Broken Collarbone (Clavicle Fracture): Symptoms, Treatment, Healing

Overview

What is a clavicle fracture?

A clavicle fracture is a break in the collarbone. You have two clavicles — long, slender, S-shaped bones connecting the shoulders to the upper chest. Broken collarbones are common, making up about 5% of all adult bone fractures.

Are there different kinds of clavicle fractures?

A collarbone can crack in one place or break into several pieces (comminuted fracture). The broken pieces may still line up or may end up out of place (displaced fracture).

Symptoms and Causes

How do people break their collarbones?

A clavicle breaks when force or pressure causes it to snap. Common causes are:

• Collisions (trauma) when an arm is outstretched, like during skiing, hockey, football and other sports.
• Direct hits to the clavicle, such as in a car accident.
• Falls onto the clavicle or an extended arm.
• Passing through the birth canal for a baby.

What are the symptoms of a broken collarbone?

If you break your collarbone, you may experience:

• Snapping or grinding noise when the bone breaks.
• Sharp pain, which gets worse when you move that area.
• Shoulder slumping down or forward because the bone no longer supports it.
• Difficulty moving or lifting the arm, with a possible grinding feeling when you do.
• Bruising, swelling or tenderness in the area.
• Bump that you can see through the skin.
• Numbness or “pins and needles” (less often).
• Bone poking through the skin, with bleeding (rarely).

Diagnosis and Tests

How is a clavicle fracture diagnosed?

If you think you’ve broken your clavicle, seek immediate medical attention. A healthcare provider will:

• Ask you to describe what happened.
• Examine the area.
• Take X-rays of the injured area to confirm a broken bone. X-rays can also show exactly where the break is, how bad it is and whether any other bones broke.

If the healthcare provider thinks there’s damage to a joint or artery, you may get more tests:

• Arteriography/arteriogram, which uses X-rays and dye to see inside the arteries.
• CT scans, which provide more detailed pictures than X-rays.
• Ultrasound, which uses sound waves to create pictures of what’s happening in the body.

Management and Treatment

What should I do if I break my clavicle?

If you think you broke your collarbone, take these steps immediately:

• Put your arm in a sling to stop it from moving. You can create a sling from a piece of cloth like a towel or shirt. Wrap it around your arm and fasten it to the back of your neck to hold up your arm.
• Apply ice to reduce pain and swelling.
• Take over-the-counter pain medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen (Advil®, Motrin®), naproxen, (Aleve®) or acetaminophen (Tylenol®) if it doesn’t interfere with your other medications or health issues.
• Call a healthcare provider or go to the emergency room.

What does a healthcare provider do to treat a broken collarbone?

Most clavicle fractures don’t need surgery. If the broken parts of the bone are in a good position to heal, healthcare providers may recommend:

• Arm support: A sling can help you feel more comfortable as you heal. It can also prevent broken parts of bone from moving around.
• Medication: Over-the-counter medications can relieve pain as the bone heals. Some healthcare providers may prescribe stronger drugs, such as opioids, for a very short period of time. Those come with risk of drug addiction, though, and should be used only if really necessary
• Physical therapy: A physical therapist can teach you special exercises. These exercises can improve motion in your arm, strengthen your shoulder and prevent stiffness. You may do the exercises in a physical therapist’s office, at home or both.

What if I need surgery?

Sometimes you need surgery to treat a broken collarbone, like when:

• Blood vessels or nerves get injured.
• Fractures break through the skin.
• Pieces of broken collarbone are not in a good position to heal.

Surgery to treat a clavicle fracture is called open reduction and internal fixation. The operation puts broken pieces of collarbone back where they belong (reduction). It then uses metal devices to keep the pieces in place (fixation). An orthopaedic surgeon (specialist in bone and muscle injuries) may perform the procedure using:

• Plates and screws attached to the outer surfaces of the bone. The hardware usually isn’t removed after the bone heals, unless it causes discomfort (this usually happens a year or more after the surgery).
• Pins or screws through the bone. They are usually removed once the fracture has healed.

Prevention

How can I prevent a clavicle fracture?

Clavicle fractures happen suddenly and are difficult to prevent. But certain things can help keep your bones safer:

• Drive safely and wear a seatbelt when riding in a vehicle.
• Eat a well-balanced diet with plenty of calcium to keep your bones strong.
• Use good technique and body positioning for any sports you play or activities you do (such as bike riding).
• Wear protective gear when playing sports or participating in hobbies.

Outlook / Prognosis

What is the outlook for a broken clavicle without surgery?

Most collarbone fractures heal in six to eight weeks, without surgery or complications. Most people are able to start getting back to normal activities by three months or so, but full recovery may take up to six to 12 months.

You may feel a bump where the fracture healed. The bump may get smaller on its own over time, but it might never go away completely. You may also have less strength in your shoulder and arm. But unless you have other injuries, you can often return to normal activities within a few weeks.

What is the outlook for a broken clavicle with surgery?

If you have surgery, you may feel the plate or other hardware inside your body. You’ll also have limited use of your arm for six to eight weeks. After that, you can start using it for normal daily activities such as bathing, dressing and eating. You should wait for your healthcare provider’s permission before doing things that involve lifting, pulling or pushing. You should also wait to play sports. In general, recovery is similar to treating a broken clavicle without surgery with return to normal activity around three months or so and full recovery up to six to 12 months after surgery.

While your break heals, you should follow-up with your surgeon or other healthcare provider to make sure you don’t have complications. Complications after surgery may include:

• Malunion: If the pieces of bone move out of place and heal in the wrong position, healthcare providers call it a malunion. It may need surgery.
• Pain and stiffness: Sometimes the shoulder can get very stiff or painful after surgery. Your healthcare provider may recommend physical therapy or remove any irritating pieces of hardware.
• Wound problems: The place where the surgeon cut your skin may have trouble healing, get infected or bleed.

Living With

What can I do to make sure I heal after a broken collarbone?

Whether you have surgery or not, you should go to all your follow-up appointments. At those checkups, your healthcare provider will:

• Check the motion in your shoulder.
• Talk to you about how you feel and whether you still have pain.
• Take more X-rays if needed.

You should also follow all exercise advice from your healthcare provider and physical therapist. Physical therapy can be slow and uncomfortable, but it’s important if you want to return to your normal activities.

In the first few weeks of physical therapy, you will do gentle exercises to help prevent stiffness and pain. You will eventually start exercises with light weights and stretchy bands. Once the bone fragments rejoin, you will do more aggressive strength training.

A note from Cleveland Clinic

A clavicle fracture is a break in the collarbone that’s often painful. Most people don’t need surgery, but some require an operation to put the pieces of bone back in place. Physical therapy is important to get you back to daily activities. Talk to your healthcare provider about exercises to reduce pain and stiffness and regain strength.

Broken Collarbone (Clavicle Fracture) (for Teens)

What Is a Broken Collarbone?

Your collarbone (or clavicle) is the bone that runs horizontally between the top of your breastbone (

sternum) and shoulder blade (scapula). You can feel your collarbone by touching the area between your neck and your shoulder. A broken collarbone, also called a clavicle fracture, is when this bone breaks.

How Does a Broken Collarbone Happen?

Falling hard on a shoulder or an outstretched arm can cause a broken collarbone.

These fractures are common in contact sports like football, wrestling, rugby, lacrosse, and hockey. They also can happen in sports where there is a chance of falling hard, such as biking, skiing, snowboarding, and skateboarding.

A collarbone also can break in a car crash or if someone is hit by a car.

What Are the Signs & Symptoms of a Broken Collarbone?

Someone who breaks a collarbone may have:

• pain over the collarbone
• trouble moving the arm or shoulder on that side
• swelling, tenderness, and bruising along the collarbone
• a bulge or “tenting” of the skin above the break

How Are Broken Collarbones Diagnosed?

To diagnose a collarbone fracture, a health care provider will:

• ask about the injury
• do a physical exam
• order X-rays

How Are Collarbone Fractures Treated?

Most broken collarbones heal with ice, arm support, pain medicine, and exercises. The arm is supported either by a sling or a shoulder immobilizer. A shoulder immobilizer is like a sling but it also has a strap that goes around the waist.

While the collarbone heals:

• Use ice for pain and swelling. Put an icepack, cold gel pack, or bag of frozen vegetables over the collarbone for 20–30 minutes every 2–3 hours. Be sure to put a towel between the ice/cold pack and your skin.
• Use the sling or shoulder immobilizer as directed by your health care provider. You’ll wear it for about a month, but can remove it during bathing and sleeping.
• Follow your health care provider’s instructions for using medicine for pain.

