How does a collarbone break?
The collarbone is the only bone that rigidly connects the arm to the skeleton of the body. When you fall on the shoulder, the entire load is transferred along it, and the bone breaks most often in the middle third, where it is most thinly curved. The muscles pull the fragments in different directions: the internal fragment goes up, the outer fragment goes down under the weight of the hand, hence the typical step under the skin. Fractures of the outer end are less common, but heal less well because the ligaments holding the scapula are broken there.
- The middle third is the most common location
- Outer (acromial) end - fuses worse
- Internal (sternal) end - rare, requires attention to the chest organs
- Non-displaced fracture and subperiosteal fracture in children
- Comminuted fracture due to high-energy trauma
Symptoms and first aid
The pain occurs immediately and intensifies when you try to raise your arm or move it to the side. The person instinctively supports the forearm with the healthy hand and tilts the head towards the injury. A swelling quickly appears above the collarbone, later a bruise, and an unevenness is often visible or palpable. Before arriving at the clinic, you need to hang your hand on a scarf, apply cold through the fabric and not try to set the fragments. If the hand becomes cold, numb, or there is a wound above the bone, help is needed immediately.
- Sharp pain in the shoulder girdle, worsening with movement
- Swelling, bruising, step under the skin
- The shoulder is dropped and shifted forward
- Crunching sound when trying to move
- First aid: headscarf, cold, rest, contact a traumatologist
Diagnostics
The diagnosis is confirmed by radiography: the image shows the fracture line, the number of fragments and the amount of displacement. Additionally, a chest X-ray is performed to exclude damage to the lungs and ribs, especially in case of injury in an accident. CT is prescribed for complex comminuted fractures, damage to the sternal end and when planning surgery. Ultrasound helps assess the condition of soft tissues and detect a fracture in a newborn, to whom they try not to give radiation exposure.
- X-ray of the clavicle in direct and oblique projection
- Chest X-ray for severe trauma
- CT scan for comminuted fracture and damage to the sternal end
- Ultrasound of soft tissues and clavicle in infants
- Checking the pulse and sensitivity of the hand during examination
Treatment: bandage or surgery
Fractures without significant displacement are treated conservatively. The arm is fixed with a scarf or a special bandage for several weeks, painkillers and cold are prescribed in the first days. Figure-of-eight dressings are used less frequently today: they do not improve fusion, but are less tolerated. Surgery is discussed in case of shortening and displacement of fragments by more than the width of the bone, threat of skin eruption, open fracture, damage to blood vessels and nerves, as well as fractures of the outer end with ligament rupture. Then the fragments are fixed with a plate or rod, which allows movement to begin earlier.
- Bandage or bandage for 3–6 weeks in adults
- Pain relief and cold in the first two days
- Control photo after 1–2 weeks
- Osteosynthesis with a plate or intramedullary rod during displacement
- In children, fusion is faster, fixation is shorter
- Removal of metal structures, if necessary, after a few months
Recovery time and rehabilitation
Bone callus forms in adults in 4-8 weeks, in children - in 2-4 weeks. Movements of the hand and elbow are allowed almost immediately so that stiffness does not develop, and raising the arm above shoulder level and loads are added gradually with the doctor’s permission. They usually return to everyday activities after 1.5–2 months, to contact sports - no earlier than three months and after a control image. A slight thickening or bump at the fusion site is normal and does not require treatment. If pain and mobility of the fragments persist after a few months, we may be talking about nonunion, and a re-examination is needed.
- Early movements of the hand, elbow and fingers
- Pendulum exercises for the shoulder as prescribed by a doctor
- Gradual increase in amplitude after removal of the bandage
- Therapeutic exercise and strengthening of the shoulder girdle muscles
- Limiting heavy lifting before union
- Re-examination if pain and crunching persists