COLLARBONE (CLAVICLE) FRACTURE, SHAFT MIDPORTION |
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General Information
DEFINITION--A complete or incomplete break in the middle third of the clavicle (collarbone). This is the most common collarbone fracture.
BODY PARTS INVOLVED
Clavicle (collarbone).
Shoulder joint.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments, blood vessels and bone attached to ligaments.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling around the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness or coldness in the shoulder and arm on the affected side, if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the clavicle, either at the shoulder or at the collarbone midpoint.
RISK INCREASES WITH
Contact sports such as football or hockey.
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
Children.
Obesity.
If surgery is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build adequate muscle strength and achieve good conditioning prior to exercise, athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas, including the shoulder joint and joint between shoulder and clavicle.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture. This is common in fractures of the clavicle because of its naturally poor blood supply.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Excessive scar tissue at the fracture site, causing compression on nerves and blood vessels in the neck. This may lead to pain, numbness and tingling in the neck, shoulder, arms and hands.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Proneness to repeated collarbone injury if healing is incomplete.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
PROBABLE OUTCOMEPlates and screws implanted in surgery may be in place for a year or more. However, try to resume full function and normal range of motion by 3 or 4 weeks. Healing is complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible. Don't move the injured area to remove clothing.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use a sling to immobilize the injured area and surrounding joints before taking the injured person to a medical facility.
CONTINUING CARE
The doctor will realign and set the broken bones with surgery or, if possible, without. Children rarely require surgery. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to normal.
Immobilization will be necessary. For this fracture, a sling usually works quite well.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use heat lamps, hot soaks, hot showers or heating pads.
Use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for moderate pain.
ACTIVITY
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Circumduction exercises (See Glossary) should begin the first day after surgery.
Begin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes following exercise.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a collarbone fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Change in skin color beyond the sling to blue or gray, particularly under the fingernails.
Loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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