The collarbone is one of the bones of the human body. It is quite long, but thin and tubular. In this regard, when exposed to it with a force exceeding its strength, a fracture occurs. The clavicle is injured in 15-25% of cases from damage to bone tissue. Such a high percentage is explained by the subtlety and high vulnerability of this bone.
Clavicle anatomy
It refers to the bones of the shoulder, providing the relationship of the trunk and upper limb, while basically such a connection is made with the help of muscles. The shape of the clavicle is S-shaped. Its inner end is called the thoracic, it accounts for about 5% of the bone, and the external - acromial (about 15%). The rest is in the body of the clavicle. The midpoint of the body is most exuded.
It is located above the first rib of the sternum. As a result of a fracture of the clavicle, pieces of this bone can damage nerves and blood vessels located between the neck and arm, which can lead to impaired functioning of the upper limbs.
Bone function
Unlike other tubular bones, the collarbone does not contain bone marrow. The following functions are inherent in it:
- transmission of nerve impulses to the axial skeleton from the upper limb;
- protection of the cervical-axillary canal from damage;
- provides movement of the hand in a wide range, including its scapular suspension in a free state.
Clavicle fracture in the ICD
With the help of the 10th revision guide, you can decipher the codes of the international classifier of diseases listed on the sick leave. It is an international document, with the help of which the unity of methodological approaches and the comparability of results internationally are ensured.
Fracture of the clavicle in the ICD-10 belongs to the class "Fracture at the level of the shoulder girdle and shoulder." But if we consider in more detail, it is worth pointing out the block. Such an injury refers to the Clavicle Fracture block. The open form has the code S42.01. A closed fracture is designated S42.00.
Causes of Bone Fracture
It may arise due to the following circumstances:
- getting injured;
- due to impact;
- due to a fall;
- as a result of corroding tissue by cancer metastases.
The tone of the muscles attached to the clavicle is increased. This causes the displacement of debris.
The main reason is injury. It is especially characteristic for the occurrence of a clavicle fracture in a child, as well as in athletes experiencing excessive stress. This bone is most durable after 25 years of age. Similar injuries occur in the form of collarbone fractures in newborns. The latter arise due to the presence of a narrow pelvis in the mother and the large size of the child.
Symptoms of Injury
The following symptoms of a clavicle fracture are observed:
- limited movement of the upper limb;
- shoulder displacement forward and its lowering with lengthening of the arm from the side of the damaged clavicle;
- hemorrhage;
- shortening and deformation of the shoulder girdle;
- swelling, swelling, redness and hyperthermia of the affected area;
- local pain, aggravated by free hanging of the hand.
In the event of a fracture, the injured cannot perform any action with the upper limb, which leads to the fact that the elbow is pressed against the body. Symptom is the smoothness of the supraclavicular fossa. During palpation of the bone, crepitus of fragments is heard (a sound reminiscent of steps on frozen snow).
If a subclavian artery is damaged by a bone fragment, the hand becomes white, cold to the touch, without feeling the pulse. When injuring a nerve, paralysis of the fingers of the limb and its general sensitivity can be noted. If blood vessels are damaged, a hematoma appears in the clavicle.
Due to the shock experienced, short-term loss of consciousness is possible.
In the case of a bone fracture due to oncology, a general condition worsens, the temperature rises to 37.5-38 ° C, and headaches appear.
A fracture of the clavicle in a child proceeds as a green branch. In this case, a partial fracture is observed due to the high elasticity of the bones. They remain fastened by the periosteum during a fracture.
Fracture classification
The following types of injuries of the bone in question are distinguished:
- without bias;
- with offset;
- closed;
- open.
When fragments are formed, fractures can be:
- comminuted;
- non-split;
- multi-fragmented.
By the nature of the fracture, the following injuries are distinguished:
- oblique;
- transverse;
- screw;
- T- and S-shaped.
The type and nature of the fracture determines the method of treatment.
Open fractures are observed with damage to the skin, with a rupture of ligaments, tendons and muscles. This damage is determined through a wound through which bone fragments are visible that communicate with the environment.
