CLAVICLE FRACTURE

Understanding Clavicle Fractures

When it comes to clavicle fractures, there are different ways to categorize them based on specific characteristics. Each type has unique implications for treatment and recovery.

Key Types of Fractures:

Simple vs. Comminuted Fractures

• Simple Fracture: The fracture occurs at one singular point on the clavicle.
• Comminuted Fracture: The bone shatters or breaks into multiple pieces, requiring more complex management.

Displaced vs. Nondisplaced Fractures

• Displaced Fracture: The broken pieces of the clavicle have shifted from their original alignment, potentially necessitating surgical intervention.
• Nondisplaced Fracture: The bone fragments remain in their natural positions, often allowing for non-surgical treatments like a sling.

Fracture Classification Systems
Healthcare providers may use systems, such as the Neer classification, to specify the fracture type, focusing on the precise location on the clavicle and the involvement of surrounding tissues. These systems are essential for determining the most effective treatment strategy.

By understanding these fracture types, you gain insight into the complexity and the tailored approaches to address each specific situation.

Symptoms of a Clavicle Fracture

A fractured collarbone exhibits the following symptoms:

• During shoulder movement, the pain gets worse
• Swelling
• Tenderness
• Bruising
• a growth on or next to the shoulder
• When your child attempts to move his or her shoulder, you hear a grinding or crackling noise
• Your child’s shoulder appears stiff or immobilized.
• A newborn infant who sustains a collarbone fracture during delivery frequently won’t move their arm for a few days.

Diagnosing a Clavicle Fracture (Broken Collarbone)

If you suspect a broken collarbone, it’s crucial to seek medical help immediately. Here’s how healthcare professionals determine if your clavicle is fractured:

• Patient Inquiry: Your doctor will ask detailed questions about the incident leading to your injury. This helps them understand the context and potential impact of the accident.
• Physical Examination: A thorough examination of the affected area is conducted. The healthcare provider will look for signs like swelling, bruising, or abnormal positioning that indicate a fracture.
• Imaging Tests:
  • X-rays: Typically, an X-ray is the first step to confirm a collarbone fracture. It provides a clear image showing the exact location and nature of the break and checks for involvement of other bones.
  • CT Scans: In cases where the injury appears complicated or if multiple injuries are suspected, a CT scan may be utilized. This advanced imaging technique offers a more detailed view, ensuring a comprehensive assessment.

These steps enable healthcare providers to accurately diagnose a broken collarbone and formulate an appropriate treatment plan.

Understanding Bone Calluses

What are bone calluses?

Bone calluses are hard, bony lumps that can form on a bone at the site of a fracture as it heals. They develop as part of the body’s natural bone repair process, similar to the way a callus forms on the skin due to repeated friction or pressure.

How do they form?

When a bone breaks, the body works to heal the fracture by creating new bone. During this healing process, a temporary, thicker bony structure known as a callus may emerge around the healing area. This formation is essential to ensure the bone remains strong and stable as it repairs.

Who is likely to develop them?

Bone calluses are more common in children, whose bones are still growing. However, they can occur in people of all ages, depending on healing patterns and individual differences in recovery.

Are they permanent?

Generally, bone calluses are harmless. They often decrease in size with time, sometimes disappearing entirely after about a year. In some cases, a small lump might remain, but it typically does not cause any problems or discomfort.

Key points to remember:

• Nature: A part of the natural healing process for broken bones.
• Commonality: More frequently seen in younger individuals.
• Duration: They usually diminish over time and rarely cause issues.

Understanding bone calluses can help alleviate concerns about these bumps, reinforcing that they are typically a non-issue in the long-term healing journey.

Difficulties:

The majority of fractured collarbones mend easily. When complications do arise, they may consist of:

Harm to a nerve or blood vessel

A shattered collarbone may harm adjacent nerves and blood vessels due to its sharp tips. If your child experiences numbness or freezing in his or her arm or hand, get emergency medical care right away.

Inadequate or slow healing

A badly fractured collarbone can heal slowly or not at all. Shortening of the bone can occur when the bones do not mend properly. This is why it’s crucial to have a qualified healthcare provider assess the injury. They ensure the bone pieces are positioned correctly to promote proper healing and to check for any other internal injuries that might need attention.