For about the first 4–6 weeks:

• Avoid raising your arms above shoulder level.
• Avoid lifting anything that weighs more than 5 pounds (2.3 kg). This is about the weight of a 72-ounce bottle of liquid laundry detergent.
• Stay out of all sports and physical education.
• Do all exercises to prevent elbow and shoulder stiffness and to help with muscle strength.
• Go to physical therapy, if needed.
• Go to all follow-up appointments.

Call your health care provider if your pain or swelling gets worse.

Will the Collarbone Heal Straight?

Even if the broken bones aren’t perfectly lined up, the body usually can make them straight again. That’s because the collarbone has a thick periosteum (outer layer of the bone). The collarbone periosteum doesn’t usually break, so it acts like a sleeve to hold the bone together while it heals. Rarely, the doctor might recommend surgery if the broken bones are very out of line.

Sometimes while the broken collarbone heals, there is a bump where the bone was broken. Sometimes the bump doesn’t fully go away. But it doesn’t hurt or cause other problems with the arm or shoulder.

When Can I Go Back to Sports?

Your health care provider will see you again and let you know when it’s OK to go back to sports. This is usually when:

• There’s no pain when the health care provider presses on the collarbone.
• Your shoulder strength is normal.
• You can move and use the arm and shoulder without pain.
• In general, people can go back to noncontact sports (such as running or swimming) in about 6 weeks and contact sports (such as football, lacrosse, and hockey) in 8–12 weeks.

Can Broken Collarbones Be Prevented?

Because collarbone fractures happen suddenly and unexpectedly, it can be hard to prevent them. But to decrease your risk:

• When playing contact sports, wear all the recommended protective gear and learn the proper techniques for your sport.
• Keep your bones strong by eating a well-balanced diet. Be sure to eat lots of vegetables and foods that are rich in calcium and vitamin D to help build strong bones.
• Do strength training and stretching to build strong, flexible muscles. Muscles that are strong and flexible will help support your bones better and keep you agile and less likely to experience a hard fall. A proper warm-up, including dynamic stretching exercises, can help your muscles perform at their best during play.
• Wear well-fitting, supportive footwear that’s right for your sport.

Looking Ahead

Most broken collarbones heal quickly and completely. Within a few months, you should be back to doing all the things you enjoyed before the injury.

Clavicle Fracture (Broken Collarbone) | Orthopaedic Trauma Association (OTA)

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Basic Anatomy

The clavicle or collarbone is an S-shaped bone that connects your scapula or “shoulder blade” to your sternum or “breastbone.” The clavicle connects your arm bones to the rest of your skeleton. The clavicle has very little muscle or other soft tissues around it, which is why it is so easy to feel under your skin.

Figure 1: The clavicle the dashed line is your clavicle or collar bone. Some people have very prominent clavicles that are easy to see. The trapezoid shape is the sternum location where the clavicle attaches to your breastbone.

Figure 2: Skeleton showing the clavicle and how it attaches to the shoulder blade (scapula) and sternum (breastbone).

Mechanism and Epidemiology

The clavicle is the most commonly broken bone. The limited amount of muscle and soft tissue around the clavicle makes it easily injured. The most common causes for broken clavicles are direct blows or impacts, including a fall. The clavicle can break near the shoulder, the sternum, or in the middle (most common).

Figure 3: Fracture in the middle portion of the clavicle.

Figure 4: Fracture at the far end of the clavicle near the shoulder and attachment to the shoulder blade.

Initial Treatment

Clavicle fractures usually hurt a lot, and it often hurts when you try to move your arm. You may see or feel a bump where the bone is broken, and sometimes your shoulder may look like it droops down lower than your other side. When you see a doctor, they will examine your shoulder and arm and get an x-ray if they think it may be broken. If your bone is not too displaced and did not come through the skin when it broke, it may be treated with a sling and limited weight bearing. You should make an appointment with an orthopaedist or your primary care doctor for follow-up. People typically do not need to be admitted to the hospital for an isolated clavicle fracture.

General Treatment

Most clavicle fractures can be treated without surgery. The broken bone will take 3-4 months to heal. If surgery is not needed, there may be a time during which movement and lifting is limited. Some clavicle fractures may benefit from surgery. The discussion about your injury and the pros and cons of surgical vs. non-surgical treatment can be had with an orthopaedic surgeon. Surgery is required if the bone came through your skin or is close to breaking through the skin. Otherwise, there are few absolute reasons to do surgery. If surgery is needed, an incision (or “cut”) is made over the clavicle, the bones are realigned, and metal plates and screws are used to fit the bones back together.

Figure 5: X-rays of a clavicle fracture with a piece in the middle that was sticking up under the skin. X-rays from 6 months later showing bone healing and remodeling (reshaping) of the fracture pieces.

Figure 6: X-rays of a patient with a clavicle fracture initially and 6 months later. He had a fibrous union, meaning the bone healed back together not with bone but with connective fibrous scar tissue. They had no pain, full motion and normal strength of the arm.

Figure 7: A clavicle fracture after it has been fixed with a plate and screws.

Post-operative Care

While your broken clavicle is healing, you may not be able to lift heavy objects or fully move your shoulder. This can be because of pain and/or instructions from your surgeon. Sometimes physical therapy is prescribed to help with motion and lifting after surgery.
Lying flat in a bed after a clavicle fracture can cause pain, so it may be more comfortable to sleep in a recliner or upright position. A sling may also be used for comfort. It is important to remove the sling several times a day and to move your elbow, wrist, and hand (and shoulder if possible) to prevent stiffness. The ability to move your shoulder and lift more will get easier as your bone heals. It is important to follow instructions from your surgeon regarding your post-operative care for best results.

Long Term

Long-term issues after clavicle fractures can include a deformity such as a bump, or a shoulder that appears lower than the other side. The “bump” may decrease in size over time, but it may always look and/or feel different from your other side. Your shoulder may also feel more tired or stiffer compared to before your injury.

If surgery is done, you may have numbness over the chest around the scar. The plate and screws may also be felt under the skin. This may make wearing a backpack, shirts, or bras uncomfortable. If they are bothersome, the plate and screws may be removed after the fracture has healed. On rare occasions, the bone does not heal or there is a complication like an infection. In these cases, another surgery may be needed.

While most clavicles can heal without surgery, sometimes they do not heal, or heal in a position that causes discomfort. Surgery to get the clavicle to heal, or to line up the broken pieces can be done at any time. However, this surgery may be more difficult and may have more risks if a long time has passed. If you are still having difficulty with your clavicle, you can talk to your surgeon about whether or not you may benefit from surgery.

Figure 8: A scar and some prominence of the plate after a clavicle was fixed with surgery.

More Information

—

Christopher Domes, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Domes

The Broken Clavicle or Collar Bone

The clavicle or collarbone is one of the most commonly broken bones in our body. It represents 4-5% of all fractures.  Fractures of the clavicle are more common in children, cyclists, rugby players and football players. Many of you will be reading this because you were told that surgery was necessary to fix your clavicle.  The research might not agree with early surgical intervention.  You do have a choice. We are going to dive into what the research says about how we should manage a midshaft fracture of the clavicle.

The clavicle connects the arm to the rest of the skeleton. That means that all the pressure put on the arm from lifting or motion will go through the clavicle and around the ribs, into the spine and disburse through the ground.  The clavicle will break or fracture if you fall onto the side of your shoulder. Another common cause of collarbone injuries is a direct hit from a helmet. Once struck you will notice pain, and you will usually notice a bump in the middle of your collarbone.   Moving your arm will be very painful.  A trip to a local Urgent Care center will reveal the diagnosis on a routine X-ray. Cat scans or an MRI of the clavicle is not necessary to make this diagnosis.  We know from many publications that most clavicle fractures will heal well without surgery. Again, most collarbone fractures will heal well without surgery. Most athletes can return to sports after their clavicle has healed.  Surgery might improve the time to return to sports.

[Updated with more recent scientific evidence October 2018. ]

You break your clavicle.. what’s your next step?

You or your child break their clavicle… you were seen in an urgent care center, then you met with an Orthopedic surgeon.  Your surgeon recommends a sling or they recommend surgery.  Perhaps you are a professional rock climber, or a fireman. Perhaps you are a desk worker, or a runner.  We need a lot of information about you, your occupation and hobbies to give you the appropriate treatment recommendation.

You would think that there would be a simple consensus on how to manage a broken clavicle by now – but there isn’t.  Competing interest exist. There is evidence, there is the fee for service model in medicine, and there is physician personal preference.  Evidence should guide decision making about whether or not your injury or your child’s injury should be managed with surgery or with a sling. That’s why I am writing this.  If there is a need for surgery, it should be based on science and sound judgement.

