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Clavicle fracture
Classification and external resources
X-ray of a left clavicle fracture
ICD-10	S42.0
ICD-9	810
MedlinePlus	001588
eMedicine	orthoped/50

A clavicle fracture is a bone fracture in the clavicle, or collarbone. It is often caused by a fall onto an outstretched upper extremity, a fall onto a shoulder, or a direct blow to the clavicle.

Contents 1 Frequency 1.1 History 2 Symptoms 3 Treatment 4 Post Surgical Healing 5 See also 6 References 7 External links

[edit] Frequency

Clavicle fractures involve approximately 5% of all fractures seen in hospital emergency admissions^{[citation needed]}. Clavicles are the most common broken bone in the human body^{[citation needed]}. It is most often fractured in the middle third of its length. Children and infants are particularly prone to it. Newborns often present clavicle fractures following a difficult delivery.

After fracture of the clavicle, the sternocleidomastoid muscle elevates the proximal fragment of the bone. The trapezius muscle is unable to hold up the distal fragment owing to the weight of the upper limb, and thus the shoulder droops. The adductor muscles of the arm, such as the pectoralis major, may pull the distal fragment medially causing the bone fragments to override.

[edit] History

Hippocrates, 4th century BC:

• When, then, a [clavicle] fracture has recently taken place, the patients attach much importance to it, as supposing the mischief greater than it really is, and the physicians bestow great pains in order that it may be properly bandaged; but in a little time the patients, having no pain, nor finding any impediment to their walking or eating, become negligent; and the physicians finding they cannot make the parts look well, take themselves off, and are not sorry at the neglect of the patient, and in the meantime the callus is quickly formed. [1]

The management of skeletal injuries in ancient Egypt – Collar bone:

• If thou examinest a man having a break in his collar bone and shouldst thou find his collar bone short and separated from its fellow, I will treat. Place him prostrate on his back with something folded between his shoulder blades; thou shouldst spread out with his two shoulders to stretch apart his collar bone until the break falls in its place. [2]

[edit] Symptoms

• Pain, particularly with upper extremity movement
• Swelling
• Often, after the swelling has subsided, the fracture can be felt through the skin.
• Sharp pain when any movement is made.
• Referred pain: dull to extreme ache in and around clavicle area, including surrounding muscles.
• Possible nausea, dizziness, and/or spotty vision due to extreme pain

[edit] Treatment

Treatment usually involves resting the affected extremity and supporting the arm with the use of a sling. In older practice, a figure-8 brace was used, designed to immobilize and retract the shoulder, maintaining symmetric positioning to facilitate healing. More recent clinical studies have shown that the outcomes of this method were not measurably different from simple sling support^{[citation needed]}, and due to the movement difficulties caused to the patient, this method has mostly lapsed^{[citation needed]}. Current practice is generally to provide a sling, and pain relief, and to allow the bone to heal itself, monitoring progress with X-rays every week or few weeks. Surgery is employed in 5-10% of cases. However, a recent study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients^[1].

More than 90% of clavicle fractures are successfully healed by non-operative treatment. The surgery is indicated when one or more of the following conditions presents.

1. Comminution with separation (multiple piece)
2. Significant Foreshortening of the clavicle (indicated by shoulder forward).
3. Skin penetration (Open Fracture).
4. Clearly associated nervous and vascular trauma (Brachial Plexus or Supra Clavicular Nerves).
5. Non Union after several months (3–6 months, typically)
6. Distal Third Fractures which interfere with normal function of the ACJ (Acriomio Clavicular Joint).

A discontinuity in the bone shape often results from a clavicular fracture, visible through the skin, if not treated with surgery. Surgical procedure will often call for ORIF (Open Reduction Internal [plate] Fixation) where an anatomically shaped titanium or steel plate is affixed along the superior aspect of the bone via several screws. In some cases the plate may be removed after healing, but this is very rarely required (based on nerve interaction or tissue aggavation), and typically considered an elective procedure. Typical surgical complications are infection, neurological symptoms distal the incision (sometimes to the extremity), and non-union requiring re-plating.

[edit] Post Surgical Healing

Healing time varies based on age, health, complexity and location of the break as well as the bone displacement. For adults, a minimum of 3–4 weeks of sling immobilization is normally employed to allow initial bone and soft tissue healing, teenagers require slightly less, children can often achieve the same level in two weeks. During this period, patients may remove the sling to practice passive pendulum ROM exercises to reduce atrophy in the elbow and shoulder, but they are minimized to 15-20 degrees off vertical.

The immobilization is followed by a theraputic regimen of passive exercises, and later of active exercises. Full radiological union is typically achieved in 16 weeks for adult surgical patients, and shorter times are achieved by teenagers and young children. In patients who participated in prescribed physical therapy, 85-100% mobility returned in 6–9 months, with full strength returning in 9–12 months.
More details can be found in the following studies:
http://www.ejbjs.org/cgi/content/full/89/1/1
http://www.ejbjs.org/cgi/content/full/91/2/447
http://www.ejbjs.org/cgi/content/abstract/90/Supplement_2__Part_1/1
http://www.jaaos.org/cgi/content/abstract/15/4/239

[edit] See also

• Bone healing

v • d • e Injury : Fractures (Sx2, 800-829) General Avulsion fracture · Greenstick fracture · Salter-Harris fractures Head Skull fracture · Basilar · Blowout Vertebral Cervical · Jefferson · Hangman's · Flexion teardrop · Extension teardrop · Clay-shoveler · Burst · Compression · Wedge · Chance · Hyperextension fracture dislocation Ribs Rib fracture · Flail chest · Sternal Shoulder, arm and hand Clavicle · Humerus (Supracondylar) · Monteggia · Galeazzi · Colles' · Smith's · Barton's · Scaphoid · Rolando · Bennett's · Boxer's · Distal radius · Scapular Hip, leg and foot Hip fracture · Patella fracture · Calcaneal fracture tibia · fibula tibia: Bumper, Segond · fibula: Maisonneuve · both: Trimalleolar, Bimalleolar, Pott's metatarsal Lisfranc · Jones · March Bone and cartilage navboxes: anat / physio / dev, noncongen / congen / neoplasia, symptoms+signs / eponymous signs, proc

v • d • e Chest trauma Chest wall injuries and fractures Rib fracture (Flail chest) · Sternal fracture · Clavicle fracture · Scapular fracture Lung and respiratory system injuries Pneumothorax (Tension) · Hemothorax · Hemopneumothorax · Pulmonary contusion · Pulmonary laceration · Tracheobronchial injury · Diaphragmatic rupture (Diaphragmatic hernia) Cardiac and circulatory system injuries Pericardial tamponade · Hemopericardium · Myocardial contusion · Traumatic aortic rupture · Thoracic aorta injury Injuries of other systems Esophageal injury

[edit] References

[edit] External links

• /clavicle-immobilization.info Elastic wrapping method