Orthopedics-Online

Clavicle fracture

synonym

Collarbone fracture, clavicle fracture

definition

A break of the Collarbone is one of the most common types of fractures in children, and they are also relatively common in adults. A distinction is made between a fracture in the

inner (medial),
middle or
outer (lateral) One-third,

where the fracture of the middle third at a distance of most common is.
The causes are mostly Falls on the poor or the shoulder.

Symptoms of a clavicle fracture

Since the collarbone is relatively superficial, i.e. close under the skin, a sign of a fracture is often a swelling over the affected area.
Furthermore are a

Tenderness over this area and
Typical pain when moving the arm and chest.

Depending on the location of the fracture, a step formation can also be noticeable, since the outer and inner ends then protrude in different directions. Often those affected take a relieving posture in which they put their arm against their body and lean their shoulder forward.
With every fracture of the collarbone - as with every other fracture - it is important to have the DMS status checked by a doctor.

D stands for blood circulation,
M for motor skills and
S for sensitivity.

As part of a fracture, blood vessels or nerves can be injured, so that one or more of these qualities can be limited or failed. Then action must be taken quickly so that no permanent damage occurs.

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Pain in a clavicle fracture

In addition to swelling, restricted mobility and crepitations (rubbing of the bone parts), pain is a general sign of fractures. The pain usually occurs immediately after the trauma. If the trauma is indirect, the clavicle breaks in 80% of the cases in the middle third. This area in the middle third is particularly painful on pressure. In general, the pressure pain over the broken part of the clavicle is very pronounced. Pain in a clavicle fracture manifests itself primarily as pain in motion, which is associated with a restriction in arm and shoulder movement. Some of the pain can radiate to the chest, arm, and shoulder.

Read more on the topic: Pain in the collarbone

When does the pain subside?

The duration of the pain can vary individually. In the context of conservative (non-operative) therapy measures, those affected usually receive adequate pain therapy for acute pain reduction. However, immediate freedom from pain cannot be achieved immediately. Immediately after an operation, the pain can reappear because the surrounding tissue and the fracture site itself are irritated by the invasive procedure. In general, the pain should optimally subside with the start of therapeutic measures. In order to have a positive influence on a reduction in pain, those affected should rest their shoulders in a backpack or Gilchrist bandage for as long as prescribed. Overall, you can expect the pain to last up to 4 weeks. From then on, physiotherapeutic treatment can begin, which at best takes place in a painless state.

Operation of a clavicle fracture

In most cases, a clavicle fracture is treated non-surgically, i.e. conservatively.
In newborns who have contracted the fracture as part of a birth trauma, the fracture heals completely independently, so that there is no intervention here.
For older children and adults, bandage therapy, typically with a so-called backpack bandage, is the rule. The Gilchrist bandage, in which an arm sling is used, is also often used.

Surgery is only considered if the fracture ends

are sharply angled or
clearly overlap, i.e. lie in a pronounced misalignment.

Here the operation serves to correct the deformity. This is particularly common with fractures in the area of the external (lateral) The collarbone is necessary, as these are the most unstable and a bandage is often not sufficient for stabilization. The operation then combines an open reduction, which means that after a skin incision, the ends of the fracture are brought back into the correct position, and fixation with an implant, usually one

Plate or with
Wires.

This is known as osteosynthesis.
A so-called intramedullary nail osteosynthesis, in which a nail is inserted into the collarbone, has also become more and more established in recent years. The advantage of this variant is that only small incisions are necessary.
In any case, an operation must be performed if:

Accompanying injuries to vessels and nerves,
with open fractures (i.e. those in which the fracture ends have pierced the skin),
for fractures close to the joint and
for fractures with additional dislocation, i.e. dislocation.

When do I need an operation?