Growth on the bone

A bony lump forms where the bones fuse together during the healing process. Due to its proximity to the skin, this bump is clearly visible. The majority of lumps go away with time, but some remain.

Osteoarthritis

The chance of subsequently developing arthritis in a joint may rise if your child sustains a fracture involving the joints that attach the collarbone to the shoulder blade or breastbone.

Importance of Proper Care and Checkups

Without proper care, such as keeping the shoulder immobilized and practicing exercises correctly, healing can be compromised. Not following these steps can lead to a stiff, frozen shoulder. Moreover, regular checkups are essential as they help in identifying potential problems early on, preventing them from going unnoticed and worsening over time.

Up until the age of 20, the collarbone doesn’t totally stiffen. Children and teens are more likely to break their collarbones as a result. After age 20, the risk goes down, but as people age and their bone strength declines, the risk goes up again. Consult a doctor as soon as possible if you or your kid exhibit any of the warning signs or symptoms of a fractured collarbone or if pain limits daily activities. Poor healing might result from delays in diagnosis and treatment.

Non-Surgical Treatment for a Clavicle Fracture

Your child might not require surgery if the shattered ends of the bones have not moved out of position. Without surgery, many fractured collarbones can recover.

Arm Support

Doctors recommend a simple arm sling immediately after a break to provide comfort and to keep the arm and shoulder in place until the injury heals.

Do:

• Ensure your child wears the sling all day and night, removing it only during bathing or as advised by your healthcare provider.

Don’t:

• Let your child engage in activities that involve using the injured arm to lift, push, or pull until the doctor gives the green light.

Medication

As the fracture heals, over-the-counter painkillers can assist with pain and discomfort.

Do:

• Administer pain medications as needed, strictly following the dosage instructions.

Don’t:

• Mix medications without explicit instructions from your child’s healthcare provider.

Physical Therapy

Even though the child has some discomfort, it’s crucial to keep your child’s arms moving to avoid shoulder and elbow stiffness. Patients frequently start performing elbow mobility exercises right away after suffering an injury. Children lose some shoulder and arm strength after a clavicle fracture.

Do:

• Encourage gentle movement of the shoulder, arm, and hand daily, as instructed by a healthcare professional.
• Attend all follow-up appointments to monitor healing progress.

Your child’s pain will subside as the bone starts to mend, and your doctor could suggest starting light shoulder workouts. These exercises will aid in avoiding weakness and stiffness. Once the fracture has fully healed, your child can gradually begin doing more demanding workouts.

Don’t:

• Allow any strenuous activity until the fracture is fully healed and the doctor approves it.

By following these comprehensive guidelines, you can help ensure a safe and effective recovery for your child’s clavicle fracture.

Follow-up Care for a Clavicle Fracture

Up until the fracture heals, your child will need to regularly visit the doctor. The doctor will have X-rays taken during these appointments to check if the bone is mending properly. Your child will gradually resume his or her usual activities after the bone has healed. A clavicle fracture may occasionally shift before it heals. To ensure that the bone stays in place and heals properly, parents should take their children for periodic checkups with their doctor. Nonunion is the medical term for a fracture that does not heal properly.

• When nonunion takes place, doctors may recommend surgery, even if the patient has minimal discomfort and an excellent range of motion.
• Other times, nonunion can cause pain and doctors will definitely recommend surgery.

A malunion occurs when the bones mend in the wrong position after the fractured pieces shift out of position. Depending on how much the bones are misaligned and how that impacts your child’s arm’s range of motion, the doctor will determine if surgery should take place. The fracture may mend with a noticeable lump over the location. Over time, this often gets smaller, although a little bump frequently lasts forever.

