There are 2 basic ways for treating a clavicle fracture. This treatment strategy reportedly achieved high union rate, good functional recovery, and high patientrelated satisfaction. Therefore, for unstable distal clavicle fractures classified as neer type ii or v 4, 5, surgical treatment is usually. Get information on broken collarbone clavicle symptoms in newborns, children, teens, adults, and the elderly such as pain and bruising at the site of the fracture. Jan 14, 2019 given the excellent results obtained with nonoperative treatment of uncomplicated midclavicular fractures, such therapy, using a figureofeight brace or regular support sling, is recommended. A history and physical examination performed by an orthopedic specialist, and xrays are usually enough to officially diagnose and formulate a treatment plan for a clavicle fracture. Clavicle fractures are classified according to the fracture location with the use of the allman classification. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Clavicle surgery may be needed if the fractured bones if the fractured pieces of bone are not in their correct, anatomical location. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. This is due to the trauma from the fracture and from the surgery. The majority of clavicle fractures can heal without surgery. Surgical options to achieve bony union include transacromial wire fixation, a modified weaverdunn procedure, use of a tension band.
Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. Most people with clavicle fractures have an excellent outcome with return to normal activities and a pain free shoulder at 35 months after injury. Broken collarbones are most common in children in young adults. The original classification by neer in the 1960s described two types of distal clavicle fractures. The decision whether to operate may be influenced by the amount of fracture displacement and the individual demands of the patient. The clavicle bone lies just beneath the skin, so a fracture usually causes an obvious protrusion or bump at the fracture site, along with swelling. Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Fractures here usually are caused by an accidental fall or some other type of direct impact football tackle, hockey check, car collision. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the the swedish fracture register sfr that collects national prospective data from large fracture populations.
This is a followup leaflet to your recent telephone consultation with the fracture care team explaining the ongoing management of your injury. The history and physical examination remain the primary means of diagnosing this injury. More than twothirds of cases are due to a fracture in the middle third of the clavicle group i of the allman classification. Treatment consists of drainage of the hemothorax and conservative treatment or operative.
Pain and antiinflammatory medications may also be prescribed. Following a clavicle fracture, a figureofeight clavicle strap, along with a sling, is fitted to the. Pdf clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466%. Ideally, nondisplaced clavicle fractures are treated nonoperatively using. Broad arm sling to support limb for 2 weeks or until comfortable. Mathes expect swelling and bruising for a few weeks following the surgery. If the fracture is displaced the outer lateral side of the clavicle is usually pulled down due to the weight of the arm and the inner. The classification and treatment of distal clavicle fractures depend on where the fracture occurs in relation to these ligaments. Many times when someone has undergone clavicle fracture surgery they will heal faster than those who do not and use other methods to treat their clavicle fracture. Clavicle fracture knowledge for medical students and.
Most clavicle fractures are treated without surgery. Pdf clavicle fractures is there a standard treatment. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Over onethird of clavicle fractures in males occur between the ages of and 20 years, while 20 percent of clavicle fractures in women occur in the same age. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Clavicle fractures are very common injuries in adults 25% and children 1015 % 1 and represent the 4466% of all shoulder fractures 2.
A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. This helps prevent arm movement as the collarbone recovers. Newborn clavicle fractures nationwide childrens hospital. Clavicle fractures take the same time to heal with or without surgery. This leaflet gives you the advice and exercises to help your clavicle collar bone to recover after your fracture. Normally, a sling is applied to the arm for treatment of a fractured clavicle. Clavicle fractures also result from abusive trauma. Surgery is an option in fractures that have high potential for nonunion e. A surgery is required in cases where there are multiple pieces of the bone, or there is a penetration in the skin leading to what is called an open fracture. Do not return to contact sport until you are pain free and at least 8 weeks after your injury. Collarbone pain clavicle pain causes and treatment. Fracture of the clavicle is very common in people of any age. A poor result was more common in patients with distal clavicle fracture, and a good result was more common in patients in whom less than 10 mm of clavicle was. The primary focus, however, will be upon fracture management, with specific attention paid to the most recent literature regarding operative versus nonoperative treatment of clavicle fractures.
This is largely because of reported nonunion rates of less than 1% and separate reports by neer40 and. Trauma is the most common cause of a clavicle fracture. Historically, nonoperative treatment of midshaft clavicular fractures was. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. First aid, treatment, and recovery time for a broken collarbone is provided. Nonsurgical treatment for a broken clavicle can include the following. Treatment will depend on the damage and the kind of fracture you have.