There are clearly defined reasons when those affected need surgical treatment for a clavicle fracture. In medicine one speaks of absolute indications. This includes, on the one hand, the open clavicle fracture, i.e. when a piece of bone has speared the thin skin above it. The existing risk of spit through afterwards makes an operation necessary. A dislocated fracture can also only be treated surgically. Dislocated describes the condition of the resulting bone fragments. If these are shifted or twisted against each other, one speaks of a dislocation. Due to this position, the bone ends can no longer grow together correctly, so that the original physiological shape and functionality can be restored. As soon as there are injuries to surrounding structures such as nerves, ligaments or vessels as part of the clavicle fracture, these must be treated in a surgical procedure next to the fracture itself. An operation may still be necessary if conservative therapeutic measures already taken remain unsuccessful after 3 to 4 weeks. In addition, healing disorders of any kind are considered a reason for an operation. Nowadays it is known that better results in terms of functionality can be achieved with the help of surgical measures than with conservative therapeutic approaches. Therefore, apart from the absolute indication criteria, an operation makes sense if those affected have to put full load on the shoulder and arm for professional or sporting reasons and are therefore dependent on a complete restoration of functionality.

Should you remove the plate after an operation or not?

If a clavicle fracture has been treated with a plate, later metal removal is usually planned. The plate is only removed when the clavicle has had enough time to grow back together. So don't set the date for metal removal too early. However, a later point in time is also not optimal, since the surrounding tissue can then have formed too much around the plate, which makes removal more difficult.

In the event of a clavicle fracture, the plate is removed after about 18 months. In children, removal may be indicated earlier. The whole thing is carried out in a small surgical procedure under general anesthesia, which only takes about 45 minutes. The incision is made as in the first procedure, so that there is no second scar.

Follow-up treatment of a clavicle fracture

There is a fixed follow-up regimen for the follow-up treatment of a clavicle fracture. Wearing a Ruck or Gilchrist bandage is always indicated. For the further procedure you can orientate yourself on the wound healing phases. Up to the 5th day one speaks of one Inflammatory phase. Pain reduction, manual lymph drainage and maintaining mobility of the elbow and wrist of the affected side play a role here. From the 5th day the healing process begins Proliferation phase over. The focus is now on the careful mobilization of the shoulder with the help of various measures. It is important that those affected perform these exercises correctly under guidance, as this is the only way to positively support the healing process. After about 4 weeks, we are now talking about the Conversion phase, the mobilization of the shoulder can be increased to over 90 ° movements. Another x-ray check should take place 2 weeks later. The return to a certain sport must be discussed individually, taking into account the healing progress and the sport.

Backpack bandage as follow-up treatment for a clavicle fracture

The rucksack bandage is an integral part of the follow-up treatment scheme for a medial / central clavicle fracture. Wearing a rucksack bandage is not indicated for fractures on the outside; a Gilchrist or Dessault bandage is created here. The primary goal when using the rucksack bandage is to immobilize the clavicle and thereby alleviate pain. It also serves the purpose of stabilizing the shoulder. The rucksack bandage consists of padded loops that run like the straps of a rucksack - hence the name. The loops converge on the back in an intermediate piece. This adapter varies depending on the manufacturer or model, but is often shaped like a ring to thread the loops. The tightness is also adjustable on this intermediate piece. By wearing the rucksack bandage, a straight back posture is achieved and the shoulder is pulled down and back. The tightness must be checked regularly in order to be able to make possible corrections in the form of loosening or tension. On the one hand, it is essential that the clavicle has an optimal position through the right amount of tension and, on the other hand, that a misalignment of the shoulder blade can be avoided. In general, the correct application of the rucksack bandage must be ensured, as otherwise it will negatively affect the healing process. Overall, the wearing time for adults is 3-4 weeks, but only 10 days for children.

Physiotherapy after a clavicular fracture

Physiotherapy treatment after a clavicle fracture is always necessary. Physiotherapy usually starts after around 4 weeks. The exact start varies, of course, depending on the healing process.

At the time of the first physiotherapy session, those affected have to occasionally wear the Gilchrist bandage or backpack bandage. This can safely be put down for the exercises and then put on again.

The aim of physiotherapy is to carefully mobilize the shoulder and bring it back to full capacity and functionality. At the beginning, the focus of physiotherapy is on pain reduction, lymphatic drainage and heat and / or cold therapy.

In the further course, exercises for mobility, stretching, flexibility and strength building of the shoulder are in the foreground. It is important that those affected carry out and learn the exercises under the precise guidance of a physiotherapist, so that they can later practice them independently.

You might also be interested in: Therapy of the broken collarbone

What is the best way to sleep with a clavicle fracture?

Sleeping with a clavicle fracture is often very uncomfortable, especially at the beginning, because every movement, no matter how small, hurts. However, the pain subsides over time.

