Broken Collarbone: Causes and Treatment

Symptoms and treatment of clavicle fracture

Fracture of the clavicle bone is one of the most common injuries, very common among patients in adolescence and old age (can manifest itself as a birth trauma). Damage is not dangerous, if it is not associated with complications. Fracture of the clavicle in most cases successfully fuses and does not lead to pathological abnormalities in the body.

Structure of clavicle

The bone, called the clavicle, has an S-shape and is easily probed when pressed into the region of the foreleg. Bone performs the function of monitoring the shoulder joint (helps to fix it) and takes over some of the physical activities that the hand performs.

The clavicle is divided into three divisions:

• epiphytic (border points of the bone body, in which it adjoins the joints);
• metaphyseal (adjoining to the epiphysis part, communicated with capsules of joints);
• diaphyseal (the body of the bone).

The clavicular department has a complex anatomy, since it is associated with vascular and nerve endings, passing behind the bone and the upper part of the lungs, which are in close proximity to the forelegs.

Causes of fractures

Fractures of the clavicle can have a traumatic (more than half of all cases) and pathological character. But pathological degradation of bone tissue is very rare. They are caused by:

• metastases that destroy tissue;
• osteoporosis and osteomelitis;
• tuberculosis (tuberculosis infection can accumulate in bone tissues communicated with the lungs).

Traumatic fractures are caused by strong external impact on the bone. It can be a blow to the shoulders area or a drop in the arm and elbow, as a result of which the collarbone was loaded onto itself.

Types of fractures

Fracture of the clavicle has a complex classification, which doctors appeal when diagnosing, setting the timing and method of treatment.

According to the time characteristic:

• congenital (can occur in infants, during the "reception" of which doctors used medical methods of extraction by the type of forceps and vacuum devices);
• purchased (all other types).

By the nature of the reason:

• traumatic;
• pathological.

By the degree of interaction with soft tissues:

• closed (latent fracture);
• open (soft tissue damage, bone fragments visually visible on the bottom of the wound).

In relation to the broken fragment to the joint:

• fracture of diaphysis;
• fracture of metaphysis;
• fracture of the epiphysis.

A broken collarbone can lead to complications: damage to the periosteum (almost not found in children under 12 years old), displacement (read about fracture of the clavicle with displacement) and fragmentation.

How symptoms are expressed

Broken bones are often mistaken for severe bruises, but the clavicle fracture symptoms are fairly pronounced and it is easy for the victim to determine the damage. Attention is drawn to the following features:

• Severe pain, which is increasing and decreasing, when the victim presses the bent arm to the chest.
• The supraclavicular fossa disappears as a result of edema, skin changes color unnaturally gray (in case of vascular damage, a bruise or bruise may occur)
• The hand stops rising, and attempts to bring the limb into dynamics are accompanied by a characteristic crunch (especially if it is a fracture of the acromial end of the clavicle).
• A hand reported with a fracture can visually appear longer, and the key zone itself is severely deformed.
• If the nerve endings are damaged, then the fingertips, and then the entire hand, may lose sensitivity.

Signs of fracture of the collar bone, resulting from pathological changes, are expressed by a general deterioration of the condition patient, headaches, an increase in temperature to 37 degrees Celsius and short-term, but repetitive fainting.

Diagnostics

Diagnosis at a fracture is necessary in order to reveal the severity of the damage to health caused by the same traumatic effect.

If you suspect a traumatic bone injury, the patient is assigned an X-ray of the upper thorax, as well as visual diagnostics.

If pathological deformation of the bone is possible, the list of necessary analyzes increases, and the patient will have to pass the examination and give a general blood test, urine, venous blood and biopsy material (part of the tissues collarbone).

First aid

First aid should be given very correctly and carefully, so that the nearest systems, tissues and organs (especially the upper lobe of the lungs) do not appear.

To prevent possible consequences of fracture of the clavicle, it is necessary immediately after the injury to give the limb a static position, which will exclude the possibility of movement of the fragments.

Provision of correct transport immobilization in case of fracture of the clavicle:

• under armpit a small cut of cloth or bandage is rolled up, twisted into a roller;
• The arm bends at the elbow to a comfortable position (approximately 90 degrees);
• the limb is pribintovyvaetsya to the body (completely);
• for the hand, it is necessary to provide additional support in the form of a dressing through the neck;
• the bandage can replace the tire (no-till).

Proper transportation is as important as dressing. The patient will be most comfortable in a semi-sitting and sitting position, and it is advisable not to rely on the side with the damaged bone.

