Clavicle Fracture

Introduction

A fracture of collarbone or clavicle fracture is a common in people of all ages. It may be caused by a direct blow to the shoulder, a fall on the shoulder, any road traffic accident or a fall onto an outstretched arm.

Normal Anatomy

The collar bone or clavicle is a long bone placed horizontally, connecting the breast bone to the humerus or bone of the upper arm, on either side of the body.

Causes

The clavicle fracture can be very painful which is aggravated by shoulder movements. Patient can also notice swelling and tenderness over the fracture site. Sagging of the shoulder may also be noticed. It may be associated with a deformity or ‘bump’ and bruising over the fracture site. Movement of shoulder may produce a grinding or cracking sound.

Diagnosis

The diagnosis of a clavicle fracture comprises of physical examination, X-ray imaging, and CT scan.

Physical examination determines the site and location of the fracture. X-ray and CT scan help evaluate the type, severity of fracture and other associated injuries.

Treatment

The management of clavicle fracture comprises of conservative and surgical approach. The choice of treatment depends on the type and location of fracture.

Conservative management

Immobilization

Immobilization of the fractured by an arm sling is the common and preferred non-surgical modality of treatment. A figure-of-eight strap is recommended to support the fractured bone. A sling supports the arm and maintains bone alignment to promote healing.

Medications

Pain relieving and anti-inflammatory medications can be used to reduce pain over the fractured site.

Physical therapy

Prolong immobilization of fractured site may cause stiffness, reduction in muscle strength and the range of motion. Physical therapy has proved to be beneficial for preventing complications and restoring and regaining strength

Surgical management

Surgery may be considered in patients with a displaced fracture or in cases where the bone has fragmented into several pieces. Surgical treatment includes use of fixation devices such as screws, plates and rods. These devices maintain the proper alignment of the bone during healing. The common fixation procedures for clavicle fracture include plate and screw fixation method and pin fixation method.

Plate and screw fixation method

In this surgery, the bone fragments are realigned into their normal position and held in place with the help of metal plates, attached to the outer surface of the bone.

Surgical complications

Some of the patients may develop complications, after the surgery. Use of tobacco products, diabetes and advanced age increases the risk of complications. The common complications include infection, bleeding, pain, damage to blood vessels and nerves, difficulty in bone healing, lung injury and hardware irritation.

Rehabilitation

Post-operative rehabilitation includes a specific exercise program to restore movement and strengthen the shoulder. The exercise program involves gentle motion exercises and strengthening exercises. The rehabilitation program helps improve the quality of life of the patient, post-surgery.