufferers often place their arm in a protective position. In this position, the arm is shifted slightly forward and rests against the body. This results in shoulders that are pulled forward. If the shoulder joint is moved, audible rubbing noises may also occur. Pain may also occur in this case. In rare cases, injury to the nerves or tendons in the area of the clavicle also occurs as a result of the fracture.
Diagnosis and course
A clavicle fracture shows typical symptoms, so that in all cases the fracture can already be diagnosed on the basis of these symptoms. In the case of a fracture of the clavicle, the arm on the side of the fracture is automatically held in a protective posture. The shoulder is slightly tilted forward. In addition, swelling and bruising in the fracture area often indicate a clavicle fracture. In many cases, there is a palpable and visible step at the fracture site. Pain occurs when pressure is applied to the affected shoulder or when the arm is moved. If the affected shoulder joint is moved, a typical rubbing noise can often be heard at the fracture site. X-ray examination or computed tomography are used to confirm the diagnosis. If a clavicle fracture is diagnosed, it is important to check whether nerves or vessels are also affected by the injury. Usually, a clavicle fracture heals well and without complications.
Complications
As a result of a clavicle fracture, there may initially be severe pain, bruising, and swelling in the arm, usually associated with limited movement.Occasionally, these restricted movements in the arm and shoulder persist permanently. In people with certain pre-existing conditions, bone healing is delayed or fails completely. Shortening of the clavicle may also occur, usually associated with reduced range of motion of the affected arm. If the clavicle fracture is not treated or is inadequately treated, it can develop into a chronic condition. Surgical intervention is always associated with certain risks. Rarely, the clavicle becomes inflamed after the operation or bleeding, wound healing disorders and the formation of scars occur. If nerves are injured, sensory disturbances may occur. If muscles, joints or cartilage are injured, there is a risk of permanent movement restrictions. An inserted implant may fail, break or migrate and subsequently have to be replaced by a second operation. Lastly, allergic reactions to the materials and agents used may occur. Prescribed medications can cause undesirable side effects and, in the case of undiagnosed diseases, can cause serious complications.
When should you see a doctor?
A fracture of the clavicle should, of course, always be treated by an appropriate physician. Otherwise, a complete and timely recovery is not possible. Affected persons who suffer such a fracture usually visit a doctor or hospital quite automatically. The pain of such a fracture is immense and unbearable, so that as a rule the nearest hospital or an emergency doctor is visited. However, in such a case, not only the initial treatment is very important, as surgical intervention may be necessary. This can ensure that the broken bone grows back together properly. If you forgo visits to the doctor later in the healing process, you are taking a very big risk. The broken bone may grow together in a malposition, causing severe pain. Thus, the following applies: The fracture of the clavicle must be treated medically and with medication in any case. This is the only way to ensure complete healing. If this is waived, then there is a risk of complications that can not be properly restored afterwards.
Treatment and therapy
A clavicle fracture can be treated in two ways. In nearly 98 percent of cases, treatment is conservative therapy. However, surgical treatment may also be necessary. The method by which the fracture is ultimately treated always depends on the results from the X-ray examination. In conservative treatment, patients receive a backpack bandage for approximately three to four weeks. This is a traction bandage that is applied around both shoulders and is tightened and pulled tight at the back. In this way, the shoulders are pulled back and the broken bones are brought into the correct position. In most cases, the treatment is followed by physical therapy to restore full mobility to the shoulder. Whenever blood vessels or nerves have been injured by the fracture, or in the case of severely displaced fractures, the clavicle fracture must be treated surgically. During surgery, injured vessels are taken care of and the fracture is fixed either by metal plates or screws. These must be removed after six months to a year. After surgery, the arm and shoulder are fixed and immobilized by what is called a Gilchrist bandage to allow the clavicle fracture to heal.
Prevention
A clavicle fracture cannot really be prevented. It is usually a sports or accidental injury. Taking the necessary precautions when playing sports or even in other fall-prone situations can, at best, reduce the risk of injury and thus prevent a clavicle fracture.
Aftercare
If conservative treatment of the clavicle fracture is not sufficient, surgery may be performed, which in turn requires follow-up care. Treatment is performed on an inpatient basis, and a review of the sensitivity of the affected arm takes place as early as the first few days after surgery. Among other things, the patient should move his elbow or make a fist. The drainage, which is applied during the operation, can be removed after three days at the latest. After the operation, the surgical wound is thoroughly checked in the first few days.In this way, possible wound healing disorders or infections can be detected at an early stage and treated accordingly. If the wound heals as planned, the stitches are removed after around 14 days. Another important part of aftercare for a clavicle fracture is physiotherapy exercises. They are used to rebuild the affected muscle sections. In addition, the aim is to enable the shoulder to move fully again. Additional bandages do not usually need to be applied. X-ray examinations are performed to monitor progress. They are performed after five to six weeks. Depending on the results, the patient should not lift or carry heavy loads with the treated arm for about six to eight weeks. A final X-ray check is performed after three to four months. To treat any remaining pain, the patient may receive accompanying appropriate medication.
What you can do yourself
If the collarbone is fractured, the shoulder should first be cooled. This will relieve the pain and reduce the bruising. Rapid cooling by application of compresses can help the healing process. After treatment, the doctor’s instructions should be followed first and foremost. The affected shoulder should be rested. It is best to sleep in a supine position and with an orthopedic pillow to avoid further strain. Patients whose jobs place a lot of stress on their collarbone are best advised to take a sick leave. In addition, various household medications can be used to relieve the pain. For example, ointments made from aloe vera, quark compresses or pain-relieving teas are suitable. In consultation with the doctor, the healing of the fracture can be accelerated by targeted massages. Patients should ideally be referred to a specialist for this purpose. Otherwise, complications may arise that impair the healing process. A collarbone fracture should be largely healed after three to four weeks. Until then, the medication prescribed by the doctor must be taken and the suggested measures for rest must be followed. If the complaints persist or severe pain and restricted movement occur, a visit to the doctor is recommended. In addition, various homeopathic remedies such as arnica or St. John’s wort help. Patients are best to consult a suitable alternative practitioner for this purpose.