The recommended treatments for clavicle fractures have changed a lot over the last 20 years. For a long time, there was a significant amount of controversy about the best way to manage a clavicle fracture. 20 years ago many surgeons felt that all broken collarbones should be treated surgically.  Yet prior to that we were taught that all clavicle fractures were treated without surgery. The research into this area has improved our understanding dramatically over the last decade.   The most recent scientific paper was just published in prestigious journal in October, 2018.

Management of Clavicle Fractures: follow the evidence

What is our current thinking? What does the research show about the treatment of clavicle shaft fractures?  In this post, we are going to try to teach you more about clavicle fractures and what the current research says your best options are.

As the research into this area has improved, the pendulum has clearly started to swing back towards a non-surgical approach. Even though the majority of recent literature shows that most clavicle or collarbone fractures can be managed without surgery, this still remains a very controversial area. Many of you might learn that your  surgeon wants to operate on your clavicle.  Hopefully, this post will help you in your decision making on how to manage your clavicle fracture or broken collarbone. It should also help you with questions that you should be asking when you are meeting with your surgeon.

1. Will my broken clavicle heal faster after surgery?

For the vast majority of clavicle fractures, this is simply not true. The clavicle does not always heal faster with surgery.  Many collarbone fractures heal quickly when treated without surgery. The younger you are, the faster your fracture typically heals. For a fracture to heal, it requires a blood supply. That blood supply comes from the arteries and  muscles attached to the clavicle. During the surgery, we must strip off a lot of the muscle so that we can see the bone. In addition, when we place a plate and screws on the bone, the bone will not heal in the same manner as a fracture left alone to heal on its own. That process could take longer to heal than a fracture that was not operated on.  In a small number of collarbone fractures which are significantly “displaced” – eg. the distance between the fragments is large (2cm), then surgery might result in faster healing. A clavicle that has been operated on might feel better faster than a clavicle fracture treated without surgery. That is because the bones are no longer moving. But that feeling that the bones are moving goes away in a week or two when managed without surgery.  That difference might be a few weeks. That doesn’t mean the clavicle is healing faster, that means that the screws are not allowing the pieces to move as much. Given that the surgery has a relatively high risk of potential complications, 10-15%, it is hard to recommend surgery to feel better 10-14 days sooner.

 2. Will I play better if I have surgery on my broken clavicle?

Given the current evidence, you have a great chance of returning to sports after your clavicle fracture heals – with or without surgery. There are certain fractures where surgery to put the fractured clavicle back into its normal position might lead to a better chance of healing. This is usually the case if the fracture has resulted in significant “shortening” (2cm) – meaning that the two ends of the collarbone overlap by a significant distance (2cm). This is actually a rare finding and most fractures do not shorten that much.  Thus when they heal it should not affect the function of your arm. Many athletes will return to their chosen sport with or without surgery for a collarbone fracture.

References from PubMed.gov:

1. Results of conservative treatment of displaced mid-clavicular fractures in adults
2. Mid-clavicle fractures in adults: end result study after conservative treatment.
3. Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents.
4. Sports participation and radiographic findings of adolescents treated non-operatively for displaced clavicle fractures.
5. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle.

3. Will I return to sports faster after surgery to fix my broken clavicle?

Basically, the answer is maybe. But, this is a controversial area. A recent 2018 article shows that the return to sports was faster in the surgery group.   High level athletes returned had a faster return of function after surgery on the clavicle.  BUT, when all athletes were assessed at 6 month and one year following their injury there was no functional difference.

For research to be useful, we need to be sure that we are comparing apples to apples. If you want to compare one clavicle fracture treatment to another, then they need to look the same. That means that the separation between the two pieces is not significant in both, or the separation between the pieces is significant in both. In some studies, the return to sports and overall function was quite good with the non-surgical management of a clavicle shaft fracture. Other papers show that the return to sports after surgery on a clavicle fracture was also successful (reference 1). However, the later paper had no controls. In other words, they were just presenting the results of the fractures they operated on. They are not comparing them to a group of patients who did not have surgery. Thus the results of this paper lead to limited conclusions at best. A few papers do show that patients who have a clavicle fracture addressed surgically will be happier at 6 weeks after the injury. But after 6 months most all patients, whether they had surgery or not are doing the same with regards to function. In the long term – up to 5 years later, there is little or no difference between the surgically managed group and the non-surgically managed group (reference 2). Given the current scientific literature (current to 2018) on the treatment of clavicle shaft fractures it appears that the only potential upside is that there will be fewer cases of clavicle non-unions after surgery and perhaps a faster return of function. A non-union is a fracture that doesn’t heal. If it occurs, a non-union can be be operated on if it proves to be painful.  So, do we operate on 100 out of 100 fractures if only 8 -10 will not heal completely?  Also, surgery is not without risk.  The incision is not pleasant looking. You have a high risk of nerve injury causing numbness of the upper chest. There is a risk of developing a painful nerve scar (neuroma).  Surgery brought along a high risk of needing further surgery (reference 3) to remove the plates and screws, and other  complications that the group treated without surgery did not have.  After the screws and plates are removed there is a risk that a fall will cause another fracture through one of the screw holes.

References

1. Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes.
2. Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: Functional outcome and patients’ satisfaction during a mean follow-up of 5 years.
3. Plate Fixation Compared with Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter Randomized Controlled Trial.

4. Are complications more common after non-surgical management of a broken collarbone?

Complications are more common after surgery, as opposed to non-surgical treatment. Complications can occur with surgical or non-surgical treatment of any broken clavicle. Complications in the non-surgical group include the potential for pain and decreased function associated with a fracture that healed “short” – where the two broken pieces were overlapping more than 2 cm.  This is a common teaching in Orthopedics, but more recent studies show that function might actually be unaffected by shortening. The group of patients most at risk for functional issues after a clavicle fracture are high-level, elite overhead athletes. Most recent papers do not show an improvement in function when surgery is performed routinely for clavicle fractures.

Most people with non-surgically managed broken collar bones will have a bump for life. That is not a complication, but it is a fact of life. Many prefer a bump to a scar. After clavicle surgery, that scar might be painful and fairly unsightly. After surgery for a clavicle fracture, many of you will have numbness along the clavicle and upper chest wall. This will be permanent. A few of you might develop painful neuromas or nerve scars after surgery too. In an effort to minimize the scar from clavicle surgery a screw that goes inside the bone was invented. They were popular for a while, but have fallen out of favor. If your clavicle doesn’t heal and the screw breaks it can be quite a challenge to get the broken piece out.

The risks of surgery on the clavicle include a risk of infection and nerve injury which will make your upper chest area numb. There is a also risk of non-union where the fracture will not heal, even after surgery.   There is a risk that the plates and screws we place will bother you and require removal. Bottom line: the risks of surgery often outweigh the risks of non-surgical management for most all clavicle fractures.

5. Can my clavicle fracture break again?

Yes. Whether your fracture is treated with or without surgery there is a risk that the bone will break again. Both methods to manage a clavicle shaft fracture have a risk of re-fracture or breaking your clavicle again. Think of Tony Romo who found this out the hard way. If you have surgery to repair your clavicle and then require removal of the plate. Your risk of developing a another broken clavicle goes up significantly for a few months until the old screw holes heal.

Take Home Messages About Clavicle Fractures and Surgery:

• Most clavicle shaft fractures or broken collarbones do not require surgery.
• Fractures with “significant” displacement or shortening (think 2cm) might benefit from surgery.
• Most clavicle fractures heal without surgery
• Most athletes with a clavicle shaft fracture or a broken collarbone will return to sports within a few months – with or without surgery.
• Surgery will improve the early return of function… but within a few months there is no longer a difference compared to fractures managed without surgery.
• The long-term outlook for most patients with a broken collarbone is excellent.
• Research shows that a simple sling, as opposed to a figure of eight bandage is more comfortable and equally as effective.
• The risks of surgery for a clavicle shaft fracture might outweigh the potential benefits for you! Have a long discussion with your surgeon before signing a consent for surgery.

Clavicle shaft fractures are a very common injury. Most of these fractures can be managed without surgery. Many research papers show that return to sports and normal use is similar with surgery or non-surgical treatment. Surgery might decrease the risk that the clavicle will not heal. Clavicle fractures heal 88-100% of the time in many trials published about clavicle fractures – without surgery.

Surgical management of a clavicle fracture is appropriate to consider with significant shortening, and perhaps in an elite overhead athletes shoulder.