Closed fracture of the clavicle is characterized by the preservation of the skin. This type of damage is more difficult to determine because it is not clear where the fracture site is located.
Symptomatology of fractures with displacement
The following symptoms are observed with this type of injury:
- sagging broken clavicle;
- the entry of bone fragments for each other;
- nerve damage, accompanied by numbness of the hand;
- loss of motor activity and sensitivity;
- violation of the functions performed by the arm and shoulder;
- change in the relief of the scapula;
- bleeding inside the body and manifested in external form;
- pallor of the skin;
- swelling of the site of damage;
- severe pain radiating to the shoulder.
A fracture of the clavicle with a shift causes rapid edema, since closely located vessels are injured, which leads to the formation of hematomas and bleeding.
It is most difficult to treat, since there is damage to the ligaments, tendons, muscles and bones located next to the injury site. With open damage with displacement, an urgent operation is necessary, since bone fragments can damage large vessels, causing severe bleeding, which creates a potential threat to the patient's life.
Diagnostics
If you suspect a bone fracture, you need to contact a trauma doctor. He conducts an examination, palpation, auscultation, examines information about the patient, the nature of the injury, prescribes a study using x-rays.
On the radiograph, the doctor will see a fracture and prescribe the appropriate treatment. If there is no displacement of fragments, then a plaster or kerchief bandage is applied. In the case of a collarbone fracture with a shift, surgery is performed.
First aid
Near the bone are the lungs, nervous and circulatory systems. Therefore, improperly rendered first aid can lead to death or rupture of blood vessels, as well as damage to the upper lobe of the lung.
To take urgent measures, you need to carry out the following sequence of actions:
- the victim must be given an anesthetic;
- in the case of an open fracture, bleeding must be stopped by applying an aseptic dressing;
- prepare the victim for transportation.
The last action is also carried out in a certain sequence:
- a dense roller is placed in the armpit, which can be made of gauze bandage, a napkin or towel;
- the arm is bent at the elbow so that the forearm and hand are parallel to the floor, which contributes to the least pain;
- a bandage is applied, which can be a scarf or a Deso bandage, it can also include shirts, towels, sheets, scarves, and the hand can also be hung on a scarf, after which the latter is tied to the neck;
- the victim is transported to the emergency room in a sitting or half-sitting position.
When providing first aid, you can not perform the following actions:
- fix the hand with a cord or thin tape;
- straighten a damaged limb;
- pull the victim by the hands or try to tilt him forward;
- transport the victim in a standing or lying position;
- touch wounds and the site of injury and try to straighten bone fragments.
Dressing
After the victim is delivered to the emergency room, the traumatologist, having studied the x-ray, can conclude that it is necessary to fix the arm. The bandage for a collarbone fracture allows you to hold the damaged bone in a static position, which will reduce pain and prevent fragments from moving.
The following types of dressings are used:
- Corset for fixing damaged bone. It has some rigidity, although not without convenience. The shoulder is supported in the desired position, the load on the spine is minimized. The fracture grows together quickly.
- Oval Titova. They are located in the armpit, the arm is fixed to the body with plaster bandages. The forearm is suspended by a scarf.
- Headscarf. It is used when transporting the patient to the emergency room, does not provide complete immobility.
- Delbe rings. Two dense rings with a certain size, depending on the age of the victim, made of cotton wool and gauze. Superimposed in a sitting position with shoulders laid back. Rings are placed on the shoulders and behind are tied with a braid or bandage.
- Velpo's dressing. Currently almost never used. It is performed with bandages.
- Bandage Deso. It is used to fix the hand with the goal of reducing pain syndromes and preventing the displacement of fragments. It is used by ambulance teams with ordinary or elastic bandages.
Therapy
Treatment of clavicle fracture can be performed using therapeutic techniques and methods. They are determined by the type of fracture, its severity, the amount of damage and the age of the victim. In the event that the fracture occurred without displacement, conservative treatment is carried out at home. If an open wound is noted, then inpatient treatment is carried out. The hand is fixed for two months with a bandage.
Therapy can be performed in the following areas:
- Spa treatment;
- massage;
- Exercise therapy;
- physiotherapeutic procedures;
- drug treatment.
