How to treat a broken clavicle

A broken clavicle is quite serious because the clavicle is the skeleton that supports our entire shoulder. It will cause swelling and subcutaneous bruising in the patient. We should displace the fracture, which requires the patient to go to the hospital for corrective surgery and then reconnect the fractured part before it can be cured. For the examination and treatment methods of clavicle fracture, you can learn about the contents introduced in this article.

Clinical manifestations

The main manifestations are local swelling, subcutaneous congestion, tenderness or deformity. The displaced fracture ends can be felt at the deformity. If the fractures are displaced and overlap, the distance between the acromion and the manubrium of the sternum becomes shorter. The function of the injured limb is limited, the shoulder is drooping, the upper arm is pressed against the chest and dare not move, and the affected elbow is supported with the healthy hand to relieve the pain caused by the traction of the sternocleidomastoid muscle. The fracture site is tender to palpation, and bone crepitus and abnormal clavicle movement may be felt. The deformity of greenstick fractures in young children is often not obvious, and they are often unable to report the location of pain, but their heads are often tilted toward the affected side and their jaws are turned toward the healthy side. This feature is helpful for clinical diagnosis. Sometimes fractures caused by direct violence can puncture the pleura and cause pneumothorax, or damage the subclavian blood vessels and nerves, resulting in corresponding symptoms and signs.

examine

The auxiliary examination method for this disease is mainly imaging examination, and clavicle fractures often occur in the middle section. Most of them are transverse or oblique fractures. The medial end is often displaced upward and backward due to the traction of the sternocleidomastoid muscle, and the lateral end is displaced inward and downward due to the gravity of the upper limb, forming an angulated, dislocated and shortened deformity with a convex surface upward.

1. X-ray examination

When a clavicle fracture is suspected, an X-ray is required to confirm the diagnosis. Generally, 1/3 clavicle fractures are imaged in the anteroposterior position and in the oblique position tilted 45° toward the head. The imaging range should include the entire length of the clavicle, the upper 1/3 of the humerus, the shoulder girdle and the upper lung field. If necessary, a chest X-ray should be taken. The anteroposterior image can show the superior and inferior displacement of the clavicle fracture, and the 45° oblique image can observe the anterior and posterior displacement of the fracture.

Non-displaced clavicle fractures or greenstick fractures in infants and young children are sometimes difficult to diagnose on the original X-ray images. Repeat X-rays 5 to 10 days after the injury can often reveal callus formation.

In the case of fractures of the outer third of the clavicle, the diagnosis can usually be made by X-rays in the anteroposterior position and at a 40° tilt toward the head. It is sometimes difficult to diagnose a fracture of the lateral articular surface of the clavicle using conventional X-rays, and sectional X-rays or CT scans are often required.

The anteroposterior X-ray image of the inner 1/3 of the clavicle overlaps with the mediastinum and vertebral body, making it difficult to show the fracture. Taking X-ray images tilted 40° to 45° toward the head can help find the fracture line. During the examination, one should not be satisfied with the diagnosis of soft tissue injury based on the absence of fracture on the frontal X-ray. A careful examination is required to determine whether there are signs of fracture of the medial end of the clavicle or of the local area in order to make a correct diagnosis.

2. CT examination

CT examination is often used for complex clavicle fractures, such as fractures involving the articular surface and acromion. It is especially better than X-ray examination for fractures of the articular surface.

diagnosis

The patient has a history of trauma such as falling with upper limbs abducted or direct local violence. After the injury, he experienced shoulder pain and was afraid to move his upper limbs. X-rays can confirm the diagnosis and show the displacement and comminution of the fracture.

treat

The appropriate treatment should be selected according to the fracture type and degree of displacement.

1. Greenstick fracture

Most of them are children. For those without displacement, they can be fixed with an "8" bandage. For those with angular deformity, the "8" bandage should still be used to maintain the position after reduction. For older children who are prone to re-dislocation, an "8"-shaped plaster bandage is appropriate.

2. Non-displaced fractures in adults

Fix with an "8"-shaped plaster bandage for 6 to 8 weeks, and pay attention to shaping the plaster to prevent displacement.

3. Displaced fractures

All should be manually reduced under local anesthesia, and then fixed with an "8"-shaped plaster. The operation instructions are as follows: the patient sits upright with his hands on his hips, chest out, head raised, and shoulders stretched back. The surgeon stands behind the patient, holds the patient's anterior and lateral parts of the shoulders (or the outer sides of the elbows) with both hands and pushes upward and posteriorly to allow the patient to stretch his back and straighten his chest. At the same time, the surgeon uses the front of the knee to press against the back of the patient's lower thoracic segment to form a fulcrum. This can achieve a more ideal reduction of the fracture. On this basis, fix it with an "8"-shaped plaster bandage. To avoid compression of axillary blood vessels and nerves, during the entire process of wrapping the plaster bandage, the assistant should squat and place the middle and index fingers of both hands in a crossed position on the patient's armpits. The plaster bandage is wrapped around the middle and index fingers of the assistant's hands and continues until the plaster bandage is formed. In general, clavicle fractures do not require complete anatomical alignment. As long as the displacement is not very severe, good function can be achieved after the fracture heals.

4. Surgery

Indications for surgical treatment include open fractures; fractures with vascular or nerve damage; displaced fractures of the outer end or outer third of the clavicle with rupture of the coracoclavicular ligament; and nonunion fractures. The internal fixation method can be selected depending on the type and location of the fracture, such as "8"-shaped wire, Kirschner wire or plate screw fixation.