The risks of surgery on a clavicle include infection, numbness over the front of your chest, the need for a removal of the hardware and the possibility that the fracture will not heal.

Do you have a story about your clavicle fracture journey? Share it with our readers in the comments below.

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

Caring for a collarbone fracture fact sheet

A collarbone (clavicle) fracture usually occurs in the middle of the bone. Sometimes, these fractures have a bend, but they will heal well and the bones will reset themselves into a straight position with rest and time.

This type of injury is treated in a supportive arm sling for four to six weeks. This will minimise your child’s shoulder movement and reduce their discomfort.

How should I manage my child’s fracture?

• Pain relief – Your child may experience discomfort in the first few days, so try administering regular doses of pain-relieving medications such as Panadol and Nurofen. Reduce the dose as their pain settles.

• Movement – Encourage your child to move their fingers, wrist and elbow. However, shoulder movement should be avoided until the sling is removed.

Does my child need a follow-up appointment?

In the vast majority of cases, no follow-up appointment and/or X-rays are required as most collarbone fractures are non-displaced. Displaced collarbones may be referred for a review in a fracture clinic in seven to ten days.

The development of a lump at the fracture site is normal and can take up to a year to subside. In some cases, a small lump may remain, but this will not affect your child’s use of their arm.

A fractured collarbone generally takes three to four weeks to heal, depending on your child’s age. Once your child is pain-free, they can return to normal activities. Contact sports should be avoided for 10 weeks after the sling is removed to reduce the likelihood of a refracture.

Please notify your GP/nurse if:

• Your child suffers increasing discomfort, despite pain-relief medicine.
• The injury site becomes more swollen, causing pins and needles, or any altered sensation.
• You are concerned for any reason.

Contact us

Queensland Children’s Hospital
Level 1, 501 Stanley Street, South Brisbane
t: 07 3068 1111 (general enquiries)

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

How Long For Collar Bone To Heal

A broken collarbone, or fractured clavicle, is a common injury. It usually happens after a fall or a blow to the shoulder. It takes about 6 to 8 weeks to heal in adults, and 3 to 6 weeks in children. The collarbone is a long, slender bone that runs from the breastbone to each shoulder.

How can I make my collar bone heal faster?

To help speed the healing, you might get: A splint or brace to keep your shoulder from moving. A sling for your arm, which you might use for a few days. Anti-inflammatory painkillers, like aspirin, ibuprofen, or naproxen, which will help with pain and swelling. Range-of-motion and strengthening exercises.

How do you heal a collarbone?

Most heal well with ice, pain relievers, a sling, physical therapy and time. But a complicated break might require surgery to realign the broken bone and to implant plates, screws or rods into the bone to hold the bone in place during healing.

How do you know if a broken collarbone needs surgery?

Specifically, surgery should be strongly considered if the fracture is shortened by 2 centimeters or more, displaced more than 100% (the fractured ends aren’t touching at all), when there are specific fracture patterns (such as Z-type fractures), or when the fractures are highly comminuted (shattered).

Can you move your arm if you break your collarbone?

A broken collarbone can be very painful and can make it hard to move your arm. Most clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs.

How do you shower with a broken collarbone?

It is ok to shower or sponge bathe 2 days after surgery but you must keep your shoulder incisions clean and dry at all cost! This usually entails using saran wrap or press and seal to waterproof your shoulder. 3. Do not submerse your shoulder in water – no bathtubs, swimming pools, jacuzzi’s.

What exercises can I do with a broken collarbone?

Rehabilitation Exercise Suggestions Pendulums: Perform two minutes each of front to back, side to side, and both clockwise/counter clockwise circles. Supine shoulder flexion with cane: Perform 2 x 20 reps staying in a pain-free range of motion.

How long do you have to wear a sling for a broken collarbone?

Either method is appropriate treatment for the broken collarbone. Patients will be instructed to wear the sling at all times until there is no further pain with movement. This is usually 2 to 4 weeks for children and 4 to 8 weeks for adults.

What are the most painful bones to break?

The 4 Most Painful Bones To Break 1) Femur. The femur is the longest and strongest bone in the body. 2) Tailbone. You could probably imagine that this injury is highly painful. 3) Ribs. Breaking your ribs can be terribly distressing and quite painful. 4) Clavicle. You’re probably asking, what’s a clavicle?.

Can you live without a clavicle?

Despite its location, the clavicles are not indispensable to protect these organs, even though they do contribute to this role. Some people don’t develop collarbones; they can be born without them, have defective ones, or grow them at an older age.

Is collarbone surgery painful?

You may have some pain after your procedure, but pain medicine may help to reduce the pain. You should be able to resume a normal diet fairly quickly. You will probably need an imaging procedure, like an X-ray, to make sure that your surgery was successful.

What can I expect after a broken clavicle?

What to expect during healing of a Clavicle Fracture: While the bone heals usually within 2-3 months, recovery takes much longer. Typically most of the recovery is completed by 3-5 months. Some stiffness in the shoulder can happen after these injuries, but usually resolves by 6 months after the injury.

Can you sleep on your side with a broken collarbone?

Holding the broken bone above your heart prevents blood from pooling and causing swelling. First, try sleeping on your back while supporting yourself on several pillows. If this doesn’t help, adjust slowly to the side position if possible. Sleep in the middle of the bed, so you don’t fall in the middle of the night.

How long before I can drive with a broken collarbone?

Avoid lifting and overhead movement for 6 weeks. You should not drive whilst in a sling. You can return to work as soon as you are able to do your normal duties.

Is it easy to break your collarbone?

Your clavicle is easy to fracture because it’s frequently exposed to force. The middle third of your clavicle is its thinnest and outermost part and has a lack of support by muscles and ligaments, so it’s more vulnerable to injury.

How long does it take for a collarbone to heal without surgery?

Most collarbone fractures heal in six to eight weeks, without surgery or complications. Most people are able to start getting back to normal activities by three months or so, but full recovery may take up to six to 12 months. You may feel a bump where the fracture healed.

What should I wear with a broken collarbone?

At first you need to wear a sling or brace as the bone heals. This will keep: Your collarbone in the right position to heal.

Do you need physical therapy for a broken collarbone?

Most collarbone fractures are treated without surgery. However, more severe fractures may require surgery. Physical therapists treat collarbone fractures before and after surgery. They provide pain management, guided exercise, and functional training during the healing process.

How do you sleep with a broken collarbone?

Try sleeping with pillows propped under your arm for comfort. After a few days, put your fingers, wrist, and elbow through their full range of motion several times a day. This will keep them from getting stiff.

How do you relieve collar bone pain?

Treatment options include: rest and ice on the shoulder. a brace that fits over the shoulders to help stabilize the joint. surgery, in severe cases, to repair torn ligaments and possibly trim a portion of the collarbone to make it fit properly in the joint.

Broken Collarbone Symptoms & Treatment

Your clavicle, or collarbone, stretches across your chest, connecting the upper breastbone to your shoulder. A fall onto outstretched hands or a blow to the collarbone can cause the bone to fracture (crack or break while the bone stays in place) or break (split into several pieces or move apart).

A fractured or broken collarbone is a very common type of injury, especially among children, young adults and athletes. When you suspect a collarbone injury, it’s best to seek medical advice about the right treatment.

A bruised collarbone can heal with simple treatment. A complicated clavicle fracture will need more care, like surgery to hold the bone in place so it can heal.

Treatment & recovery for clavicle fractures

Aurora Health Care orthopedic and sports medicine specialists treat all types of clavicle fractures and breaks.

Whether you need a sling, physical therapy or complex surgery, our experts in trauma care and joint reconstruction can help restore your collarbone. We provide:

• Convenient evaluation and treatment: We have many locations across eastern Wisconsin and northern Illinois, so you can easily find a clinic close to home. For all types of injuries, we offer free injury evaluations to help you choose the right treatment path.
• Experts in orthopedic surgery: When a broken collarbone needs surgical repair, you can have confidence in our fellowship-trained orthopedic specialists. These doctors have additional education and practice in orthopedic surgery beyond medical school, in addition to their years of professional practice.
• Coordinated care: Whether or not you need surgery, your orthopedic specialist will coordinate with your physical therapist and primary care doctor to treat your collarbone injury. For example, your doctor will be able to easily track your physical therapy progress in your Aurora electronic medical record.

Causes of a clavicle (collarbone) fracture

A direct blow to the shoulder causes most clavicle fractures or breaks. Sometimes, bending or pressure causes a break.

