Introduction
Collarbone fracture is one of the most common bone fractures in children (about 10%). The gender distribution is not completely balanced: Boys make up the larger part of patients with about 2/3. A collarbone fracture can occur in a variety of ways. The majority of fractures can be treated in a very uncomplicated manner and without surgical intervention.
Causes
The causes of a collarbone fracture are largely to be found in accident situations. The violent impact can be directly on the clavicle, for example a fall in which the child hits a solid object, another person or the ground with the clavicle. Direct traumas account for about 90% of clavicle fractures.
Less common are fractures of the clavicle caused by indirect force. This means that the child does not hit directly with the collarbone, but absorbs the fall or impact with the hand or elbow. The force acting on the arm is transferred to the collarbone.
Since the collarbone is not built to withstand such enormous forces, it can also fracture (break) in such accidents. This is the case, for example, when a child falls off a bicycle and hits the ground with the handlebars and tries to restrain himself with his hand or arm. Similarly, a collarbone fracture can also occur when playing with other children, in sports involving direct physical contact (e.g. soccer).
A further cause is the obstetric traumatic fracture. At birth, the child must pass through the very narrow birth canal to the outside. It may happen that the child bumps against bony structures of the mother, e.g. the symphysis (the connection between the two pubic bones in the anterior pelvis). If the birth is more complicated and requires manual or forceps assistance, a fracture of the clavicle may also be caused by this force.
Symptoms
The symptoms in the children manifest themselves as mild to severe pain in the shoulder area. The movement of the arm is painful to impossible. The arm is usually held in a gentle position on the body.
If the arm is moved upwards and against resistance, the child complains of pain and may not be able to perform the movements. Other symptoms are swelling in the area of the collarbone and redness. Bruises in the shoulder area can also indicate a fracture.
Fractures with dislocations (displacements) show visible steps in the clavicle, which may also be pushed away. Another symptom is that the child puts his or her head slightly on the injured side, as this means that less traction is applied to the broken collarbone, thus reducing pain. The pain of a clavicle fracture can sometimes be very severe.
The fracture irritates the periosteum, which causes the pain symptoms. Pain relief is already achieved by immobilising the arm. Since the clavicle is not affected by muscle tension, it does not move and the ends of the fracture are close together, allowing them to heal.
Pain relief in children can be achieved with paracetamol and ibuprofen. The dosages of the drugs must be adjusted to the child’s body weight, so the pediatrician should be consulted at the first administration. Often, especially in children, distraction from the pain helps. Since children can easily get distracted by playing or
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