Clavicle Fractures

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Clavicle Fractures A broken collarbone (fractured clavicle) is a common injury among two very different groups of people: children and athletes. Many babies are born with collarbones that broke during the passage down the birth canal. A child's collarbone can easily crack from a direct blow or fall because the collarbone doesn't completely harden until a person is about 20 years old. An athlete who falls may break the collarbone because the force of the fall is transmitted from the elbow and shoulder to the collarbone. The collarbone is considered part of the shoulder and helps connect the arm to the body. It lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the collarbone breaks. The collarbone is a long bone, and most breaks occur in the middle section. Signs of a break • Sagging shoulder (down and forward). • Inability to lift the arm because of pain. • A grinding sensation if an attempt is made to raise the arm. • A deformity or "bump" over the fracture site. • Although a fragment of bone rarely breaks through the skin, it may push the skin into a "tent" formation. Diagnosis Although a broken collarbone is usually obvious, your orthopaedist will do a careful examination to make sure that no nerves or blood vessels were damaged. An X-ray is often recommended to pinpoint the location and severity of the break. Treatment Most broken collarbones heal well with conservative treatment and surgery is rarely necessary. • A simple arm sling can usually be used to immobilize the arm. A child may have to wear the sling for 3 to 4 weeks; an adult may have to wear it for 6 to 8 weeks. • Depending on the location of the break, your physician may apply a figure-of- eight strap to help maintain shoulder position. • Analgesics such as acetaminophen or nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help reduce pain. • A large bump will develop as part of the healing process. This usually disappears over time, but a small bump may remain. • Range of motion and strengthening exercises can begin as soon as the pain subsides. However, you should not return to sports activities until full shoulder strength returns. In rare cases, depending on the location of the break and the involvement of shoulder ligaments, surgery is needed. Surgery usually gives improved results in these more severe fractures. * Materials borrowed from the American Academy of Orthopaedic Surgeons. More information can be found at www.aaos.org . .

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Altered Alignment of the Shoulder Girdle and Cervical Spine in Patients with Insidious Onset Neck Pain and Whiplash- Associated Disorder
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The Appendicular Skeleton Appendicular Skeleton
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175 Cambridge Street Boston, MA 02114 617-726-7500 www2.massgeneral.org/sports Clavicle Fracture (Broken Collarbone) A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages. Anatomy The collarbone (clavicle) is located between the ribcage (sternum) and the shoulder blade (scapula), and it connects the arm to the body. The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the clavicle breaks, even though the bone ends can shift when they are fractured. Description The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade. Cause Clavicle fractures are often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In babies, these fractures can occur during the passage through the birth canal. Symptoms Clavicle fractures can be very painful and may make it hard to move your arm. Additional symptoms include: • Sagging shoulder (down and forward) • Inability to lift the arm because of pain • A grinding sensation if an attempt is made to raise the arm • A deformity or "bump" over the break • Bruising, swelling, and/or tenderness over the collarbone Nonsurgical Treatment If the broken ends of the bones have not shifted out of place and line up correctly, you may not need surgery. Broken collarbones can heal without surgery.
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Clavicle Fractures George M
LWBK652-c31_p152-156.qxd 5/17/10 11:32 PM Page 152 Aptara Inc CHAPTER 31 Clavicle Fractures George M. Bridgeforth, Shane J. Nho, Rachel M. Frank, and Brian J. Cole A 25-year-old woman who fell Clinical Presentation on her right arm complains of The clavicle is the only bony connection marked pain and soreness between the upper arm—shoulder and the thorax. It is the most frequently bro- SECTION 6 around her right collarbone. ken bone in the human body. The clavi- cle is divided into thirds. Fractures of the middle third are the most common, accounting for 80% of cases. Many of Shoulder these fractures are caused by direct blows or falls, including falls onto an outstretched hand. Fractures of the lat- eral third account for 15% of cases. Generally, these types of fractures are caused by a direct impact injury at the top of the shoulder (Fig. 31.1). Fractures of the medial third account for 5% of cases and are usually caused by direct chest trauma. Patients with clavicle fractures complain of marked pain, partic- ularly with movement; swelling and bruising; and tenderness. The clinician should evaluate clavicle fractures, especially those involving the medial and middle thirds, for any associated thoracic and cervical injuries. It is essential to treat any associated cervical injury as an unstable acute spinal cord injury until it is proven otherwise. Stabilization of the patient on a spine CLINICAL POINTS board and in a hard cervical collar is necessary until a cervical injury is • Most clavicle fractures affect excluded by radiographs and a computed tomography scan.
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