Other common causes include:

• Falls onto the shoulder or outstretched arm
• Car accidents
• Collisions while playing sports
• The passage through the birth canal, for a baby

Signs of a clavicle fracture

The symptoms of a fractured or broken collarbone can vary depending on the type of break and its location. A clavicle fracture causes pain. A traumatic break will be so painful that it’s hard to move your arm.

Other signs of a clavicle fracture or broken collarbone include:

• A painful bump or bulge over the break
• The shoulder sagging forward and down
• Tenderness, bruising or swelling
• Pain that prevents lifting the arm
• A grinding sensation when you lift the arm

In a newborn baby, the infant might not move the arm for several days on the side with the fracture. A baby’s broken collarbone usually heals on its own with gentle care.

It’s important to see a doctor right away if you suspect a broken collarbone. You’ll need medical attention to get the care that will help the collarbone heal.

Confirming a broken collarbone

When you come in for a diagnosis, we’ll examine your collarbone and ask how the injury happened. We’ll also perform an exam to check for open wounds, swelling and bruising.

You may have an X-ray before you see the doctor. The X-ray provides a closer look at the fracture to help us determine if nearby joints are damaged. For more complex breaks, computed tomography (CT) scans can provide more detail. CT scans compile a series of X-rays into a detailed image.

Learn more about orthopedic diagnosis.

How we treat a clavicle fracture

Treatment for a clavicle fracture depends on the injury. A simple fracture might heal without surgery, given time and support.

If the ends of the bone have not moved out of place, we might fit you with a sling to immobilize the arm while the bone heals. Anti-inflammatory pain relief medications will help keep you comfortable during this time. Complete healing usually takes 6 to 12 weeks.

Physical therapy can help you maintain and rebuild arm and shoulder strength as your collarbone heals. Read more about orthopedic physical therapy, find sports health care near you or request a free injury evaluation.

Surgery to repair a broken collarbone

When a fractured clavicle breaks into several pieces, breaks through the skin or is severely out of place, surgery can fix it. Our orthopedic specialists will discuss the surgery with you so you know what to expect.

Broken collarbone surgery usually includes placing screws, plates or pins in the collarbone or surrounding bones. These devices hold the bone tight and steady while it heals, the same way a furniture clamp holds a chair together while glue sets. Like a clamp, the screws might be removed after the bone has set.

If the injury has damaged the joints surrounding the collarbone, our joint specialists can repair, reconstruct or replace the shoulder joint. Find out more about treatments for shoulder pain.

After surgery, medications and ice can relieve pain while you heal.

Clavicle fracture – treatment, symptoms, causes, diagnosis

Clavicle fracture is a fairly common injury, especially in adolescents and young adults. The clavicle connects the upper part of the sternum to the scapula. The most common causes of collarbone fractures are falls, sports injuries and road traffic injuries. Newborns sometimes have a fracture of the collarbone during the birth process. If you suspect a clavicle fracture, you should definitely see a doctor.In most cases, a clavicle fracture is treated conservatively with a bandage and physical therapy. Complex fractures of the clavicle require surgical treatment with fixation with plates, screws or rods, which allows the bone tissue to consolidate.

Symptoms

Clavicle fracture symptoms include:

• pain that increases with shoulder movement
• edema
• soreness
• contusion
• the presence of bulging in the shoulder area
• grinding or crackling when trying to move the shoulder
• stiffness or inability to move the shoulder

Therefore, if there are signs or symptoms of a collarbone fracture or there is pain in the shoulder that does not allow the shoulder to move normally, then it is imperative to see a doctor. Failure to diagnose and treat a clavicle fracture can lead to slow healing of the fracture.

Reasons

The most common causes of a clavicle fracture include:

• Falls. Falling onto your shoulder or outstretched arm can break your collarbone.
• Sports injuries. A direct blow to the shoulder while playing on the field (football, hockey, etc.) or in single combats in the ring can cause a fracture of the collarbone.
• Car injuries.A fractured collarbone can result from an accident while driving a car, motorcycle or bicycle.
• Birth trauma. In newborns, a fracture of the collarbone can occur during the birth process.
• Young age is a risk factor since the bone tissue of the clavicle finally completes its formation by the age of 20. Therefore, adolescents and young adults have a higher risk of collarbone fracture. The risk of fracture also increases in old age as the strength of bone tissue decreases due to the development of osteoporosis.

Complications

In most cases, a clavicle fracture heals without consequences. But sometimes the following complications are possible:

• Damage to nerves or blood vessels. The pointed ends of a broken collarbone can damage nearby nerves and blood vessels and, in such cases, it can manifest as numbness or coldness in the arm.
• Poor or slow healing. With a severe fracture of the clavicle, the consolidation of bone fragments may be delayed or incomplete.Poor alignment of the bone fragments can shorten the clavicle, resulting in disruption of normal range of motion in the shoulder.
• Bone growths can be an integral part of the regeneration process of bone tissue (callus) and are visually identified, since the clavicle is located shallow under the skin. But callus usually disappears after a while. But sometimes bone growths persist for a long time.
• Bone infections. In cases where fragments of the clavicle violate the integrity of the skin, there is a possibility of infection penetration into the bone tissue. Therefore, timely adequate treatment for such fractures is of great importance.
• Arthrosis. If a clavicle fracture occurs in the joint at the point of articulation with the sternum or scapula, then there is a certain risk of developing arthrosis of these joints.

Diagnostics

During a physical examination, the doctor examines the damaged area for tenderness, swelling, deformity, or an open wound. X-rays are usually sufficient to diagnose a clavicle fracture.In some cases, an additional examination (CT or MRI) may be ordered to diagnose possible soft tissue damage in the event of a clavicle fracture.

Treatment

Immobilization is a prerequisite for any bone fracture (including the clavicle). In case of a clavicle fracture, immobilization can be performed using a scarf bandage or using Delbe’s rings, which allow to preserve the length of the clavicle to a greater extent after consolidation of the bone fragments.

The duration of immobilization depends on the severity of the fracture. It usually takes 3 to 6 weeks for clavicle bone to regenerate in children and 6 to 12 weeks in adults. If a collarbone fracture occurs in a newborn during childbirth, then the treatment will consist only in careful care.

Drug treatment consists in the appointment of anti-inflammatory drugs to reduce pain.

Rehabilitation. It is necessary to start movements in the shoulder some time after immobilization (in a small volume), which will avoid impaired mobility in the shoulder or the development of frozen shoulder syndrome.After removing the bandage, it is necessary to conduct a course of exercise therapy, which will restore muscle strength and joint mobility.

Surgical treatment

Surgical treatment for a fracture of the clavicle is necessary in cases where fragments of the clavicle violate the integrity of the skin with a strong displacement of fragments or the presence of a comminuted fracture. The operation of osteosynthesis is performed when the fragments are connected with screws of the plates of the bolts. Complications in the surgical treatment of clavicle fractures are quite rare.

Clavicle fracture

Brief Anatomy

The clavicle is a small, S-shaped curved tubular bone that connects at one end to the sternum (sternoclavicular joint), and at the other end to the acromial process of the scapula (acromioclavicular joint). A clavicle fracture can occur anywhere, but most often the fracture is localized in the diaphysis, less often in the acromial end of the clavicle, and even less often in the sternal end (20.8 and 1 case per 100,000 population per year, respectively).

Mechanism of injury:
A typical cause of a collarbone fracture is an injury (direct hit or fall on the arm). The clavicle gains maximum strength by the age of 20.

Classification of fractures:

There are clavicle fractures with and without displacement, and they can also be divided into closed and open. It is worth noting that open fractures of this type occur quite rarely, and this happens most often due to a direct blow to the clavicle region.Open fractures of the collarbone are most often the result of a traffic accident or a fall from a great height. In terms of location, fractures of the outer, middle and inner third of the clavicle can be distinguished. Most often, with fractures, it is the middle third that breaks, because it is the thinnest place of the entire bone. Another criterion is the nature of the fracture fragments, and they can be divided into oblique, comminuted, oblique and transverse

Symptoms:
• Anterior and downward displacement of the shoulder
• Inability to raise the arm due to pain
• Crunching sensations (crepitus) when trying to raise the arm up
• Deformation or unevenness in the clavicle;
• Pain in the shoulder girdle.

Diagnostics:
Visual inspection. “Gold standard” X-ray of the clavicle in two projections. In rare cases, a CT scan (fractures of the sternal end of the clavicle) is required for diagnosis.

Treatment:
Conservative treatment: after repositioning, the shoulder girdle is fixed with a plaster cast or orthosis. The immobilization period is 4-5 weeks. With conservative treatment, there is a high risk of non-union or improperly healing fracture.In this regard, the function of the entire upper limb is impaired.

