Clavicle/Collar Bone Fracture

This Blog will provide the information about the Clavicle Fracture / Collar Bone Fracture, Following Information is being provided in this blog:
1) Clavicle / Collar Bone
2) Clavicle Fracture
3) Symptoms of Clavicle Fracture
4) Diagnose of Clavicle Fracture
5) Types of Clavicle Fracture
6) Treatment of Clavicle Fracture
7) Prevention


What is the clavicle?
The clavicle, or collar bone, is the long curving bone connecting the sternum (breast bone) to the shoulder. In fact, it is the only real bony connection between the arm and the rest of the body. A number of ligaments attach to the clavicle to connect the clavicle to the scapula (shoulder blade), the sternum (breast bone), and the ribs. It is easy to feel the clavicle, because unlike other bones which are covered with muscle, only skin covers a large part of the bone.


How does Clavicle Fracture Happen?
Most commonly the fractures is due to fall on an outstretched hand, or a direct hit to the clavicle. It one of the most common fractures sustained while cycling, usually from a fall off the bike onto the pavement. In babies, clavicle fractures occur at birth during passage through the birth canal.


What are the symptoms of a broken collarbone?
Signs that someone may have a clavicle fracture includes:
- Pain in the affected area
- Difficulty moving the arm
- Swelling, tenderness, and bruising along the clavicle
- Increased pain when trying to move the shoulder or arm
- A grinding or crackling sensation when trying to raise the arm
- A bulge above the break (in rare cases, the broken end of the bone might even penetrate the skin and be exposed)
- The shoulder sags down and forward


What Should You Do?
If you think you've fractured your collarbone, you'll want to see a doctor. Your doctor will first ask questions about how the injury happened and what symptoms you're feeling. The doctor will examine your shoulder and may press gently on your clavicle to see if it is tender. This will also help the doctor find out where the fracture is and make sure no nerves or blood vessels are damaged. This part of the exam also might include checking the feeling and strength in your arm, hand, and fingers.
If the doctor thinks you have a broken collarbone, he or she will order X-rays of your shoulder and the affected area. X-rays will help the doctor pinpoint the location of the break and decide how severe it is. X-rays also let doctors see if other bones are broken.
If other bones are broken or if the doctor needs to see the fracture in greater detail, he or she may ask you to get a computerized tomography (CT) scan.


What are types of Clavicle fractures?
The clavicle can be broken in three different regions, and the symptoms vary according to the site:


- Fracture of the Middle 1/3
Usually this causes pain with any movement of the shoulder. Often the injured individual will hold the arm against the chest to prevent motion. Often there is an obvious change in shape of the affected shoulder, the shoulder moving downward and backward. The clavicle may be extremely tender over the site of fracture. In some cases, there may be motion or creaking (crepitus) at the site of fracture. Bruising over the skin is common.


- Fracture of the Distal 1/3
These fractures may be subtle, and are often overlooked. They may also be confused with a separated shoulder (acromioclavicular separation). Pushing on the joint between the end of the clavicle and the shoulder (AcromioClavicular or A-C joint) may cause pain. Pain with arm movement, and skin bruising may also appear.


- Fracture of the Proximal 1/3
In this fracture, pain, tenderness, and swelling are located over the sternum (breast bone). Once again, any shoulder movement will cause pain, and injured persons are most comfortable sitting quietly with the arm held. If the joint between the clavicle and sternum is disrupted (sternoclavicular dislocation) the usual bump at this junction may be lost


What are different treatments for different types of Clavicle Fractures?
Treatment of clavicle fractures varies widely between the various types of fractures--from a simple sling to surgical operation. Although the topic is complex, in general treatment is as follows:


- Fractures of the middle 1/3:
Treatment of these fractures is usually quite simple. In order to minimize the movement of the two pieces of bone to promote good healing some sort of support is usually needed. A sling may be sufficient in the fracture is not displaced. However, often a bit more support is needed and a "figure 8" splint is needed. This holds the shoulders in the position of attention , and is intended to hold the two ends of the fractured clavicle together.
Generally, the splint is necessary for 4 to 8 weeks in adults, and 3 to 6 weeks in children. A repeat X-ray is often performed at 6 weeks to assess healing.
While healing is taking place, the person may use the arm as needed, but should avoid contact sports or lifting the arm high above the head.


- Fractures of the distal 1/3:
Treatment of these fractures may be more complex, and depends on the exact type and location of the fracture:
Type I
This is the most common distal clavicle fracture. in this case the supporting ligaments remain strong, and the fracture remains well immobilized.
Generally, these can be treated with an arm sling for 3 to 6 weeks, or until pain subsides. Activity can gradually be increased as pain allows, but contact sports should be avoided for 2 to 3 months to avoid re-injury.
Type II
In this fracture, the distal tip of the clavicle remains attached to the shoulder via strong ligaments (coracoclavicular ligament) while the more proximal fragment displaces upward.
Type II fractures should be seen by an orthopedic surgeon, and surgery is often necessary to rejoin the two fragments. Following surgery, the shoulder is put in a sling and swathe for 6 to 8 weeks. Once again potential for re-injury should be minimized for several months.
Type III
The fracture line in this cases passes directly into the joint between the clavicle and shoulder (acromioclavicular joint).
Type III fractures are treated with a sling as in type I, and with the same activity precautions.
In type III fractures, arthritis may develop long after the actual accident. In this case, physiotherapy and anti-inflammatories may be needed. In cases of severe arthritis, referral to a surgeon may be necessary for removal of the tip of the collarbone (distal clavicle resection).


- Fractures of the Proximal 1/3
These are generally treated with an arm sling for comfort measures, for 3 - 6 weeks. The arm can be used as the pain permits, with avoidance of contact sports for 1 to 2 months.
In general, fractures tend to heal much more quickly, and with a better functional and cosmetic results in children as compared to adults.
Also, For fractures where the bone fragments stay aligned, doctors will recommend the following treatments:
Ice:
To help control the pain and swelling associated with a clavicle fracture, apply ice packs to the affected area for the first 2 to 3 days after the injury. Don't put ice directly against the skin ― wrap it in a towel or other fabric.
Arm support:
Keep your arm immobilized by using a sling or wrap. This keeps the bone in position as it heals and helps to control pain.
Medication. Talk with your doctor about what sort of medications (ibuprofen, acetaminophen) you should be taking to help reduce the pain associated with a clavicle fracture.
Physical therapy:
You may lose muscle strength and range of motion in your shoulder while it is immobilized. Once the bones have started to heal, begin gentle motion exercises to reduce stiffness while you're wearing the sling (your doctor or a physical therapist can show you some). When the bone has healed completely, your doctor may recommend a more strenuous rehabilitation program to enable you to regain strength and flexibility in your shoulder.


How Can You Prevent a Clavicle Fracture?
Because clavicle fractures happen suddenly and unexpectedly, it can be hard to prevent them. But you can take a few precautions to decrease your risk:
- When participating in contact sports, wear all the recommended protective gear and learn the proper techniques for your sport. Knowing the right way to play decreases the chances of an awkward fall or unexpected blow.
- 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.