The clavicle can be too painful in case of a fracture, therefore it is allowed to give the patient an analgesic before the ambulance arrives. In the absence of drugs, you can use cold compresses or apply ice.

Treatment

Treatment of a clavicle fracture without bias for young children (up to three years) does not require limb immobilization (gypsum). Enough medical dressing, fixing the arm in anatomically correct position, and "Dezo" bandage, covering the shoulder area.

Older people require the imposition of a plaster bandage (before that, necessarily anesthetize the area from which they will conduct medical manipulations).

If displacement is observed, the fragments can be combined without surgical intervention. Since the clavicle is located in an easily accessible place, the doctor can match the fragments by repositioning.

The procedure should be performed under local anesthetic.

The choice of tactics for conducting surgical intervention is determined by focusing on the severity of the damage to health, which was caused by a fracture.

Main indications:

• unsuccessful closed reposition;
• fracture of intraarticular type;
• open trauma;
• damage and rupture of nerve endings;
• concomitant fractures (scapula).

Rehabilitation

The rehabilitation period includes a set of measures that help restore motor activity, blood circulation and nerve impulses at the site of injury and the entire limb as a whole.

The most important "helper" for the victim after the removal of gypsum is moderate physical activity and exercise therapy (exercise therapy). Exemplary complex of loads:

• active rocking from side to side in the area of ​​the joints of the shoulder and elbow (at an average amplitude);
• tension and relaxation of muscles;
• "Surprised" shoulder lifting;
• straightening of the shoulders with the subsequent transition to the posture "stoop
• transfer of the ball behind the back;
• Walking (which actively involves the shoulders and hands).

Fracture will grow easily and without complications, if the patient complies with all the recommendations of the attending physician, adheres to a balanced diet and does not load the injured limb.

Effects

The consequences are the same as with other fractures:

• incomplete or complete absence of bone fusion;
• a false joint after a fracture, which causes abnormal and unnatural mobility in the clavicular region;
• persistent pain;
• deformity of the limb, its shortening.

To break the clavicle did not bring you such consequences, it requires correct first aid and immediate treatment. Take care of your health and be careful.

A source: https://PerelomaNet.ru/perelomy/kak-lechit-perelom-klyuchitsy-simptomy-i-posledstviya.html

Signs of clavicle fracture, treatment of this injury and long-term prognosis for athletes

The clavicle is a small bone that lies between the rib cage and the scapula.

In the immediate vicinity of the clavicle pass several large nerves and blood vessels.

Nevertheless, these vital structures, with a fracture of the clavicle, are rarely traumatized, even when the fracture turns out to be offset.

Since the clavicle is a rather long and thin bone, fracture, it is most often found in its middle. Less often the bone breaks down in the first or third third.

Symptoms and signs of clavicle fracture

The main symptom of a clavicle fracture is pain in the area of ​​trauma.

Additional symptoms:

1. The shoulder on the fracture side is lowered down and pushed slightly forward.
2. The victim can not raise his hand, as this movement causes severe pain.
3. When you try to move your arm, the injured person experiences a feeling of friction at the fracture site.
4. Edema and, possibly, a bruise around the broken collarbone.

Causes

The cause of the fracture of the collarbone is a direct blow to the shoulder when falling, or during a car accident. Less often the clavicle breaks down when a fall occurs on an elongated arm. Sometimes, when passing through the birth canal, the newborn receives a crack in the clavicle.

Diagnosis - examination and collection of anamnesis

The doctor begins the diagnosis with an examination and anamnesis.

Usually, trauma doctors after the examination know if there is a fracture, but nevertheless, the X-ray and / or computer tomography is assigned to everyone.

This is necessary not only to ascertain the fracture itself, but also to make sure that there are no fractures of other bones.

Often fracture of the collarbone is accompanied by such traumas as a dislocation of the shoulder joint, dislocation of the wrist joint and dislocation of the elbow joint.

Treatment

Treatment of a collarbone fracture, depending on the condition of the patient, may be non-surgical or require immediate surgical intervention.

Non-surgical treatment

If the bone is broken, but its ends are not displaced, then everything will cost without surgery. Hand from the side of the broken clavicle is fixed in such a way that the clavicle is in the most correct position.

The victim walks with the latch until the collarbone heals completely.

Previously, fixation was carried out through sheets, twisted into a tourniquet or even gypsum, but now the manufacturers of medical accessories release a huge number of latches, able to support the hand in the right position - this is convenient and aesthetically.