Surgical treatment in our clinic:
During this operation, the displacement of the fragments is eliminated and the bone is fastened with a metal structure, the choice of which is determined by the nature of the fracture.
Currently, the most widespread is the osteosynthesis with plates and screws. If the fracture is located in the diaphysis, then conventional reconstructive plates or special S-curved plates for the clavicle will do.But if the fracture, the fracture line affects the acromial end of the clavicle, then other constructions may be needed.
Operational access: 1. Longitudinal section parallel to the clavicle; 2. Transverse (saber strike).

Treatment of diaphyseal clavicle fractures.
Patient supine position in the beach chair position. Pain relief: local anesthesia or endotracheal anesthesia. The operation is performed as soon as possible using modern techniques and implants.Implants made in Switzerland and Germany. Implant material: titanium or medical steel.

Before surgery:

After surgery:

After surgery, patients can start restoring limb function the next day. In our department, an exercise therapy instructor works with each patient. They carry out gymnastics, massage, physiotherapy. After surgery, patients return to their daily life as soon as possible.

Treatment of fractures of the acromial end of the clavicle.

Before surgery:

After surgery:

After surgery, patients can start restoring limb function the next day. In our department, an exercise therapy instructor works with each patient. They carry out gymnastics, massage, physiotherapy. After surgery, patients return to their daily life as soon as possible.

90,000 Non-surgical interventions in the treatment of clavicle fractures in adolescents and adults

Relevance and Purpose

Clavicle fracture is a common injury, especially among adolescents; it accounts for up to 4% of all fractures. Most clavicle fractures occur in the middle third. These fractures are often treated with conservative treatments that do not involve surgery. Usually, conservative treatment is an arm band, pull-ups, and cruciform bandages.

This review aims to assess the effect of various non-surgical methods of conservative treatment of clavicle fractures in adolescents and adults. The main outcomes we were interested in were long-term function and pain.

Search results

We searched the scientific literature up to January 2016 and found 4 eligible studies, involving a total of 416 people. Four small studies had methodological limitations that could affect the reliability of the results.Among the conservative treatments evaluated were a cruciform and arm band (in three studies) and therapeutic ultrasound and sham (placebo) (in one study).

Main results

Three studies (296 participants) comparing a cruciform to an arm band found that shoulder function was similar in the two groups at the end of follow-up. Although the data from the two studies did not show a difference in pain in the first two weeks after injury, the third study reported more severe pain and discomfort in people in the cruciform bandage group.It was noted that one participant underwent surgery due to a complication. None of the three studies found differences in fracture healing time, adverse outcomes, or time to return to school or work.

A fourth study compared therapeutic ultrasound and sham surgery in 120 people with clavicle fractures. There were no differences in outcome between the two groups, including fracture healing time.

Conclusions and quality of evidence

The evidence from three studies comparing cruciform and arm bandages was of very low quality and therefore cannot be relied upon to draw firm conclusions about how clavicle fractures should be treated.We assessed the quality of the evidence from one study comparing therapeutic ultrasound versus sham treatment as moderate because the study was conducted appropriately but was not large enough and therefore informative.

Overall, there was insufficient evidence to draw conclusions about the best conservative management of these fractures.

Clavicle fracture in children – causes, symptoms, diagnosis and treatment

Fracture of the clavicle in children is a common injury that ranks third in frequency after fractures of the shoulder and forearm.It is usually caused by a fall on the arm or compression of the chest. Less commonly, a fracture occurs when the collarbone is struck. In young children, subperiosteal fractures are observed, in patients of older and middle age groups, complete fractures. A complete fracture is accompanied by severe pain, deformation and swelling of the shoulder girdle. With subperiosteal fractures, there is no deformation of the shoulder girdle, pain is insignificant. The diagnosis is made on the basis of examination data and X-ray results. Treatment is usually conservative, various fixing dressings are used, and if necessary, reduction is performed.The operation is indicated in case of irreparable displacement of fragments and the threat of complications.

General information

Fracture of the clavicle in children accounts for 7.4-14% of the total number of fractures. It can occur at any age, but the largest number of cases occurs at the age of 2-4 years. It is usually an isolated injury and occurs in everyday life or during sports activities. The combination with fractures of other bones and soft tissue injuries is rarely observed, as a rule – in an accident or falls from a height.

Incomplete (subperiosteal) fractures may remain unrecognized or diagnosed late due to poor symptoms. Clavicle fractures, both incomplete and complete, heal well and do not leave behind functional disorders.

Fracture of the clavicle in children

Causes of fracture of the clavicle in childhood

In children, fractures of the clavicle are more likely to occur as a result of an indirect injury: compression of the chest or falling on the arm. The fracture is usually localized on the border between the outer and middle parts of the clavicle, since in this place the bone is thinner and its curvature is more pronounced.

Direct injury (impact to the shoulder girdle) is quite rare. In such cases, the fracture usually occurs in the outer part of the collarbone.

Features of a clavicle fracture in children

In young patients, fractures or subperiosteal fractures are more common. In traumatology, such injuries are called “green branch” fractures, since in this case the same happens as when trying to break a young branch of a tree: the inner part of the bone breaks, and the outer (periosteum) remains intact and holds the broken ends, not allowing them move.Usually such fractures are transverse. In some cases, the fragments held by the periosteum may be slightly displaced at an angle.

In older children, complete fractures of the clavicle are observed, which can be transverse, oblique, or comminuted. The degree of displacement of the fragments can vary significantly. Due to the weight of the limb and the action of the muscles during displacement, a typical picture is observed: the central fragment moves up and back, and the peripheral fragment moves down and forward.

Open fractures of the clavicle are very rare.Usually they are reopened, because they arise as a result of perforation of the skin with a bone fragment.

Symptoms of a fracture of the clavicle in children

With a subperiosteal fracture, there is a slight or moderate edema, sometimes bruising occurs at the site of injury, but the pain syndrome is usually not pronounced. The child does not complain, so the parents sometimes take such an injury for an ordinary bruise and turn to the traumatologist only after 1-2 weeks, when a noticeable callus forms at the site of the fracture, which looks like a dense swelling.

With a complete fracture, sharp pain occurs, edema appears, more pronounced when the fragments are displaced. The shoulder girdle on the side of the fracture looks shortened. The patient takes a characteristic forced position: tilts the body to the injured side, holding the sore arm and pressing it to the lower chest or abdomen.

The scapula “sags” on the side of the fracture, its edges become more visible. The upper limb is turned inward and displaced anteriorly. On palpation, the ends of the fragments are palpated, palpation is painful, sometimes crepitus is noted.Movement is limited. The maximum soreness is observed when trying to raise the arm up over the side.

Complications

With a pronounced displacement of fragments, damage to the subclavian artery, subclavian vein, branches of the brachial plexus, pleura and apex of the lung is possible.

In case of damage to blood vessels, symptoms of internal blood loss are observed: pallor of the skin, weakness, cold sweat. When the branches of the brachial plexus are damaged, neurological disorders occur.Damage to the lung and pleura is associated with respiratory distress.

In all these cases, urgent surgical intervention is necessary.

Diagnostics

Treatment of a clavicle fracture in children

At the prehospital stage, the child should be given pain relievers and the arm should be kept at rest by bending it at the elbow and hanging it on a kerchief. You can also bandage your arm to your torso. If the fracture is open, a sterile dressing should be applied to the wound.

Do not make independent attempts to reposition the fragments – such actions can cause damage to the skin, blood vessels and nerves.The patient must be transported strictly in a sitting position.

Pediatric traumatologist treats clavicle fractures. Treatment is usually done on an outpatient basis. Indication for hospitalization in trauma. separation is a significant displacement of fragments, an open fracture, damage or threat of damage to the lung and neurovascular bundle and the threat of skin perforation.

For subperiosteal fractures and complete fractures with a slight displacement, Delbe’s rings or a Desot dressing are applied.

For displaced fractures, reposition is performed. In young children, the manipulation is performed under general anesthesia. In older patients, local anesthesia may be used. In order to eliminate the offset in length, both shoulder girdles are strongly retracted backward and upward. For the reposition of fractures with angular displacement and transverse fractures, special finger techniques are used (the doctor presses fingers on the fragments in a special way). After reduction, a special fixing bandage is applied.The type of dressing is chosen taking into account the peculiarities of the displacement.

Timing of immobilization is determined by the type of fracture and the patient’s age and is usually 2-3 weeks.

Surgical treatment is rarely required. The indication for surgery is an open fracture, damage to blood vessels, nerves, pleura and lung, the threat of damage to the listed anatomical structures or the threat of skin perforation, as well as significant displacement of fragments that cannot be eliminated during reduction.