We undertook a multicenter randomized controlled trial to compare effectiveness and safety between nonoperative management and orif open reduction and internal fixation for displaced midshaft clavicle fractures in adults. Clavicle fractures are often caused by a direct blow to the shoulder. Pdf treatment of clavicle fractures giovanni merolla. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm. Clavicle fracture is a common fracture and constitutes approxi mately 4% of all fractures in adults. Clavicular injuries can lead to abnormal biomechanical stresses and longterm. If your clavicle fracture is good position, no surgery is required. Clavicle fracture broken collarbone orthoinfo aaos. The distal most lateral fractures in children may be growth plate injuries and also need to be. It is very important to keep your arm from moving to allow the clavicle to heal. Clavicle fracture treatment, healing time, surgery, management. Because of the position of the collar bone, it is not possible to wear a cast if you break this bone.
Whilst they may be very painful, clavicle injuries are rarely serious and in most cases are managed. The clavicle, also referred to as the collarbone, is a long bone located at the top of the chest. However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and nonunion, compared. Closed fracture bone has not broken through the skin. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Clavicle fractures are classified into three types based on the location of the fracture. Due to the curved shape in a tilted plane xrays are typically oriented with 15 upwards facing tilt from the front. Clavicle fractureshaft childrens hospital at montefiore. The incidence of nonunion following non operative care of displaced midshaft fractures of the clavicle a number of recent studies of completely displaced, midshaft fractures of the clavicle reveal nonunion rates between 15% and 20% 5,6.
Jan 31, 2011 fractures of the clavicle le kim trong md. Plate fixation is the primary treatment for symptomatic nonunion of a clavicle shaft fracture. Give parent fracture of the clavicle collarbone fact sheet. When a bone breaks or cracks, the injury is called a fracture. In former times, xrays were taken of both clavicle bones for comparison purposes. Clavicle fracture introduction clavicle fractures are a common orthopedic injury, particularly among infants and young children. Diagnosis and causes of a clavicle fracture sportshealth. Surgical treatment in displaced fractures of the clavicle in our study produces satisfactory results. Forces sufficient for fracture can be inflicted by a direct blow to the shoulder or, alternatively, if the child is thrown or pushed and subsequently falls onto his or her shoulder figure 329. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. The peak incidence occurs in children and young adults. In addition to plate fixation, in the setting of atrophic.
Neer sup3 reported low nonunion rates after nonoperative treatment of midshaft clavicle fracture of 0. Rarely, clavicle fractures can occur from a direct blow or from a fall on an outstretched. The treatment of displaced midshaft clavicle fractures remains controversial. Browse by title browse by subject journal indexing. Once the fracture heals, this special plate may be removed. Most clavicle fractures heal nicely with conservative, nonsurgical treatment. Historically, only unstable distal clavicle fractures were treated operatively. In fact, they account for about 5% of all fractures seen at the hospital. Jan 01, 2008 the usual mechanism of a clavicle fracture is a fall directly on the shoulder with the arm at the side. The emphasis of this article is on the management of these injuries. When examining a patient with an acute clavicle fracture i typically look for the usual deformity of the. N2 fractures of the clavicle are relatively common injuries that can occur in patients of all ages. The majority of clavicle fractures are treated conservatively.
No evidence to support figure of 8 bandage or brace. Diagnosis and management of distal clavicle osteolysis. Epidemiology clavicle fractures account for approximately 2. Clavicle fractures are common in children and adolescents. Clavicle fracture broken collarbone a broken collarbone is also.
Factors that may increase the risk for a clavicle fracture include the newborn being large in size, the newborns shoulder getting stuck during delivery, or the use of tools to assist with the delivery. The oldest document that reports on the treatment of clavicle fractures dates back to 16001700 bc breasted, 1930. Displaced, clavicle fracture, mid shaft and plating. Nonsurgical and surgical management provide similar results. Clavicle collar bone fractures are the most common injury sustained by newborns during birth. Historically, the vast majority of clavicle fractures have been treated nonoperatively in the acute setting. Even displaced fractures have been successfully managed without surgery. Physiotherapy department helping your clavicle to recover. On occasion, a severe fracture, or what appears to be a mild fracture, will not heal properly. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. A clavicle fracture, aka broken collar bone, is a common injury usually caused a fall, direct blow or car accident.
You have sustained a fracture to your clavicle collar bone. Males are more prone to fracture than females 68% versus 32%. Free range of motion is usually allowed after 6 weeks 19. One is surgical and the other is nonoperative treatment. The clavicle is the bone that connects the breastplate sternum to the shoulder. Now that you are using your sling less, it is very important that you use your shoulder as normally as possible. Xrays will be taken to determine the location and extent of the injury. Pdf clavicle fractures, especially of the mid third, are an injury commonly seen in. Treatment for collar bone fracture includes immobilization of the arm and minimal movement of the upper body during the healing process. Treatment of distal clavicle fractures using a scorpion. Clavicle fractures are common fractures that usually affect children and adolescents and typically occur from a direct fall onto the shoulder. Jan 14, 2019 clavicle fractures are common and easily recognized because of their subcutaneous position, as shown in the images below.