Drug therapy

Physiotherapy

During the time the patient wears a fixator, the muscles of the shoulder, on the side of the fracture, weaken. Therefore, once the bone has healed, but the retainer has not yet been removed, a not too active massage is prescribed.

Perhaps the physiotherapist will first massage his arm in the elbow, and in a day or two he will add a shoulder massage.

This approach will allow to normalize the muscles of the arm, after the fracture of the clavicle, that is, to return limbs mobility and former strength.

By the way, after the fixator is removed and the bone heals definitively, more aggressive, physiotherapy, which will allow the victim to gradually return to the familiar way of life.

It happens that a joint fracture, due to improper wearing of the fixative bandage, or some other factors, is complicated by the displacement of the fragments of the broken bone.

To avoid this, the patient must strictly follow the recommendations for wearing a fixative bandage and from time to time visit the attending physician, so that he checks the condition of the injured collarbone.

Another complication is a large cone, sometimes developing at the site of the fracture. Over time, as a rule, it becomes smaller, but a small bump remains.

Surgery

If the fragments of the clavicle are displaced so much that they can not be combined blindly, an operation is prescribed, The time of which the fragments are combined and fixed by internal plates, bone implants or screws. This approach allows the collarbone to properly grow together, and after the recovery of the injured, it increases the strength of its shoulder.

Complications after surgery

After the operation, numbness of the skin area can be observed just below the surgical incision. After a while, this numbness will completely or significantly decrease.

As a rule, the plates and screws that the fragments of the clavicle combined did not disappear, and as there is almost no muscle and fat layer around the clavicle, they can be probed through the skin.

And when a person, after recovery, is forced to constantly wear backpacks, or use seat belts, implants can become a source of inconvenience.

If the inconvenience is so annoying that the injured person agrees to a second operation - the implants will be removed.

Complications after surgical treatment

People elderly, smoking, suffering from diabetes and cardiovascular diseases, are at a higher risk of postoperative complications.

Postoperative complications:

• Infection of the surgical incision.
• Bleeding from a wound.
• Severe pain after surgery.
• Formation of thrombi in the legs.
• Damage to the blood vessels and / or nerves located near the broken collarbone.
• Damage to the lung.
• Nausea after anesthesia.
• Poorly healing postoperative wound.
• Rejection of implants.

Forecast

Whether the operation will be carried out or everything will be limited to wearing a fixative bandage, it will take several months for the clavicle to heal completely.

Most people will return to normal life not earlier than 3 months after the injury.

However, even then, before loading the injured hand, the patient should talk with the doctor and accurately find out how to do it, otherwise the clavicle may break down again and all have to start at first.

An Example of Healing

The patient Stakanov I.A. entered the emergency room after falling off the bicycle, complaining of pain in the clavicle area.

After examination of the doctor and carrying out of a roentgen the diagnosis has been put - fracture of a clavicle without displacement.

The patient was given a fixative bandage, given an anesthetic drug and sent home.

On this day he was able to move his fingers and wrist of the fixed hand, without much effort.

The doctor recommended the patient to perform, small in amplitude, shoulder movements, explaining that this will not prevent the collarbone from growing, but to prevent the shoulder muscles from atrophy.

Three months later, a repeated X-ray picture recorded that the collarbone of IA Stakanov. healed completely.

The patient underwent a twenty-day course of therapeutic massage and acupuncture treatment, after which he was declared perfectly healthy and able, without danger to health, to return to cycling.

A source: http://spina-sustav.ru/travmyi-pozvonochnika/perelom-klyuchitsyi-priznaki-lechenie-i-dolgosrochnyiy.html

Fracture of collarbone: symptoms and consequences, treatment and rehabilitation period

Fracture of the clavicle is a common and dangerous injury that often occurs in young patients. The clavicle is the twin bone that connects the arm and the skeleton of the trunk.

The clavicle bone is a kind of springy spacer between the spherical joint of the shoulder and the sternum, thanks to which the joint does not occupy the medial (medial) position.

The clavicle and the muscles attached to it allow the upper limbs to move freely. In addition, this bone provides protection of the neurovascular bundle.

Treatment of clavicle fractures takes a long time, and the recovery period lasts about 3 months. How to recognize, classify a fracture, provide first aid to a patient, conduct treatment? About this further.