The surgery is performed under general anesthesia.If the fracture is localized in the middle part of the clavicle, osteosynthesis of the clavicle with a pin or wires is possible. Special S-shaped plates and conventional reconstructive plates are also used. In case of damage to the acromial end of the clavicle, osteosynthesis of the clavicle is usually performed with a plate with locking screws or a hook-shaped plate.

After the operation, the arm is suspended on a scarf. The stitches are removed on day 7-10. In the recovery period, exercise therapy, massage, electrophoresis and magnetotherapy are prescribed.

The forecast is favorable. Movements are preserved in full. With adequate reduction of the fragments, the normal configuration of the clavicle is restored within a few months.

About the implantable port | Memorial Sloan Kettering Cancer Center

This information tells you how to install an implantable port and how to care for it. An implantable port is a type of central venous catheter (CVC).

to come back to the beginning

About implantable ports

An implantable port (also called simply a “port”) is a flexible tube that is inserted into a vein in your chest.It will make it easier for your healing team:

• intravenous (iv) drug administration;
• intravenous fluids;
• collection of blood samples;
• continuous administration of drugs for several days. In some cases, medications must be injected through a vein that is larger than the vein in the arm. The port allows the drug to enter the bloodstream through a large vein near the heart.

The implantable ports are usually located approximately 1 inch (2.5 cm) below the center of the right clavicle (see Fig.picture 1). If you are wearing a bra, the implantable port will be 1 inch (2.5 cm) from the bra strap.

Figure 1. Port Location

Implantable ports can be installed for many years. Once the port is no longer needed, your doctor will remove it.

Types of implantable ports

All implantable ports consist of 2 parts: a port with a membrane and a catheter (see.Figure 2).

• The port is the starting point for fluid entry through the catheter. It is located under the skin and has a convex central part called the membrane. The diaphragm is made of self-tightening rubber material. This is the part of the port where the needles will be inserted. It is also called an access point.
• The catheter is a thin plastic flexible tube. One end of the catheter is attached to a port, and the other end is in a large vein near the heart.

Figure 2. Port Components

There are 2 types of implantable ports:

• Single lumen port is a port with 1 access point (see Figure 3). A single lumen port is installed in most cases.
• Double-lumen port is a port with 2 access points (see Figure 3). Needles can be inserted into each access point. Double-lumen ports are installed for patients who regularly require more than 1 access point.

Figure 3. Single and double lumen ports

Most implantable ports are about the size of a five- or twenty-five cent coin. They can be round, oval or triangular in shape. Your doctor will select the port that works best for you and your treatment option. Your port might be called BardPort ^® , Mediport ^® , PowerPort ^® , or Port-A-Cath ^® .

Pressure injection ports

Most implantable ports are used during medical imaging procedures, such as computed tomography (CT) or magnetic resonance imaging (MRI), to speed up the delivery of contrast media. These implantable ports are called power-injectable ports.

After the implantable port is installed, the nurse will tell you if you have a pressurized injection port.You will also be given a reminder card with information about your implantable port. You should always carry it with you.

Implantable Port Access

If you require intravenous fluids or drugs, the nurse will insert a needle into the access point in the implantable port. This is called port access (see Figure 4). Fluids or drugs will flow from the implantable port into the bloodstream through the catheter.

Do not allow unauthorized persons to access the port.

Figure 4. Port Access

to come back to the beginning

About installing an implantable port

Before the procedure

The port placement procedure is performed in the Interventional Radiology department or operating room. This is a short procedure. Your doctor or nurse will tell you how to prepare for it.

Before the procedure, you will be given an IV line in your arm.It will give you a medication to make you sleepy. This medicine relieves pain and soothes.

Removing devices from the skin

If you are wearing any of the following devices on your skin, the manufacturer recommends that you remove it before having a scan or procedure:

• Continuous Blood Glucose Meter (CGM)
• Insulin pump

Contact your healthcare professional for an appointment closer to the date of the planned device replacement.Make sure you have a spare device with you that you can wear after your scan or procedure.

If you are unsure of how you can control your glucose level while the device is off, talk to your diabetes care provider prior to your visit.

During procedure

The site of the implantable port is cleaned and anesthetized with a local anesthetic (a drug that numbs an area of ​​the body). The local anesthetic is given in two places – the neck and the chest.

A small incision (surgical incision) is made at the base of the neck. A second incision is made in the chest under the collarbone. A catheter is inserted through a second incision, passed under the skin to the first incision, and inserted into a vein.

Sutures or Dermabond surgical glue will be applied to the incisions
^® . If stitches are applied to you, they will dissolve on their own and will not need to be removed.

After procedure

You may experience some discomfort at the incision sites and in the area where the catheter passes under the skin.This pain should subside within 24 to 48 hours. You can take an over-the-counter (over-the-counter) pain medication if needed. In most cases, patients do not need to take prescription pain relievers.

If the port will be used on the day of insertion, the clinician will insert the access needle into the membrane during the insertion procedure. A bandage (bandage) will be applied to the needle and port. A small bandage will also be placed over the upper incision.

Care of the incision site

If sutures were applied to the incisions:

• 2 small bandages will be applied to the incisions;
• Do not remove bandages within 48 hours or as prescribed by your doctor;
• do not wet the bandages; you can take a shower after they are removed;
• seat belt can press on cuts; you can put a small pillow or folded towel under the belt;
• Do not lift anything heavier than 10 pounds (4.5 kg) for 3-5 days after inserting the implantable port.

If Dermabond adhesive has been applied to the incisions:

• small strips of plaster or bandages may be applied to the incisions;
• Do not apply lotion or glue anything over the patch or bandage;
• Do not peel or scrape Dermabond,
  he will come down on his own;
• seat belt can press on cuts; you can put a small pillow or folded towel under the belt;
• Do not lift anything heavier than 10 pounds (4.5 kg) for 3-5 days after inserting the implantable port.

After incisions have healed

Once your incisions have healed, you can return to your normal daily activities, such as work duties, housework and exercise. You can swim if there is no needle inserted into the implantable port. Avoid contact sports such as soccer or rugby.

The implantable port can lift the skin approximately 1/2 inch (1.2 cm). You can feel the port under your skin, but you probably won’t see it if you wear a V-neck tee.Most people will not be aware that you have a port set.

The skin over the implantable port requires little maintenance. You can wash it as usual.

A transparent dressing is applied over the needle while the port is being used. While the needle is in the port, the dressing should remain in place and dry. If the port is not in use, the bandage is not needed.

Metal detectors do not respond to the implantable port.

Flushing the implantable port

If the implantable port is not in use, the nurse will need to flush it once every 4 weeks.This is done to prevent blockage of the catheter. If a blockage occurs, it may stop working and have to be removed.

to come back to the beginning

Call your interventional radiologist if you have:

• pain appeared or increased at the site of the port installation;
• there is a swelling or bruising at the port installation site;
• Pus or fluid comes out of your incision (s)
• You notice that the incision is hot, painful, and reddened or irritated around it.

to come back to the beginning

Call your healthcare provider if you have:

• Temperature 100.4 ° F (38 ° C) or higher
• chills;

to come back to the beginning

90,000 Dislocation of the clavicle – causes, symptoms and treatment

Dislocation of the clavicle – an injury that is accompanied by the displacement of one of the ends of the S-shaped bone: sternum or acromial. It is accompanied by severe painful symptoms.Treatment is mainly conservative. In the presence of complications, surgery is required.

Causes and classification

Dislocation of the clavicle occurs most often when falling from a height onto a limb that is laid aside. Less often, a sharp and strong pressure on the shoulder girdle can lead to injury. The classification of dislocation is based on how much time has passed since the injury and how exactly one of the ends was displaced.

Dislocation may be:

• fresh – no more than 3 days have passed since the injury was received;
• stale – up to 3 weeks;
• old – more than 3 weeks have passed.

Fresh dislocations of the clavicle, if there are no complications, are treated with conservative methods. If the injury is old, you have to resort to surgical intervention. How to treat the injury, the doctor decides after diagnosis. More details about the methods used to detect dislocation of the clavicle can be found at sportmed.com.ua.

Depending on the location and severity, dislocations can be complete or incomplete.

Symptomatic picture

Immediately after receiving a traumatic injury, severe pain in the arm appears.Severe edema forms on the soft tissues. There is also a deformation of the clavicle: one of its ends can be raised or deflected to the side.

A specific sign of dislocation is the “key” symptom. If you press your finger on the protruding end, it returns into place, and when the mechanical action stops, the end deflects again. How much it goes to the side depends on the type of dislocation – complete or incomplete.