Those affected often find it pleasant when the headboard is slightly raised and a pillow lies under the arm of the affected side. In this way, the arm is positioned softly, so that the shoulder and thus also the clavicle are relaxed and relieved. What the exact sleeping position ultimately looks like varies from person to person. It is only important that the shoulder is not cramped or tense and that the person affected is not lying directly on the side of the shoulder.

Whether a prescribed Gilchrist bandage or backpack bandage should be left for the night is up to you. If it continues to be worn, those affected should make sure that there is adequate blood flow. If the bandage is too tight, it can happen in certain sleeping positions that vessels and nerves are pinched off.

How long after that am I unable to work?

The total healing time for a clavicle fracture is about 6-8 weeks. During this time, those affected are usually on sick leave, as the shoulder must be spared. During this period, physiotherapy or physiotherapy is also prescribed.

How long a sick leave or incapacity for work is issued after these 6 weeks depends on the profession. An office job can usually be resumed after 8 weeks. In the case of physically demanding jobs, the inability to work can be extended to 12 weeks.

How long should I not exercise?

Sports activities should be paused long enough for the clavicle to allow sufficient time for complete healing. As long as a Gilchrist bandage or rucksack bandage is worn for the first 3-4 weeks, no sport is allowed. This should be followed by physiotherapy to mobilize and strengthen the shoulder again.

After that, the total healing time is about 6-8 weeks, you can start again with light physical activity. Bicycle or Those affected are not allowed to go mountain biking or martial arts until after six months at the earliest. Sometimes even a later point in time is recommended, around 8-9 months, since the clavicle is extremely stressed in these sports. How long after a clavicle fracture no sport can be done depends largely on the sport.

Duration of a clavicle fracture

Depending on the severity of the break, the time it takes to recover also varies.
For fractures that are treated conservatively, it takes around 8 weeks to almost completely recover.

The bandage must be worn for the first 4-6 weeks, after which physiotherapeutic treatment is indicated. Wearing the bandage restricts mobility and thus also the activities of everyday life, but in the majority of cases a satisfactory healing result can be expected afterwards.

In the case of an operative procedure, good stability is ensured by inserting implants quickly after the operation. The implants differ in terms of how they remain in the body. Some can - depending on the patient's decision - remain in the body, others have to be removed after a few weeks.
In any case, the clavicle fracture is already one under conservative therapy

very good recovery rate and a
has a low complication rate.

Classification of clavicular fracture

A clavicle fracture is classified according to Allman in medicine. This classification is primarily based on the location of the fracture. There are three groups of different locations:

Group 1 describes a fracture in the middle third of the clavicle. Since this area of bone is called the diaphysis, it is also referred to as diaphyseal clavicle fractures;
Fractures that manifest on the outer or lateral third count in group 2;
Group 3 ultimately includes all fractures in the medial, i.e. central third;

A classification can also be based on the frequency:

Group 1 fractures are very common (80%);
Fractures in the medial or lateral third, i.e. group 2 (10-15%) and 3 (5-6%), are less common.

Special features of the clavicle fracture in the newborn

The clavicle fracture is the most common birth-related fracture in newborns. There are various reasons that during the birth process can cause the child's clavicle to break. An example would be a shoulder stuck in the birth canal. The clavicle fracture is generally often associated with a Macrosomia associated. Newborns with macrosomia weigh more than 4350g at birth. Usually the newborns are so-called Greenwood fracture, a bending fracture. This special and typical break has relatively few symptoms and is often only noticed on a physical examination when callus, i.e. new bone tissue, has already formed at the break point. This callus formation starts after about 7-10 days. An x-ray is usually not necessary, so the newborn does not have to be exposed to x-rays. If there is a simultaneous fracture of the clavicle Dislocation, i.e. a displacement of the broken bone fragments, the pain symptoms are more pronounced. The pain manifests as pressure and movement pain. Typically, the newborns have one asymmetrical spontaneous motor skills on. As soon as the clavicle fracture is associated with a dislocation, an X-ray should be taken. In general, such clavicle fractures heal in newborns without major therapeutic measures. The exception is the dislocated Clavicle fracture, which may have to be treated surgically. Otherwise, the parents are only encouraged to ensure that the arm on the affected side should be moved as little as possible and if so, then only very carefully. In this way, the clavicle fracture heals in newborns mostly without complications.

Read our article about this Collarbone fracture in children!