Symptoms of clavicle fracture

Trauma of the clavicle is characterized by specific signs, so it is quite easy to identify the damage. The main symptoms of clavicle fracture:

• Intense, sharp, acute pain that persists even if the patient is in a calm state. When the palpation of the shoulder or the movement of the upper limb in the shoulder region, the pain increases;
• The trauma can be recognized by the characteristic position of the body: the patient holds the bent injured hand healthy and presses it to the body. This posture a little relieves pain;
• Within 60 minutes after injury, edema develops in the region of the forehearth. The skin in this area blushes, thinens, the temperature rises (only in the damaged area);
• If the patient has a lean physique, then one can see another obvious sign - the clavicle bone is deformed. This is seen from the uneven or sharply contoured contour of the bone, which is visible through the skin in the region of the forehearth;
• The patient tries to completely immobilize the shoulder, since any movement causes acute pain.

Identify the fracture itself is much easier than complications, this requires special diagnosis, althoughsome symptoms should alert you:

• If the swelling quickly builds up, the skin in the clavicle blushes red, and in other places it turns pale, then this is a sign of internal bleeding. In addition, the patient is dizzy, darkens in the eyes, general weakness appears;
• The loss of sensitivity in the part of the upper limb indicates a nerve damage. If part of the upper limb is paralyzed, then this indicates a rupture of the upper, middle or lower trunk of the brachial plexus. If the entire plexus is damaged, the arm is completely immobile.

With a pathological fracture, a temperature of 38 ° remains for a long time, the body weight decreases, weakness does not pass, painful sensations appear in the clavicle region.

Classification of fractures

To correctly choose the method of treatment, it is necessary to distinguish the types of fractures. Depending on the time and reason for the appearance, the degree of skin damage,distinguish the following types of fractures of the clavicle:

1. Depending on the time of appearance, the following key fractures are distinguished:
   • Congenital - the most rare type of injury that occurs in children during childbirth. It arises because of the pathological condition of the newborn (transverse, "on the leg"), the mother's narrow birth strokes, as a result of the use of auxiliary extraction methods (for example, obstetric forceps);
   • Acquired - any injuries that occur after giving birth;
2. Injury of the clavicle, depending on the cause of the appearance:
   • Traumatic - damage to the clavicle, which occurs as a result of the intense impact of force on a certain area;
   • Pathological - a fracture that occurs due to a violation of the structure of the clavicle due to a serious disease (osteomyelitis);
3. Fracture depending on skin damage:
   • Open - injury, which results in damage to the skin in the area of ​​the clavicle;
   • Closed - damage, in which the integrity of the skin is not broken;
4. Fracture depending on the location of the damage to the clavicle:
   • Intraarticular - a fracture of the sternal or acromial end of the clavicle;
   • Periarticular - a fracture of the metaphysis (part of the bone adjacent to the joint) of the clavicle;
   • Extra-articular - a violation of the anatomical integrity of the diaphysis (central part of the tubular bone) of the clavicle;
5. Fracture depending on damage to the periosteum (connective film covering the bone from the outside):
   • Subperiosteal fracture - broken clavicle covered with intact periosteum;
   • Fracture with violation of the integrity of the periosteum;
6. Depending on the direction, fracture of the clavicle is transverse, longitudinal, helical, spiral, etc .;
7. Fracture of the clavicle with and without bias.

When determining the type of fracture, it is necessary to identify complications: defeat of subclavian veins, arteries, upper, middle or lower nerve trunk of the brachial plexus.

First aid for trauma

If you suspect a fracture of the clavicle, call an ambulance. Before the arrival of physicians it is necessary to help the patient.

First of all, you need to stop pain with non-hormonal anti-inflammatory or combined pain killers.

To do this, use Pentalgin, Ibuprofen, Analgin, etc. Give the patient 1-2 tablets, after half an hour the drug should work.

Do not forget to call the medication the drug that the patient took.

Fix the shoulder so that it remains stationary, otherwise the person will experience severe pain, besides, the damaged bone may shift. Put a bandage on your shoulder, as in the picture.

To do this, attach the middle of the kerchief to the forearm, and wrap its ends around the neck and tie it.

In order not to overload the muscles of the neck and prevent further displacement of the bone, draw the outer end of the scarf behind your back.

5 minutes after the fracture, apply a cold for half an hour to the damaged shoulder. So you reduce the swelling and pain.

Physicians will fix fixation defects or will themselves bandage themselves.

Doctors use elastic rings, which are worn on both limbs in the area of ​​the shoulder and are tightened by a fastening mechanism. This allows to weaken the painful syndrome and prevent the displacement.

