Clavicle fracture

A clavicle fracture is a bone fracture in the clavicle, or collarbone.

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Frequency

Clavicle fractures involve approximately 5% of all fractures seen in hospital emergency admissions. It is most commonly fractured between the proximal 2/3 and distal 1/3 of its length. Children and infants are particularly prone to it. Clavicle fractures can be present in the newborn period, especially following a difficult delivery.

History

Hippocrates, 4th century BC:

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

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

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

Symptoms

• Patient often reports a fall onto an outstretched upper extremity, a fall onto a shoulder, or direct clavicular trauma.
• Pain, particularly with upper extremity movement
• Swelling
• Often, after the swelling has subsided the fracture can be felt through the skin.
• sharp pain, when any movement is made.

Treatment

Treatment usually involves resting the affected extremity and supporting the arm with the use of a sling, supported over the opposite shoulder. In older practice, a figure-8 brace was used, designed to provide immobilisation of the fracture to facilitate healing, but more recent clinical studies have shown that the outcomes of this method were not measurably different from simple sling support, and due to the movement difficulties caused to the patient, this method has mostly lapsed. Current practice is generally to provide a sling, and pain relief, and to allow the bone to heal itself, monitoring progress with X-rays every week or few weeks. Surgery is rarely used, only if it is an open fracture.

More than 90% of clavicle fractures are successful healed by non operative treatment. The surgery is indicated in the following conditions. 1.The impending of the fracture site penetrating the skin. 2.The fracture of clavicle with associated to nerve and vessel injuries. 3.The symptomatic or painful nonunion and 4.Fracture of at the end of the clavicle which injuries to the ligament of acromioclavicular joint.

A discontinuity in the bone shape often results from such a fracture. In rare cases (2-5%) surgery may be required when skin is broken or if the fracture is extremely displaced (disunion). Surgical procedure will often call for a plate to be affixed along the bone on either side of the fracture and screwed into the clavicle. In some cases the plate may be removed after healing. Surgical intervention in the region of the clavicle is avoided if possible, due to various important structures beneath.

For adults, healing time – four to six weeks – is longer than for children – three weeks. After two to three months the clavicle begins to strengthen back to normal, to gain its former full strength after half a year.