Surgical Treatment

Open reduction and internal fixation

Doctors will recommend surgery if the broken ends of the clavicle are pressing on the skin if they greatly overlap, or if they are extensively dislocated. The pieces are repositioned during surgery, and the plate and screws hold them in place. Most patients can go home the same day after this treatment, which typically takes an hour and a half to complete at the Medical City Children’s Orthopedics and Spine Specialists. The neurosurgeons of Medical City Children’s Orthopedics and Spine Specialists are adept at figuring out the best course of action for every patient and circumstance. Utilizing state-of-the-art equipment and skilled physicians, we are experts in treating clavicle fractures. Intrinsic fixation frequently takes the following forms:

• Screws and plates. The bone pieces are maintained in place after being realigned into their usual positions using specialized screws and metal plates fastened to the outside of the bone. A surgeon can remove them once the fracture has healed, pins or screws sometimes irritate the area where they have been put.
• The patient can detect a little area of numb skin behind the incision after surgery. With time, the patient will sense this numbness less and less. The plate can sometimes be felt through the skin.
• After the bone has healed, plates and screws are not often removed unless they are uncomfortable. While hardware issues are uncommon, some patients report that the collarbone region might get irritated by seatbelts and backpacks. In this case, when the fracture has healed, the hardware may be taken out.

Clavicle Fracture Pain Management 

There is discomfort following surgery. This is a typical stage of the recovery process. For a lot of people, using ice and over-the-counter painkillers are sufficient pain reliever. If the pain is severe, your doctor might prescribe a strong pain medication for a few days.

Clavicle Fracture Rehabilitation

You can strengthen your child’s shoulder and regain mobility by your child participating in certain exercises. Your doctor could recommend working with a physical therapist or your doctor can provide you with a plan for home treatment. Exercises with mild motion are a popular starting point for therapy regimens. As your child’s fracture heals, your doctor will gradually incorporate strengthening activities into the regimen. Following the physical therapy plan is crucial for helping your child go back to being normal, even if it is a gradual process. Every surgical procedure carries some risk. These consist of:

• Infection
• Bleeding
• Difficulties with wound healing
• Pain
• Blood clots
• Harm to blood vessels or nerves
• Reaction to anesthesia

The following risks are particular to clavicle fracture surgery:

• Bone healing
• Lung injury
• Numbness below the clavicle
• Hardware irritation

Patients with a higher risk for problems during and after surgery include those who smoke or use tobacco products, have diabetes or are old. Additionally, they are more susceptible to issues with bone and wound healing.

Clavicle Fracture Outcomes

The recovery process for a clavicle can take several months, whether or not surgery is part of the treatment. Within three months of their accident, the majority of patients resumed their usual activities. When your child’s injuries are stable enough to do so, your doctor will let you know. If your child resumes his or her usual activities or raises something with their arm before your doctor suggests it, the fracture fragments or the hardware might migrate causing problems that might require therapy to start over. Children can resume participating in sporting activities once their fracture has fully healed. It’s important to ensure there is no pain during movement before considering a return. For those involved in contact sports, additional time might be necessary to rebuild strength and confidence.

Before returning to the field or court, make sure to consult with a healthcare provider. They will likely perform an X-ray and a physical examination to confirm that the collarbone is completely healed. This professional evaluation is crucial to prevent any setbacks in recovery and ensure a safe return to sports.

Our Practice, Medical City Children’s Orthopedics and Spine Specialists, Treats Kids with Clavicle Fractures

Some general reasons why a parent might consider taking their child with a broken clavicle to a specialized orthopedic center like Medical City Children’s Orthopedics and Spine Specialists:

• Expertise in Pediatric Orthopedics: Specialized centers often have a team of pediatric orthopedic specialists who have extensive experience in treating children’s musculoskeletal issues. These experts are well-versed in the unique challenges of treating pediatric fractures, including those involving the clavicle.
• Child-Centric Care: Pediatric orthopedic centers are typically designed with children and families in mind.
• Advanced Diagnostic and Treatment Options: Centers like Medical City Children’s Orthopedics and Spine Specialists are often equipped with state-of-the-art technology and access to the latest advancements in pediatric orthopedic care, ensuring that children receive the most appropriate and effective treatments for their specific injuries.
• Comprehensive Care: These specialized centers usually offer comprehensive care, including evaluation, diagnosis, treatment, and rehabilitation services, all under one roof.
• Pediatric Rehabilitation Services: Rehabilitation is a crucial aspect of recovering from a broken clavicle. Pediatric orthopedic centers may have dedicated rehabilitation specialists who can work with children to regain strength and mobility in a safe and child-friendly manner.

For specific information about the services and expertise offered at Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Frisco, and McKinney, Texas, doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them. We welcome new patients and invite you to call us for an appointment for your child.

____________________

Footnote:

Ortho Info: Clavicle Fracture