Then the patient is transported to the hospital, where the doctor after the examination determines the method of treatment.

Methods of treatment

The main task of therapy is to compare the bone fragments and fix them in the correct position. When these conditions are met, the clavicle bone will grow in 5-6 weeks. If you can not fix the wreckage, then it will take more time to restore the bone.

Treatment of a collarbone fracture can be conservative or operative.

Conservative treatment involves a closed reposition (repositioning of the bone through soft tissues), this procedure can be entrusted only to a professional traumatologist.

At the expressed displacement of fragments of a clavicle or at rupture of a skin by splinters the operative method of treatment is used.

Before repositioning, the doctor must anesthetize the upper limb, for this, novocaine is injected into the foreleg. After a few minutes, you can begin the procedure. The patient is in a sitting position, the head is tilted to the injured shoulder.

After repositioning, a plaster cast is placed on the hand, which correctly fixes the clavicle.

You can also fix the hand with a bandage Smirnov-Weinstein, which covers the trunk, shoulder and forearm of the injured limb.

Remove it only after the X-ray, to make sure that the bone has grown together.

The period of adhesion takes at least 4 weeks, close people should monitor the patient and monitor his condition. If you experience any of the following symptoms, you should consult your doctor:

• Re-emerges and builds up edema;
• Reddening of the skin in the fracture zone does not take place within 6 hours;
• The temperature in the area of ​​the forehearth increases;
• Increased pain in the place of fracture.

Surgical method of treatment involves cutting soft tissue in the fracture region and bonding bone fragments with the help of internal plates, spokes, rods or external apparatus. The purpose of the surgical method of treatment is the collection of fragments and their fixation. Surgical intervention is necessary if the vessels or nerves are damaged.

After a few weeks, the plaster is removed. To the patient quickly recovered, he must regularly perform special exercises and attend a massage therapist. While the bone does not heal completely, it is forbidden to lift heavy things and move too actively.

If it is a fracture without bias, then its treatment will not cause difficulties.In newborns (up to 3 years), the bones coalesce very quickly, while the limb is fixed with wide bandages. In case of a mild fracture of the clavicle bones, a dressing of Deso is applied.

With the help of a tire or gypsum bandage, the bones will grow as quickly as possible. To ensure the fusion of bones in patients older than 5 years, they impose a rigid gypsum bandage. If the above methods were not effective and the bone does not coalesce, then the operation is performed.

With a slight shift, the doctors apply a bandage, which must be fixed with gypsum. To compare the wreckage, the traumatologist takes his shoulder back and sharply lifts up.

With multiple fragments with a significant shift to the injured limb, a Cramer splint is applied. If the blood vessels or neural bundles are damaged, an operation is performed.

Splinter fracture is treated with a special plate or knitting needle that connects all bone fragments. When the bones coalesce, the fasteners are removed.

Surgery

Surgical intervention is an extreme measure, since the operation conceals too many risks. It is not known how the human body will react to anesthesia, during operation it is possible to damage blood vessels, nerves. Also, complications may occur after surgery.

The surgical operation is indicated with an open, multi-lobed fracture, with damage to blood vessels or neural bundles.

The procedure is carried out if the ratio of soft tissues is disrupted due to injury, and also if the doctor suspects that an acute fragment will rupture the skin.

Also, the operation is performed if the bone fragments are fused incorrectly. After the incision of the soft tissue, the fragments are reconciled.

Stages of the operation:

1. The operating field is treated, the soft tissues are cut under the injured clavicle;
2. The doctor with the help of an electric drill forms a channel in the fragments of the collarbone and compares them;
3. Then he inserts a spoke into the medullary canal, if necessary, it is fastened with screws;
4. The surgeon checks the structure for strength and sews soft tissues.

After surgery, the injured arm is temporarily immobilized (immobilized), after 72 hours the limb is permanently immobilized.

Drainage tubes are removed after 2 days after surgery, if they do not produce purulent or blood fluid. Otherwise, the patient is observed until the discharge is cleared. If pus is secreted from the wound, it is opened and cleaned.

If the wound heals well, then after 14 days, the stitches are removed.Partly to move the damaged limb it is possible in 20-30 days. Before removing the bandage, an X-ray is performed to make sure that the bone has grown together.

Recovery after fracture

To the damaged arm quickly recovered, it is necessary to gradually introduce loads. Otherwise, you risk re-injuring your limb.

It is strictly forbidden to overload the injured hand immediately after the doctor removes the cast.

