Most clavicle fractures are treated without surgery. Rehabilitation protocol adopted from the massachusetts. Whilst they may be very painful, clavicle injuries are rarely serious and in most cases are managed. Historically, only unstable distal clavicle fractures were treated operatively. Given the excellent results obtained with nonoperative treatment of uncomplicated midclavicular fractures, such therapy, using a figureofeight brace or regular support sling, is recommended. 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. The collar bone is the most commonly fractured bone in the body. Pain and antiinflammatory medications may also be prescribed.
A clavicle fracture is typically associated with extreme pain, and arm movement is difficult. Even displaced fractures have been successfully managed without surgery. Anatomy the collarbone clavicle is located between the ribcage sternum and the shoulder blade scapula, and it connects the arm to the body. Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Clavicle fractures account for 5% to 15% of childhood fractures, and are the most common type of fracture in children. There are 2 basic ways for treating a clavicle fracture. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm.
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. If your clavicle fracture is good position, no surgery is required. Swelling and pain your clavicle and shoulder may still be swollen and bruised. Diagnosis and causes of a clavicle fracture sportshealth. Despite the name, the collarbone isnt really in your neck. This is a followup leaflet to your recent telephone consultation with the fracture care team explaining the ongoing management of your injury. 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. Jan 31, 2011 fractures of the clavicle le kim trong md. 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.
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. 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 clavicle is important because it stabilizes the. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 3 april 2015 v1s. 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. Neer sup3 reported low nonunion rates after nonoperative treatment of midshaft clavicle fracture of 0. The original classification by neer in the 1960s described two types of distal clavicle fractures. This is largely because of reported nonunion rates of less than 1% and separate reports by neer40 and.
You have sustained a fracture to your clavicle collar bone. Despite the high frequency the choice of proper treatment is still a challenge for the orthopedic surgeon. One is surgical and the other is nonoperative treatment. Pdf treatment of clavicle fractures giovanni merolla. When examining a patient with an acute clavicle fracture i typically look for the usual deformity of the. No evidence to support figure of 8 bandage or brace. When a bone breaks or cracks, the injury is called a fracture. Fractures of the midthird of the clavicle do well with nonoperative treatment, except for those in which the fracture is displaced posteriorly. Do not return to contact sport until you are pain free and at least 8 weeks after your injury. Normally, a sling is applied to the arm for treatment of a fractured clavicle. The fracture is found with imaging xrays andor ct scan and physical exam.
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. Displaced, clavicle fracture, mid shaft and plating. The goal of clavicle fracture treatment is to achieve bony union while minimizing dysfunction, morbidity, and cosmetic deformity. Broken collarbones are most common in children in young adults. Clavicle fracture treatment, healing time, surgery, management. Usually, the breaks heals in around 68 weeks but it is fairly common that it can take up to 3 months. Nonsurgical and surgical management provide similar results. Large multicentre studies of clavicle fractures have so far been missing. The clavicle, also referred to as the collarbone, is a long bone located at the top of the chest.
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. Newborn clavicle fractures nationwide childrens hospital. Ideally, nondisplaced clavicle fractures are treated nonoperatively using. Pdf clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466%. 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. Most clavicle fractures occur in the middle third of the bone. 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 most common type, accounting for 8085% of clavicle fractures in both children and adults as this is the weakest part of the bone presentation. Rarely, clavicle fractures can occur from a direct blow or from a fall on an outstretched. 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. If you continue browsing the site, you agree to the use of cookies on this website.
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. Therefore, for unstable distal clavicle fractures classified as neer type ii or v 4, 5, surgical treatment is usually. Closed fracture bone has not broken through the skin. 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. A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Browse by title browse by subject journal indexing. 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. Treatment consists of drainage of the hemothorax and conservative treatment or operative. The emphasis of this article is on the management of these injuries. Clavicle fractures are very common injuries in adults 25% and children 1015 % 1 and represent the 4466% of all shoulder fractures 2. The peak incidence occurs in children and young adults.