In addition, there is a violation of motor activity in the injured upper limb.Movement may be limited or completely absent. Palpation of the affected area is difficult, since this causes an increase in pain symptoms.

Treatment methods

In the absence of complications, the treatment of dislocation of the clavicle is conservative, including the reduction procedure and subsequent fixation of the limb for a period of 2 to 3 weeks. To speed up the healing process, physiotherapeutic procedures are prescribed, for example, electrophoresis with drugs of anesthetic and anti-inflammatory action, magnetotherapy.The exercise of physiotherapy exercises is mandatory.

If the dislocation is accompanied by a number of complications that cannot be eliminated by conservative methods, surgery is performed. Surgery is the only way to treat chronic dislocations. If there is a complete dislocation of the acromial end, plastic surgery of the articular joint is performed, during which the acromial end put in its place is fixed with silk threads or lavsan tapes. With retrosternal dislocation, lavsanoplasty is performed.

Operation for dislocation of the clavicle is in most cases planned. If damage to the sternal end occurs, leading to impaired breathing, surgical intervention is performed as an emergency.

Treatment Injury to the articular lip – Orthopedics Ruslan Sergienko

What is the articular lip of the shoulder and what is it for?

The glenoid lip is a rim of fibrous cartilage that is attached along the edge of the glenoid cavity of the scapula.Attaching in this way, the lip helps to deepen the rather flat cavity of the scapula, creating conditions for better insertion of the head of the humerus. In addition, the articular lip has a “suction” effect, contributing to an even closer contact of the articular surfaces of the humerus and the cavity of the scapula.

The articular lip serves as the place of attachment of the shoulder-scapular ligamentous complex and the tendon of the DHDM, which provide stabilization of the shoulder joint.Each of the ligaments resists shoulder dislocation at a specific abduction angle. If there is a separation of the articular lip from the cavity of the scapula, the stabilizing function of the complex of the shoulder-scapular ligaments is lost, therefore, damage or tearing of the lip always leads to the development of shoulder instability.

Separation of the anterior and lower part of the articular lip, together with the shoulder-scapular ligaments attached to it, leads to antero-lower instability of the shoulder and dislocation, separation of the upper part, with the attached tendon of the long head of the biceps muscle – to upper instability, separation the posterior part of the lip – correspondingly to the posterior instability.

Instability of the shoulder leads to a sharp decrease in its function, especially in patients who lead an active lifestyle. This is especially true for people whose instability has turned into a habitual dislocation of the shoulder. These patients are forced to limit physical activity, constantly monitor their movements in the shoulder joint and avoid falls.

The separation of the anterior and lower part of the articular lip, together with the shoulder-scapular ligaments attached to it, leads to anterior-lower instability of the shoulder and dislocation, the separation of the upper part, with the attached tendon of the long head of the biceps muscle – to upper instability, the separation of the back of the lip – correspondingly to posterior instability.

WHAT ARE THE SYMPTOMS OF A SHOULDER LIP DAMAGE?

Injury to the lip of the scapula is accompanied by shoulder pain, clacking sensation, and shoulder instability.

DIAGNOSIS OF SHOULDER LIP DAMAGE:

Clinical tests.

It is possible to suspect damage to the articular lip using special diagnostic tests. Diagnostic tests should be performed by a physician who has specific skills, a good knowledge of anatomy and experience in a large number of patients.The diagnostic sensitivity of these tests is extremely high – the information content of some of them is at the level or even higher than that of MRI studies of the shoulder.

Ultrasound diagnostics of the shoulder.

MRI – diagnostics – should be performed in all patients with suspicion of damage to the articular lip, while the study should be carried out on an apparatus of at least 1.5 Tesla. MRI scans obtained on devices of 1 and less tesla may not show damage to the articular lip and it will not be diagnosed in a timely manner.

According to world statistics, up to 40% of injuries to the articular lip of the shoulder are not diagnosed and damage can only be detected by an arthroscopic examination of the joint.

Arthroscopic diagnostics is the “gold standard for diagnostics” of joint lip damage, the most reliable method. With the help of a modern device – an arthroscope, the doctor can examine all structures of the joint from the inside and reveal even the smallest damage.

CONSERVATIVE TREATMENT OF SHOULDER LIP DAMAGE:

Treatment of injuries of the articular lip can be both conservative and operative.Conservative treatment consists in the patient’s compliance with the regimen of painless loads, anti-inflammatory treatment during exacerbation, undergoing a course of physiotherapeutic procedures.

SURGICAL TREATMENT OF SHOULDER JOINT LIP DAMAGE

However, the main method of treatment of articular lip injuries is surgery, since only in this case it is possible to sew on the torn off parts of the lip, to perform the reconstruction of its sections and damaged muscles and tendons. Today, the most modern method of surgical treatment of injuries of the articular lip of the shoulder is arthroscopy of the shoulder joint – an operation without an incision.

With the help of arthroscopy, we can perform the following manipulations: sew on the articular lip, if necessary, remove damaged and nonviable parts of it, perform plastic surgery and restore the torn off parts of muscles and tendons, and eliminate bone damage. The operation of sewing (refixing) the glenoid lip to the glenoid cavity of the scapula is called the Bankart operation (in case of damage to the glenoid lip in the anterior, anterior-lower part of the joint). Sewing and fixation of the severed area of ​​the glenoid lip to the edge of the glenoid cavity is performed using special absorbable anchor clamps.Currently, there are a fairly large number of different anchor clamps, differing in diameter (1.3 – 3.5 mm), absorbable (polylactic acid) or non-absorbable material (titanium), the number and type of threads, as well as knotted or knotless by the method of fixing the threads. The strength of fixation of the articular lip depends on the correct choice of anchors, the correct technique for their installation and a sufficient volume of soft tissues. The number of anchors required for a Bankart operation depends on the size of the gap.Usually 2 or 3 anchors are installed.

In case of damage to the lip in combination with a bone defect of the edge of the glenoid cavity, operations are used, including bone grafting – the Laterger operation. Latger surgery is usually performed when the bone defect of the anterior-inferior edge of the scapula is more than 25% (assessed by CT). Its meaning consists in the transplantation of a part of the coracoid process, with the muscles attached to it, into the defect zone on the anterior surface of the glenoid cavity, fixation of the displaced fragment is carried out with screws.

WHAT AFFECTS THE RESULTS OF SHOULDER ARTHROSCOPY?

To perform high-quality arthroscopy of the shoulder joint and obtain the most successful results of the operation, 3 conditions are required:

An experienced orthopedic surgeon.

Shoulder arthroscopy is a technologically more complex operation than, for example, knee arthroscopy. We can say that this is aerobatics, even for an experienced orthopedic surgeon dealing with joint arthroscopy. By international standards, a surgeon who practices shoulder arthroscopic surgeries can be considered experienced if he has performed at least 1000 such surgeries, which is a rather difficult task.

Sufficient level of equipment for arthroscopy.
It is necessary to have a full set of expensive high-tech equipment: a monitor, a digital video camera, an optical device (astroscope with a diameter of 4 4.5 mm), a xenon light source with a power of at least 150 W, a device for supplying a solution that flushes the joint during surgery (arthroscopic pump), a device for coagulation and cutting of tissues in solution (vaporizer), installation for mechanical removal of soft and bone tissues.(shaver), a special set of instruments for carrying out different types of restorative interventions. The absence of at least one of the above makes it impossible to perform high-quality shoulder arthroscopy.

Adequate anesthetic management.

REHABILITATION AFTER ARTHROSCOPY OF THE SHOULDER JOINT:

Correctly performed surgery allows you to start active rehabilitation quickly enough to prevent the development of complications and optimize the recovery time.

After shoulder arthroscopy, the arm is immobilized in the abduction position for several weeks using a special splint. Such immobilization reduces tendon tension and reduces the risk of re-rupture, creating favorable conditions for better tendon healing. The duration of immobilization is determined by the surgeon who performed the operation, since only he can assess the condition of the tendons and the strength of the suture.

Already from the first weeks after shoulder arthroscopy, patients are advised to perform special exercises aimed at developing movements in the shoulder joint.However, their intensity and sequence should be selected by the operating physician and an experienced rehabilitation therapist.

In our Medical Center, patients after shoulder arthroscopy are offered a whole range of rehabilitation measures. The rehabilitation program is selected individually and includes:

Special exercises and exercise therapy at the rehabilitation therapists of our Medical Center using the kinesiotherapy method. Exercises are aimed at improving the range of motion in the joint, preventing the development of contractures, increasing strength and endurance in the muscles of the shoulder girdle.