The latter is carried out using:
- chondroprotectors;
- nutritional supplements with calcium and phosphorus;
- immunity-enhancing drugs;
- antibiotics for open fracture to prevent infection of the wound;
- painkillers.
Physiotherapeutic techniques include the following:
- hydrotherapy (taking warm salt baths);
- laser therapy;
- magnet treatment;
- ultrasound therapy;
- UHF
Exercise therapy and massage are performed during remission with complete healing of the fracture.
Children with fractures of the bone in question are mainly given a Deso bandage or Delbe ring.
Surgical intervention
Sometimes it is impossible to avoid surgery for a fracture of the clavicle. It is called osteosynthesis. In the process of surgical intervention, bone fragments are removed, the collarbone is fastened with mechanical devices.
The most popular is the operation carried out using plates and screws. So, if the injury is in the area of the acromial end, then use hook-shaped plates or locking screws. Also, a pin can be inserted into the bone using a special fixing device.
Surgery for fracture of the clavicle with displacement is resorted to with an unstable fracture of the tubular bone or with damage to the joint.
Disadvantages of surgery:
- improper bone fusion may occur, which is most often observed with a multi-fragmented fracture, due to the complexity of the operation or the wrong choice of metal structures;
- osteomyelitis may develop, due to which the bones may not grow together correctly.
Rehabilitation
Depending on the general state of health, age, severity of injuries, the amount of injuries received, the recovery period after an injury varies. On average, it is 3-4 months, the full period is 180-250 days.
All metal parts after surgery are removed from the body after six months to a year. After a full recovery, the doctor prescribes the passage of rehabilitation measures:
- physiotherapeutic procedures;
- sodium chloride and hydrogen sulfide baths;
- amplipulse therapy;
- massage;
- shock wave therapy;
- Exercise therapy.
During rehabilitation, you need to eat foods rich in calcium.
For a quick recovery, a special orthosis helps. It is made of elastic material with inserts of knitting needles, corset, tire and bandage and is used after removing the plaster.
Effects
They occur in cases where the injury was serious enough, and the doctors did not have the necessary qualifications for appropriate treatment. Basically, the consequences of a collarbone fracture do not occur.
These may include the following:
- incapacity for a long time interval;
- the development of arthrosis (non-use of plaster dressings);
- shortening of the hand with improper growth;
- osteomyelitis development;
- accumulation of pus in the wound;
- her infection with an open fracture and the same - sutures during surgical intervention;
- the formation of scoliosis (especially in children);
- violation of posture;
- the formation of false joints;
- secondary displacements with reflex muscle contraction;
- paralysis of the fingers with nerve damage;
- loss of sensitivity
- plexitis (nerve plexus is affected);
- significant blood loss;
- damage by acute fragments of nerves, soft tissues and blood vessels.
Very large newborns have flaccid muscle paralysis with gluteal previa, which is formed when the fetus passes through the birth canal. In case of improper bone fusion, the child may lose the ability to control the hand. In the best case, an aesthetic defect will occur.
An improperly consolidated fracture creates an artificial fracture, after which the fragments are compiled in the correct sequence.
Adequate fixation of fragments during surgery does not require the use of external fixators after its implementation, movements in the shoulder joint can be carried out almost immediately. Full recovery after surgery is possible when the fragments are in the correct position and their fixation for the period that is needed for their fusion.
In order to avoid some of the consequences, it is necessary to take the correct posture during sleep. It is best to sleep on your back. Sleep may occur on the stomach. But you can’t be on your side during sleep, and above all on the damaged side, which can cause displacement of the fragments.
Finally
Clavicle fracture mainly occurs in its thinnest part. For the treatment of this phenomenon, physiotherapeutic procedures, exercise therapy, massage, various baths, magnets can be prescribed. In the event of an injury, the victim is delivered to the emergency room, while the hand should be tied over the neck with a scarf.
He undergoes an X-ray examination, the results of which establish the need for hard dressings or surgical intervention. As a rule, the prognosis is favorable, but you need to follow the recommendations given and listen to the advice of a doctor.