Clavicle Fracture (Distal)

Clavicle Fracture (Distal)



Description


A distal clavicle fracture is a complete or incomplete break in the outer third of the collarbone (clavicle) near where it attaches to the roof of the shoulder (acromion). Often this fracture extends into the acromioclavicular joint and may be associated with rupture of the acromioclavicular and coracoclavicular ligaments. These ligaments attach the clavicle to the acromion that is part of the shoulder blade (scapula) or coracoid (part of the scapula).



Common signs and symptoms



• Pain, tenderness, and swelling on top of the shoulder

• Deformity or bump if the fracture is complete, and the bone fragments separate enough to distort the appearance of the top of the shoulder

• Bruising at the site of injury, usually within 48 hours

• Loss of strength or pain with use of the affected arm

• Occasionally numbness or coldness in the shoulder and arm on the affected side, if the blood supply is impaired

• Uncommonly, shortness of breath or difficulty breathing


Causes



• Usually, a direct blow to the shoulder, falling on the tip of the shoulder, or impact on the tip of the shoulder

• Less commonly, an indirect stress, such as falling on an outstretched hand or on the tip of the elbow


Factors that increase risk



• Sports that require contact or collision, such as football, soccer, hockey, and rugby

• Sports with a high risk of falling on the shoulder, such as rodeo riding, mountain bike riding, or cycling

• Previous shoulder sprain or dislocation

• Inadequate protective equipment

• History of bone or joint disease, especially osteoporosis


Preventive measures



• Maintain appropriate conditioning, particularly neck, shoulder, and arm muscle strength, endurance, and flexibility.

• Ensure proper protective equipment fit, such as for shoulder pads.

• Use proper technique, and have a coach correct improper technique, including falling.


Expected outcome


Symptoms are usually curable with appropriate treatment. Often distal clavicle fractures require surgery to properly reposition the fracture fragments to allow healing and reduce complications.



Possible complications



• Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or other tissues

• Weakness and fatigue of the arm or shoulder (uncommon)

• Delayed union (healing) or nonunion (no healing) of the fractures, a common occurrence in outer-third clavicle fractures because of the associated injury to the ligaments and pull of the muscles keeping the fragments separated

• Arthritis, pain, and inflammation of the acromioclavicular (AC) joint

• Prolonged healing time and susceptibility to recurrent injury (fracture) if usual activities are resumed too early

• Excessive scar tissue at the fracture site, including excessive bone formation, causing compression on nerves and blood vessels in the neck or armpit, which may lead to pain, numbness, and tingling in the neck, shoulder, arms, and hands

• Infection in open fractures, when the bone breaks through the skin, or at the incision site if surgery has been performed

• Persistent bump or prominence at the fracture site

• Susceptibility to repeated collarbone injury


General treatment considerations


Initial treatment consists of medication, ice, and compressive dressing to relieve pain and reduce swelling. Use of a shoulder immobilizer, figure-eight brace, or arm sling is usually recommended. When a fracture is displaced and involves the AC joint or injury to the coracoclavicular ligaments, definitive treatment for outer-third fractures of the clavicle requires surgery, which involves repositioning the fracture fragments and holding them with plates, screws, wires, sutures, or pins. After fracture healing, these fixation devices may need to be removed before moving the arm. Exercises to regain shoulder motion and strength lost due to injury, surgery, and lack of use while healing are necessary before returning to sports. These exercises may be done on your own, or you may be referred to a physical therapist or athletic trainer for further evaluation and treatment. Surgical intervention requires waiting 2 to 6 months before returning to sports.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician. Use these only as directed, and take only as much as you need.


Cold therapy


Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours for pain and inflammation and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.



When to call your doctor



• Pain, swelling, or bruising worsens despite treatment.

• You experience pain, numbness, or coldness in the arm.

• A blue, gray, or dusky color appears in the hand or fingernails.

• You have increased pain, swelling, or drainage in the surgical area.

• You experience signs of infection, including increased pain, swelling, drainage, fever, or a general ill feeling.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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Figure 1


From Jenkins DB: Hollinshead’s functional anatomy of the limbs and back, ed 6, Philadelphia, 1991, W.B. Saunders, p 71.

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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Clavicle Fracture (Distal)

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