Wear bags and briefcases on a healthy shoulder, do not stretch your arm and do not make sudden movements. Gradually develop and strengthen the muscles.

Doctors recommend daily exercise:

• Slowly lift the limb up, just lower it slowly. Painful sensations that may arise are associated with contracture (restriction of joint mobility). Overcome the pain, gently increase the amplitude of movements;
• Slowly move the injured limb from the torso, at the same rate, return to the starting position. During the movement, try to strain the muscles to strengthen them after the fracture;
• Draw circles of a damaged arm in the shoulder region, try to increase the swing.

After 6-8 weeks after removing the plaster bandage, you can begin to train your arm with a lightweight dumbbell(about 3 kg).

Wear a bag or a backpack on the shoulder of an injured hand.

Strengthen the musculature with the help of a shoulder expander, simulators "Boat" or "Butterfly a small load (about 5 kg) is permissible.

Active sports activities are permissible six months after the removal of the plaster bandage. It is after this period that the clavic bone is fully fused, and muscle tone rises. Lessons for recovery after surgery with a collarbone fracture are very important for rehabilitation.

Complications and consequences

Fracture of the clavicle is a serious trauma, which is treated for a long time. If the patient complies with the doctor's recommendations, the bone will heal 8 weeks after the fracture.

For the period of treatment, it is necessary to exclude any load on the damaged limb, especially if it is a fracture with a displacement.

In some cases, the forearm after the fracture of the fragments is slightly shortened and changes shape, as the length of the clavicle is not restored.

In the worst case, the injured arm is completely immobilized.

This is due to the excessive load of the limb in the recovery period after the fracture with displacement.

A source: https://1travmpunkt.com/perelom/raznie/klyuchicy.html

Fracture of the clavicle with or without displacement: symptoms and treatment

Fractures of the clavicle are among the ten most common injuries and according to statistics make up about 15% of all fractures. They can be observed in people of all ages, but often occur in young people, adolescents and children.

The high frequency of such fractures is due to the peculiarities of the structure and location of the clavicle. It is a thin bone and because of this the probability of its fracture increases substantially.

In addition, the clavicle has a rigid fixation between the arm and the body of the body and all shocks or limb impacts are always transferred to it without any depreciation. To determine the appearance of a fracture of the clavicle can be by many features.

In this article, we will acquaint you with the varieties, symptoms, possible consequences and ways of treating such injuries.

Fractures of the clavicle are dangerous injuries, because the acute fragments formed during them can damage large vessels and nerve trunks located nearby. Subsequently, such complications can cause massive bleeding or loss of sensitivity and movements in the injured hand.

More often a fracture of the clavicle occurs when falling on the arm or shoulder.

In addition, the fracture of this bone can be caused by direct injuries (by a blunt object or brawl), intense muscle cramps in epilepsy or complicated by the passage of a child according to generic ways. In rare cases, the clavicle breaks down due to a malignant neoplasm - osteosarcoma.

Classification of clavicle fractures

Depending on the localization of the fracture site, the following fractures are distinguished:

• outer third;
• middle third;
• inner third.

Fractures of the middle third of the clavicle are more common, since it is in this zone that the thinner part of the bone is located.

Depending on the nature of the fault line, the following types of fractures are distinguished:

• oblique;
• transverse;
• T-shaped;
• S-shaped;
• the comminuted;
• screw.

Depending on the location of fragments of the clavicle fractures can be:

• without bias;
• with offset.

In case of collarbone injuries with a fracture, the fracture can be:

• classical - in the place of fracture the periosteum is torn and the displaced bone fragments are not retained by it;
• incomplete - bone fragments are displaced, but because of incomplete rupture periosteum are held together.

Depending on the nature of the trauma of the skin, the following fractures of the clavicle are distinguished:

Symptoms for a fracture with a clavicle bias

The severity of the signs of fractures depends largely on its type. Fractures with displacement are more difficult to bear. With such injuries, the treatment process becomes more complicated and the risk of various complications increases.

Fractures with displacement

Symptoms with a fracture with a displacement of fragments of the clavicle are more pronounced, and it is much easier to determine the appearance of such injuries.

After getting injured, the person has intense and progressive pain in the shoulder area.

The victim can not move his hand and is forced to hold it by the forearm or elbow, tightly pressing to the body.

At the site of the injury, swelling and swelling of the skin swell over the supraclavicular fossa. Visually, the foreleg is shorter and shifts anteriorly. In this case, the head of the victim leans toward the injured bone. The hand from the affected side seems longer and sags down.

