COLLARBONE (CLAVICLE) FRACTURE, OUTER END |
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General Information
DEFINITION--A complete or incomplete break in the outer third of the clavicle (collarbone). Frequently, this fracture extends into the shoulder joint and is associated with rupture of the shoulder ligaments.
BODY PARTS INVOLVED
Clavicle (collarbone).
Shoulder joint.
Joint between the shoulder and collarbone.
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 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 bone. Indirect stress may be caused by twisting or a violent muscle contraction.
RISK INCREASES WITH
Contact sports such as football or soccer.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are 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 protective equipment such as shoulder pads, when appropriate.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
Special shoulder harness to promote healing (sometimes).
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 frequent 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.
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 within 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.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign and set the broken bones with surgery or, if possible, without. 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 a normal position.
CONTINUING CARE
Immobilization will be necessary. For this fracture, a sling usually works quite well.
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, and before workouts or competition.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad, hot soaks, hot showers, heating pads, or heat liniments and ointments.
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 or aspirin for mild 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.
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 reconditioning the injured area after clearance from your doctor.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have 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).
Blue or gray skin color beyond the sling, especially under the fingernails.
Loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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