Your collarbone connects the upper part of your breastbone to your shoulder blade. Common causes of a broken collarbone include falls, sports injuries and trauma from traffic accidents.
Infants can sometimes break their collarbones during the birth process. Seek prompt medical attention for a broken collarbone. Most heal well with ice, pain relievers, a sling, physical therapy and time. But a complicated break might require surgery to realign the broken bone and to implant plates, screws or rods into the bone to hold the bone in place during healing. If you notice signs or symptoms of a broken collarbone in you or your child, or if there's enough pain to prevent normal use, see a doctor right away.
Delays in diagnosis and treatment can lead to poor healing. Your collarbone doesn't harden completely until about age This puts children and teenagers at higher risk of a broken collarbone. The risk decreases after age 20, but then rises again in older people as bone strength decreases with age. They also can happen in sports where there is a chance of falling hard, such as biking , skiing , snowboarding , and skateboarding.
Most broken collarbones heal with ice, arm support, pain medicine, and exercises. The arm is supported either by a sling or a shoulder immobilizer. A shoulder immobilizer is like a sling but it also has a strap that goes around the waist. That's because the collarbone has a thick periosteum outer layer of the bone.
The collarbone periosteum doesn't usually break, so it acts like a sleeve to hold the bone together while it heals. Rarely, the doctor might recommend surgery if the broken bones are very out of line. Sometimes while the broken collarbone heals, there is a bump where the bone was broken. Sometimes the bump doesn't fully go away. But it doesn't hurt or cause other problems with the arm or shoulder. Your health care provider will see you again and let you know when it's OK to go back to sports.
This is usually when:. Because collarbone fractures happen suddenly and unexpectedly, it can be hard to prevent them. But to decrease your risk:. Most broken collarbones heal quickly and completely. Within a few months, you should be back to doing all the things you enjoyed before the injury. Broken Collarbone Clavicle Fracture. Reviewed by: Susan M. Dubowy, PA-C. Immobilization is maintained for comfort and can be discontinued in one to two weeks or when the major pain subsides. Range-of-motion pendulum exercises can be started as soon as pain allows, with gradual progression to active range-of-motion and strengthening exercises over four to eight weeks.
Displaced midshaft clavicle fractures have higher rates of nonunion and a greater risk of long-term sequelae. Information from references 13 , 14 , and 16 through Options for operative management are open or closed reduction with plate fixation or, less commonly, intramedullary fixation.
Intramedullary fixation uses smaller incisions and restores anatomy sufficiently. It also avoids the potential complications from plate pressure and the need for a second surgery.
However, there is a small risk that the fixation device will migrate into an anatomically sensitive area. Consequently, a superior or anterior plate remains the preferred option for many surgeons. Complications from midshaft clavicle fractures are rare, despite the proximity of neurovascular structures and lung apices, but include pneumothorax and neurovascular injury.
Long-term sequelae include pain at rest or during activity, weakness, paresthesia, and cosmetic defects. Return to activity recommendations for patients with midshaft clavicle fractures depend on patient age, level of contact, and presumed trauma risk. Before returning, an athlete should have full range of motion, normal shoulder strength, clinical and radiographic evidence of bony healing, and no tenderness to palpation.
Patients usually can return to noncontact sports and full daily activities six weeks after injury. Contact and collision sports should be delayed for two to four months until solid bony union occurs. If surgery is performed, some surgeons recommend removal of hardware before returning to sports. For young adults, the most common cause of midshaft clavicle fractures is sports-related injuries.
The mean age of patients with sports-related clavicle fractures is 21 years. The mean age of patients with non-neonatal clavicle fractures is eight years; 88 percent of these fractures are midshaft.
Children often develop a significant callus formation, and it is important to educate parents about this normal progression of healing. Healing usually occurs within four to six weeks. If there is no history of trauma, then malignancy, rickets, osteogenesis imperfecta, and physical abuse must be considered. The primary restraints to vertical stability of the distal clavicle are the coracoclavicular ligaments.
There are two distinct coracoclavicular ligaments: conoid and trapezoid. The classification and treatment of distal clavicle fractures depend on where the fracture occurs in relation to these ligaments. The original classification by Neer in the s described two types of distal clavicle fractures: type I, in which the coracoclavicular ligaments remain intact; and type II, in which the coracoclavicular ligaments are torn from the medial fragment and only the trapezoid ligament remains attached to the lateral fragment.
Types I and III fractures are inherently stable and do not displace; therefore, these types of fractures can be treated nonoperatively with a sling for comfort and early range-of-motion exercises as pain allows. Much of the controversy in the literature in treating distal clavicle fractures centers around how best to treat type II fractures, which have a tendency to displace. The lateral fracture fragment is held in place by the coracoclavicular ligaments, but pulled downward and medially by the weight of the arm and by the pectoralis and latissimus dorsi muscles, while the medial fragment is pulled superiorly by the trapezius and sternocleidomastoid muscles.
Because of this displacement, there tends to be a high rate of nonunion. However, the decision to treat a displaced type II fracture operatively in the acute setting may be made if the displacement is so severe that it is at risk of compromising skin integrity. Distal clavicle fractures are rare in children, and when they occur, the mechanism is often a fall on the point of the shoulder.
Whereas this mechanism tends to cause AC joint disruption in older adolescents and adults, it much more commonly causes distal clavicle fractures in children.
The fracture often occurs through the distal physis, with disruption of the thick periosteal sleeve surrounding the clavicle. Fractures of the proximal third of the clavicle are uncommon.
The proximal clavicle and sternoclavicular joint also have good ligamentous support, so when fractures do occur they typically do not displace. Nondisplaced fractures can be treated with a sling for comfort and gradual increase in range of motion, as pain allows. Displaced fractures should be carefully evaluated for signs of neurovascular compromise; if present, this should be acutely reduced.
In a setting capable of handling an airway or hemodynamic emergency, this reduction can be achieved acutely by grasping the clavicle with a towel clip and applying anterior traction. In the absence of neurovascular compromise computed tomography should be performed to fully visualize posteriorly displaced fragments; if necessary, reduction can be performed under anesthesia. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. University and an adjunct assistant professor in Sargent College at Boston University.
He is also director of the family medicine residency curriculum in orthopedics and sports medicine at Boston Medical Center, director of the primary care sports medicine fellowship at Boston University, and a team physician for athletics at Boston University and the Massachusetts Institute of Technology in Cambridge. Pecci completed a residency in family medicine at the University of California, Los Angeles, and a primary care sports medicine fellowship at Ohio State University, Columbus.
He completed a residency in internal medicine and pediatrics at Indiana University, Bloomington. Reprints are not available from the authors. Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. Holbrook TL. Chicago, Ill. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. Epidemiology of clavicle fractures.
J Shoulder Elbow Surg. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res.
0コメント