Bone fragments in the fault area create the phenomenon of "tent" - they are juxtaposed into a corner, the top of which is located at the site of the fracture. When the injured shoulder moves, crepitation may appear.

Because of bleeding, a hematoma appears in the area of ​​the injury, and with an open fracture, bleeding is present in the damaged soft tissues.

When crushing artery fragments, passing in the armpit, the hand becomes cyanotic and pale.

The pulse in the ulnar artery disappears, and the limb becomes cold.

With a complicated fracture with displacement, the sharp edges of the bone can damage the dome of the pleura, nerves, arteries and veins.

In the case of rupture of large vessels, massive bleeding develops, accompanied by characteristic symptoms (pallor, pressure decrease, tachycardia, etc.).

If the nerves are damaged, sensitivity is lost, the brush grows numb, and the fingers become inactive.

Fractures without bias

Fractures of the clavicle without bias are more common in children. They usually have an incomplete fracture, and the bone breaks like a green branch. The signs of such injuries are not so pronounced and they do not manifest themselves with all the symptoms characteristic of a fracture with displacement.

The patient may have a slight swelling and pain in the area of ​​injury. Some children after a fracture of the clavicle can continue to make movements of the affected limb and do not feel any discomfort.

Possible consequences

In addition to temporary loss of the hand's ability to work from the damaged collarbone, such fractures can cause the following consequences:

• significant blood loss in case of damage to fragments of large vessels;
• nerve injury;
• damage to the dome of the pleura;
• plexite;
• formation of pseudoarthrosis (false joints);
• secondary displacement of fragments (with improper dressing or with active muscle contractions);
• non-occurrence;
• muscle paralysis;
• infection of the wound (with an open fracture);
• suppuration of postoperative wounds;
• non-affection (with complex multifragmental fractures or inadequate treatment);
• scoliosis due to improper adhesion;
• osteomyelitis;
• restriction of movements of the upper limb;
• cosmetic defects with incorrect adhesion;
• arthrosis.

Complications of clavicle fractures occur extremely rarely and in most cases are caused by severe trauma, improper treatment or failure to follow the doctor's recommendations.

First aid

As with fractures of other bones, with violation of the integrity of the clavicle, pre-medical care is aimed at the speedy immobilization of the limb, to prevent the possible movement of bone fragments and additional injuries, and to eliminate the pain syndrome that causes suffering the victim.

First aid is to do the following:

1. Allow the patient to take painkillers (Analgin, Ketorol, Baralgin, Ibufen, Paracetamol, etc.) or perform an intramuscular injection of an analgesic.
2. Call an ambulance.
3. In the presence of open wounds treat them with antiseptic, apply a napkin from a sterile bandage and fix it with adhesive plaster.
4. Place a small cushion in the armpit.
5. Hand bend at the elbow joint and immobilize the limb with the help of a bandage bandage. If there is no material for such a bandage, then you can use a shirt, a T-shirt or a T-shirt wrapped up. When the arm is immobilized, it is necessary that all of its part from the wrist to the elbow be fixed with a bandage. If this condition is not observed, the limb will not be immobilized sufficiently and bone fragments may shift.
6. On top of the bandage attach to the area of ​​the injury is cold.

To which doctor to apply

If there is a suspicion of a fracture of the collarbone, an orthopedic consultation is necessary.

After the examination, the doctor will prescribe the performance of X-ray images in two projections, which will allow detailed data on the state of fragments of the clavicle and to identify possible complications (ruptures of nerves, vessels, dome pleura).

Diagnosis of the disease

In most cases, fracture of the clavicle is detected already when the patient is examined by a doctor.

To confirm the diagnosis and clarify the nature of the fracture (the presence of displacements, damages of the dome of the pleura, vessels and nerves), an X-ray examination is always performed. Pictures are taken in two projections: direct and lateral.

Treatment is the main goal

The main purpose of treatment for fractures of the clavicle is aimed at fixing the broken bone in the correct position and immobilization of the shoulder girdle until a sufficient fusion of the fragments.