Anatomy the collarbone clavicle is located between the ribcage sternum and the shoulder blade scapula, and it connects the arm to the body. At first your shoulder will feel stiff and painful but it is important that you continue to move it as this will aid your. The fracture pattern will largely determine whether your surgeon will suggest treating the fracture with or without surgery. The collar bone is the most commonly fractured bone in the body. The outer third of the collarbone is near the tip of the shoulder. Nonoperative treatment of midshaft clavicle fractures in. In the setting of hypertrophic nonunion, increased stabilization with orif may be all that is required.
Nonoperative treatment of midshaft clavicle fractures in adults. Large multicentre studies of clavicle fractures have so far been missing. It articulate with sternum medially to form sternoclavicular joint. If you continue browsing the site, you agree to the use of cookies on this website. Adolescent injuries usually involve contact sports. Clavicle fractures also called simply broken collarbones are a familiar woe to many athletes. The basic method to check for a clavicle fracture is by an xray of the clavicle to determine the fracture type and extent of injury. Pain medication, typically nonsteroidal antiinflammatory drugs such as naproxen and ibuprofen.
Evidence based management of midshaft clavicle fractures. Fractures of the midthird of the clavicle do well with nonoperative treatment, except for those in which the fracture is displaced posteriorly. In these cases, the bones need to be moved and secured in order to heal properly. You may be given contrast liquid to help the fracture show up better in the pictures.
Clavicle collarbone fractures make up 44% to 66% of all shoulder fractures. Swelling and pain your clavicle and shoulder may still be swollen and bruised. Any nondisplaced distal clavicle fracture in a child type i, ii, or iii can be managed with sling immobilization for comfort and early rangeofmotion exercises as soon as pain permits. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. Nonoperative treatment is preferred for distal clavicle fractures. This recommendation is based on the analysis of 2000 patients with a very low nonunion rate of 0. Given the excellent results obtained with nonoperative treatment of uncomplicated midclavicular fractures, such therapy, using a figureofeight brace or regular support sling, is recommended. Distal clavicle fractures have a high nonunion risk 22 50% in patients treated nonsurgically due to the instability caused by the two opposing forces of trapezius traction and the weight of the upper extremity. Birth fractures occur in 1% to 2% of all vaginal deliveries, most often with largeforgestationalage infants and during extraction and difficult deliveries. Over onethird of clavicle fractures in males occur between the ages of and 20 years, while 20 percent of clavicle fractures in women occur in the same age group. Despite the high frequency the choice of proper treatment is still a challenge for the orthopedic surgeon. Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. Despite the name, the collarbone isnt really in your neck. Adult clavicle fractures an atomy the clavicle, commonly called the collarbone, forms a strut that connects the rib cage to the scapula shoulder blade.
Clavicle fractures indications for operative treatment. This may make your clavicle and shoulder sore in the early stages, but you will be able to gradually increase your activity as pain and swelling settle. If immobilization is used as treatment you may have a visible bump in the area but if you had surgery to fix the clavicle fracture you will little to no visible bumps. An arm sling or wrap is typically worn after the break occurs. Handbook of fractures pdf 3rd edition, written by leading orthopedic surgeons, this superbly illustrated pocket guide helps you expertly diagnose, classify, and, most importantly, manage every type of fracture and ligamentous injury commonly seen in clinical practice. This prevents displacement and makes type ii fractures in children more stable than in adults. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 3 april 2015 v1s. The most common type, accounting for 8085% of clavicle fractures in both children and adults as this is the weakest part of the bone presentation. Surgery and conservative treatment acute clavicle fractures were traditionally treated nonoperatively. Displaced fractures of the clavicle generally do well with nonoperative treatment nonunion rate clavicle require no treatment the only fractures of the clavicle that do not heal are the ones that you operate on. Fracture union usually progresses regardless of the treatment initiated. The fracture is found with imaging xrays andor ct scan and physical exam. Injuries of shoulder girdle clavicle fracture scapula fracture 2.
A patients guide to adult clavicle fractures compliments of. Usually, the breaks heals in around 68 weeks but it is fairly common that it can take up to 3 months. In the collarbone clavicle, fractures can happen in three separate areas. Plate fixation versus nonoperative treatment for displaced. It is important to allow adequate healing time before resuming activity. Clavicle fracture broken collarbone a broken collarbone is also known as a clavicle fracture. Rehabilitation protocol adopted from the massachusetts. The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fixation or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials rcts on this subject. Surgery is not usually necessary for clavicle fractures, but can be recommended for patients with excessive displacement or shortening of the fracture, or if the fracture end is tenting the skin. Clavicle fracture an overview sciencedirect topics. We found that surgical treatment led to a greater likelihood of union at 1 year of followup among adult patients with displaced midthird clavicle fractures. Clavicle fractures account for 5% to 15% of childhood fractures, and are the most common type of fracture in children.
Conservative management of clavicle fracture clavicle fractures typically result from a direct blow to the shoulder, occurring most frequently to the middle third of the clavicle. The clavicle is important because it stabilizes the. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. This is a very common fracture that occurs in people of all ages.
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