Operative treatment is best suited for more complicated fractures of the middle third of the clavicle. Jan 14, 2019 clavicle fractures are common and easily recognized because of their subcutaneous position, as shown in the images below. Epidemiology clavicle fractures account for approximately 2. Clavicle collar bone fractures are the most common injury sustained by newborns during birth. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Adolescent injuries usually involve contact sports. Clavicle fracture knowledge for medical students and. Brachial plexus injury about 1% of brachial plexus injuries occur following a. Plate fixation is the primary treatment for symptomatic nonunion of a clavicle shaft fracture. Once the fracture heals, this special plate may be removed.
Evidence based management of midshaft clavicle fractures. In addition to plate fixation, in the setting of atrophic. The history and physical examination remain the primary means of diagnosing this injury. Plate fixation versus nonoperative treatment for displaced. This is a very common fracture that occurs in people of all ages.
Clavicle collarbone fractures make up 44% to 66% of all shoulder fractures. Fracture of the clavicle is very common in people of any age. This type of fracture is fairly commonaccounting for about 5 percent of all adult fractures. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons. Clavicle fracture broken collarbone a broken collarbone is also known as a clavicle fracture. Nonoperative treatment is preferred for distal clavicle fractures. This helps prevent arm movement as the collarbone recovers. Clavicle fracture an overview sciencedirect topics. Diagnosis and management of distal clavicle osteolysis. In former times, xrays were taken of both clavicle bones for comparison purposes. Pdf clavicle fractures is there a standard treatment. Clavicle fracture is a common fracture and constitutes approxi mately 4% of all fractures in adults.
Nonoperative treatment of midshaft clavicle fractures in adults. It is important to allow adequate healing time before resuming activity. Give parent fracture of the clavicle collarbone fact sheet. In the collarbone clavicle, fractures can happen in three separate areas. Clavicle fractures also called simply broken collarbones are a familiar woe to many athletes. Physiotherapy department helping your clavicle to recover. Trauma is the most common cause of a clavicle fracture. 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. The oldest document that reports on the treatment of clavicle fractures dates back to 16001700 bc breasted, 1930. Clavicle fracture broken collarbone a broken collarbone is also. The fracture pattern will largely determine whether your surgeon will suggest treating the fracture with or without surgery. First aid, treatment, and recovery time for a broken collarbone is provided. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks.
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. Because of the position of the collar bone, it is not possible to wear a cast if you break this bone. This treatment strategy reportedly achieved high union rate, good functional recovery, and high patientrelated satisfaction. Adult clavicle fractures an atomy the clavicle, commonly called the collarbone, forms a strut that connects the rib cage to the scapula shoulder blade.
The majority of clavicle fractures are treated conservatively. This is due to the trauma from the fracture and from the surgery. 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 leaflet gives you the advice and exercises to help your clavicle collar bone to recover after your fracture.
Injuries of shoulder girdle clavicle fracture scapula fracture 2. N2 fractures of the clavicle are relatively common injuries that can occur in patients of all ages. Most people with clavicle fractures have an excellent outcome with return to normal activities and a pain free shoulder at 35 months after injury. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Clavicle fracture introduction clavicle fractures are a common orthopedic injury, particularly among infants and young children. Pain medication, typically nonsteroidal antiinflammatory drugs such as naproxen and ibuprofen. Clavicle fractures are often caused by a direct blow to the shoulder.
It articulate with sternum medially to form sternoclavicular joint. 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Surgery and conservative treatment acute clavicle fractures were traditionally treated nonoperatively.
In these cases, the bones need to be moved and secured in order to heal properly. Pdf clavicle fractures, especially of the mid third, are an injury commonly seen in. Following a clavicle fracture, a figureofeight clavicle strap, along with a sling, is fitted to the. 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. Clavicular injuries can lead to abnormal biomechanical stresses and longterm. 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. Clavicle fractures indications for operative treatment. Xrays will be taken to determine the location and extent of the injury. At first your shoulder will feel stiff and painful but it is important that you continue to move it as this will aid your.