If there are no displacements, the fracture can be eliminated by correct immobilization of the shoulder girdle, and in the presence of displacements for the fragments are compared and their reposition is performed and only then the limb is fixed in the fixed position. Reposition of bone fragments can be performed:

1. Closed way. The procedure for returning the ends of the bone to the physiological position is carried out using non-invasive methods under local anesthesia. After it is completed, the shoulder belt is temporarily immobilized and a control photograph is taken. When correctly comparing the ends of the clavicle, permanent immobilization of the shoulder gypsum is performed.
2. Open method. Access to displaced fragments is performed by performing a surgical procedure. For their comparison, various metal devices are used, fixing the ends of the bone in the position necessary for the fusion. Such interventions are called intraosseous osteosynthesis. With a simple displacement, a pin is used, which is inserted into the bone and fixed on another fragment. With a complex displacement for fixing, plates and screws are used. After their installation, the structure is tightened with a wire for maximum reliable fixation.

Surgery

Surgical interventions for clavicle fractures are indicated in the following cases:

• open fracture;
• probability of skin rupture with a sharp fragment;
• Multiple fractures with a probability of damage to nerves and vessels;
• trauma of nerves and vessels;
• disorders in soft tissues;
• improper coalescence of bone fragments, requiring re-osteosynthesis.

Surgical interventions for osteosynthesis are performed under general anesthesia. Depending on the clinical case, the following types of operations can be performed:

• intraosseous osteosynthesis (according to Klyuchevsky or Spiarion-Küpcher) by means of a pin, knitting needle or rod;
• osteosynthesis with bolts and plates (reconstructive, hook-shaped, S-shaped or with locking bolts);
• osteosynthesis with an external fixation device.

Drainage is performed during the intervention. In the absence of suspicious secretions (blood, pus), it is removed after 24-48 hours, and when complications develop, it is used for treatment.

After the operation is completed, temporary immobilization is carried out first, which is replaced by a permanent one after 2-3 days. When using drainage to treat complications, immobilization of the shoulder girdle is carried out after its removal.

With uncomplicated wound healing, the sutures are removed after 14 days. 3-4 weeks after the operation, a check is taken to assess the quality of bone adhesion and the patient is allowed to perform partial movements in the shoulder joint.

Immobilization of the shoulder girdle

Immobilization of the shoulder gypsum bandage is shown in almost all cases. Sometimes a soft bandage can be used. As a rule, it is used in the treatment of children with subperiosteal fractures or elderly patients.

To perform immobilization, the thoracobrachial (sternocervical) plaster bandage is most often applied.

The appearance of modern materials allows you to replace gypsum with special polymers. They are more convenient for the patient, since.

Immobilization of the shoulder girdle is carried out until the full coalescence of fragments of the clavicle. The duration of its application depends on the complexity of the fracture, the presence of concomitant pathologies that impede the fusion of bones, and the age of the patient. Usually, it takes 4-8 weeks to wear a plaster bandage.

Medication

In the treatment of fractures of the clavicle, the patient can be prescribed such medicines:

• analgesics;
• antibiotics (with suppuration of a postoperative wound or open fracture);
• preparations of calcium;
• vitamins;
• restorative means.

Physiotherapeutic procedures

The use of physiotherapy techniques in the treatment of fractures accelerates the process of recovery of the patient. They allow to reduce the pain syndrome, eliminate swelling and inflammatory reactions, contribute to the improvement of trophism in the affected area and have a myostimulating effect.

When wearing gypsum, the following procedures can be prescribed:

• electrophoresis with anesthetics and vasodilators;
• low-frequency magnetotherapy;
• SUF-irradiation;
• reception of medicinal mineral waters.

After removal of the plaster bandage may be appointed:

• massage;
• physiotherapy;
• high-frequency magnetotherapy;
• UHF;
• amplipulse;
• ultrasound therapy;
• remote shock wave therapy;
• therapeutic baths (hydrogen sulphide, chloride-sodium).

Recovery period

After the fracture of the clavicle, the patient's work capacity is fully restored in 6-8 months. These terms may depend on the age, the concomitant diseases, the presence of complications and the complexity of the fracture.

When performing osteosynthesis, the metal devices are removed after 6-12 months. The timing of such operations may depend on the same factors as the restoration of work capacity.

Fractures of the clavicle are observed frequently and are accompanied by pain, changes in the shape of the clavicle, edema and impaired movement of the arm. They are detected when examined by a doctor and on X-rays.

To treat such traumas, conservative and surgical techniques can be used.

In the absence of bias, immobilization of the shoulder girdle before bone fusion is performed, and in the presence of displacements, an open or closed reposition is performed to compare the fragments.

A source: https://myfamilydoctor.ru/perelom-klyuchicy-so-smeshheniem-i-bez-simptomy-i-lechenie/