Synonyms
- Clavicula fracture
- Clavicle rupture
- Collarbone Fracture
Overview
The collarbone (lat. : clavicula) is a bone in the shoulder girdle and connects the sternum with the shoulder blade. It plays a major role in shoulder movements and maintaining stability.
The clavicle fracture is one of the most common but rather harmless bone fractures. In about 80% of cases, the clavicle fracture occurs in the middle part of the bone, the remaining 20% is distributed between the two end parts. In addition to conservative therapy, surgery is indicated for clavicle fractures when a complicated clavicle fracture is present, in order to achieve a complete recovery.
Symptoms
Classic signs of clavicle fracture are
- Swelling and pain over the collarbone
- Hematoma discoloration (bruise)
- Malalignment
- Restriction of function (Funktio laesa), especially when lifting the arm
- Crepitation (bone rubbing)
The affected arm is worn by the patient in a protective position close to the body, an independent movement in the shoulder joint no longer takes place (Funktio laesa). When looking at the patient, a swelling and often a step formation in the course of the collarbone is noticeable. The skin is usually uninjured; open clavicle fractures with exposed or impaled bone parts are the exception.
Above the clavicle fracture, the patient complains of considerable pressure pain. Any attempt to move the shoulder joint is perceived as extremely painful, and often frictional noises of the broken bone can be produced (crepitations). Together with a clear malposition of the collarbone and open clavicle fractures, crepitatio is a sure sign of the presence of a fracture.
During the examination, it is important not to forget to search for concomitant vascular and nerve injuries in order to avoid consequential damage through early intervention and, in case of doubt, to be able to distinguish between accidental and therapeutic (iatrogenic) etiology in the event of possible complications. In addition, further consequences of injuries should always be sought: Injuries of the shoulder
- Injuries to the lung (pleural impingement by bone fragments)
- Injuries to the ribcage
- Injuries of the spine
A collarbone fracture can be very painful. Pain in this type of fracture is very subjective and can be mild but also very extreme.
Important factors that can increase pain are the position of the fracture edges and the injury to the tissue around the collarbone. If the edges of the fracture are well aligned, the risk of injury to surrounding nerves, blood vessels or other tissue types is reduced. In extreme cases, a sharp protruding fracture edge can pierce through the skin or pleura, which can lead to a collapse of the lung.
A fracture always injures local surrounding tissue. This usually affects the periosteum, smaller blood vessels and small nerve endings. However, a collarbone fracture can also involve large vascular and nerve tracts that extend from the neck region into the arm.
These smaller injuries can also explain the bruising that occurs in most cases in the event of a fracture. This causes swelling and extreme pain when pressure is applied from outside. As a result, the collarbone fracture causes pain with every movement in the shoulder, sometimes also when breathing or when moving the cervical and thoracic spine.
The duration of the pain depends on the initial intensity of the pain, the extent of the fracture and the progress of healing. Children must be immobilized for about 3 weeks. The pain lasts for an average of 2-3 weeks, with the pain decreasing daily.
If the pain medication is slowly reduced, the strength of the pain may subjectively increase, but this may be related to the reduction in dose. In the case of larger tissue damage as a result of the fracture, the duration of pain may be longer. In particular, if larger conducting pathways or the pleura are involved, several weeks of healing may be imminent.
The main pain can be attributed to local swelling at the fracture site with extreme sensitivity to touch. Immediate measures that reduce the local reaction are immobilization and cooling.In order to be as painless as possible during the subsequent healing phase, the first priority is to avoid pain and to immobilize the patient. Any movement can provoke extreme pain.
In addition, painkillers can provide relief until the healing process has progressed. Painkillers from the NSAID group can be used for this purpose. Their most prominent representatives are ibuprofen, indometacin and diclofenac.
Their dosage must be selected in such a way that the shoulder is immobilised and the pain is almost completely eliminated. If this is not possible with these drugs, opiates such as morphine can also be prescribed. However, these should only be taken for as short a time as necessary, as morphine also causes certain side effects.