Clavicle fractures are common fractures that usually affect children and adolescents and typically occur from a direct fall onto the shoulder. Surgery is an option in fractures that have high potential for nonunion e. Surgical options to achieve bony union include transacromial wire fixation, a modified weaverdunn procedure, use of a tension band. Broad arm sling to support limb for 2 weeks or until comfortable. Mathes expect swelling and bruising for a few weeks following the surgery.
Collarbone pain clavicle pain causes and treatment. The classification and treatment of distal clavicle fractures depend on where the fracture occurs in relation to these ligaments. It is very important to keep your arm from moving to allow the clavicle to heal. 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. Clavicle fractures take the same time to heal with or without surgery. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Due to the curved shape in a tilted plane xrays are typically oriented with 15 upwards facing tilt from the front. Treatment of distal clavicle fractures using a scorpion. This recommendation is based on the analysis of 2000 patients with a very low nonunion rate of 0. Males are more prone to fracture than females 68% versus 32%. 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. Treatment for collar bone fracture includes immobilization of the arm and minimal movement of the upper body during the healing process.
A clavicle fracture, aka broken collar bone, is a common injury usually caused a fall, direct blow or car accident. Handbook of fractures pdf latest edition free download ebook. Historically, nonoperative treatment of midshaft clavicular fractures was. An arm sling or wrap is typically worn after the break occurs. Clavicle fractures are classified into three types based on the location of the fracture. Clavicle fractures are common in children and adolescents. More than twothirds of cases are due to a fracture in the middle third of the clavicle group i of the allman classification. Treatment will depend on the damage and the kind of fracture you have. 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. Now that you are using your sling less, it is very important that you use your shoulder as normally as possible. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. The outer third of the collarbone is near the tip of the shoulder.
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. Historically, nonoperative treatment of midshaft clavicular fractures was considered the gold standard of care. Free range of motion is usually allowed after 6 weeks 19. Birth fractures occur in 1% to 2% of all vaginal deliveries, most often with largeforgestationalage infants and during extraction and difficult deliveries. Historically, the vast majority of clavicle fractures have been treated nonoperatively in the acute setting. In fact, they account for about 5% of all fractures seen at the hospital. The treatment of displaced midshaft clavicle fractures remains controversial. Clavicle fractures also result from abusive trauma. Clavicle surgery may be needed if the fractured bones if the fractured pieces of bone are not in their correct, anatomical location. Nonsurgical treatment for a broken clavicle can include the following. The majority of clavicle fractures can heal without surgery.
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. Fractures here usually are caused by an accidental fall or some other type of direct impact football tackle, hockey check, car collision. A patients guide to adult clavicle fractures compliments of. The clavicle is the bone that connects the breastplate sternum to the shoulder. Nonoperative treatment of midshaft clavicle fractures in. Surgical treatment in displaced fractures of the clavicle in our study produces satisfactory results. Clavicle fractures are very common injuries in adults 25% and children 1015% 1 and represent the 4466% of all shoulder fractures 2. Clavicle fractures are classified according to the fracture location with the use of the allman classification. The distal most lateral fractures in children may be growth plate injuries and also need to be. Most clavicle fractures heal nicely with conservative, nonsurgical treatment.
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. Clavicle fracture broken collarbone orthoinfo aaos. 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. Is an sshape long, curved,tubular bone, lies horizontally a cross the root of neck. This prevents displacement and makes type ii fractures in children more stable than in adults. 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. Fracture union usually progresses regardless of the treatment initiated. In the setting of hypertrophic nonunion, increased stabilization with orif may be all that is required. Jan 01, 2008 the usual mechanism of a clavicle fracture is a fall directly on the shoulder with the arm at the side. Complications can include a collection of air in the pleural space surrounding the lung pneumothorax, injury to the nerves or blood vessels in the area, and an unpleasant appearance. You may be given contrast liquid to help the fracture show up better in the pictures. On occasion, a severe fracture, or what appears to be a mild fracture, will not heal properly. Clavicle fractureshaft childrens hospital at montefiore.
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