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 Broken collarbone

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PostSubject: Broken collarbone   Broken collarbone EmptyWed Jan 05, 2011 9:46 pm

A broken collarbone is a common injury, particularly in children and young adults. Your collarbone (clavicle) connects the upper part of your breastbone (sternum) to your shoulder blade (scapula). Common causes of a broken collarbone include falls onto a shoulder, sports injuries and trauma from traffic accidents.

If you think you or your child has a broken collarbone, seek prompt medical attention. Most broken collarbones heal well with ice, pain relievers, a sling and physical therapy. But a complicated broken collarbone may require surgery to realign the broken bone and to implant plates, screws or rods into the bone to maintain proper alignment during healing.


Symptoms

Signs and symptoms of a broken collarbone include:

* Pain that increases with shoulder movement
* Swelling
* Tenderness
* Bruising
* A bulge on or near your shoulder
* A grinding or crackling sound when you try to move your shoulder
* Stiffness or inability to move your shoulder

When to see a doctor
If you notice any of the signs or symptoms of a broken collarbone, or if you have enough pain in your shoulder that you can't use it normally, see a doctor right away. Do the same for your child. Delays in diagnosis and treatment of a broken collarbone can lead to poor healing.


Causes

Common causes of a broken collarbone include:

* Falls. Falling onto a shoulder is the most common cause of a broken collarbone. Although a less common cause, falling onto an outstretched hand can also result in a broken collarbone.
* Sports injuries. Direct blows and injuries on the field or court are a common cause of broken collarbones.
* Significant trauma. A broken collarbone can be the result of a car, motorcycle or bike accident, or another direct trauma to the shoulder.
* Birth injury. In newborns, a broken collarbone can be caused by an injury that happens during the birthing process.

Risk factors

Factors that may increase your risk of a broken collarbone include:

* Age. Your collarbone doesn't harden completely until about age 20. This puts people younger than 20 at higher risk of a broken collarbone. The risk decreases after 20, but then rises again in older people as bone strength decreases with age.
* Sports participation. Participating in sports such as football, basketball, soccer, wrestling, rugby, hockey, skiing and snowboarding increases your risk of a broken collarbone. Sports injuries are among the most common causes of a broken collarbone.
* High birth weight. Infants who have higher birth weights are at an increased risk of sustaining a broken collarbone during labor and delivery.

Complications

Most broken collarbones heal without difficulty. But complications may include:

* Nerve or blood vessel injury. The jagged ends of a broken collarbone may injure nearby nerves and blood vessels. Seek immediate medical attention if you notice any numbness in the area of the break.
* Poor or delayed healing. A severely broken collarbone may not heal quickly or completely. Poor union of the bones during healing (malunion) may cause the bone to be shorter than it was before the break.
* A bulge above the fracture site. As part of the healing process, a large bump develops over the place where the collarbone broke. This bulge usually disappears over time. But in some cases, a bulge may remain permanently.
* Frozen shoulder. The immobilization required to heal a broken collarbone can sometimes result in painfully limited range of motion of the shoulder in all directions.
* Bone infection. If any part of your broken bone protrudes through your skin, it may be exposed to germs that can cause infection. Prompt treatment of this type of fracture is critical.
* Osteoarthritis. If a collarbone break involves the joint that connects it to your shoulder blade (acromioclavicular joint) or the joint that connect the collarbone to your sternum (sternoclavicular) it may increase your risk of eventually developing arthritis in that joint.


Preparing for your appointment

Depending on the severity of the break, your family doctor or the emergency room physician may recommend that you or your child be examined by an orthopedic surgeon.

What you can do
It may be helpful to write a list that includes:

* Detailed descriptions of the symptoms and the event that caused the broken collarbone
* Information about past medical problems
* All the medications and dietary supplements you or your child takes
* Questions you want to ask the doctor

What to expect from your doctor
During the physical exam, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. He or she will likely want to see X-rays of the injury.


Tests and diagnosis

X-rays are taken to determine the extent of a broken collarbone, pinpoint its exact location and determine if there's any injury to the joints. Occasionally, your doctor may also recommend a computerized tomography (CT) scan to obtain more-detailed images.


Treatments and drugs

Treatment of a broken collarbone varies, depending on the type and location of the break.

Fracture type

* Open (compound) fracture. In this type of fracture, the skin is pierced by the broken bone. This is a serious condition that requires immediate, aggressive treatment to decrease the chance of an infection.
* Closed fracture. In closed fractures, the surrounding skin remains intact.
* Displaced fracture. In this type of fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.
* Comminuted fracture. This term means that the bone is broken into several pieces. This type of fracture may require surgery for complete healing.

Fracture location

* Middle third fracture. These fractures occur in the middle portion of the collarbone, which is the thinnest part of the bone. Most collarbone breaks are located in the middle third of the bone.
* Distal third fracture. A distal fracture occurs on the outer third of the collarbone, closer to your shoulder blade.
* Proximal third fracture. A proximal fracture occurs on the inner third of the collarbone, closer to your sternum. Proximal fractures are rare. They're often the result of a traffic accident or other serious trauma.

Ice
Applying ice to the affected area during the first two to three days following a collarbone break can help control pain and swelling.

Immobilization
Restricting the movement of any broken bone is critical to healing. To immobilize a broken collarbone, you'll likely need to wear an arm sling. In some cases, your doctor may recommend a figure-eight strap that fits around both your shoulders to help keep the bone in place. The length of time immobilization is needed depends on the severity of the injury. Union of the bone usually takes three to six weeks for children and six to 12 weeks for adults.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever. If you have severe pain, you may need a prescription medication that contains a narcotic for a few days.

Therapy
Rehabilitation begins soon after initial treatment. In most cases, it's important to begin some motion to minimize stiffness in your shoulder while you're still wearing your sling. After your sling is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to restore muscle strength, joint motion and flexibility.

Surgery
Surgery may be required for a fractured collarbone if the bone has broken through your skin, if it is severely out of place or if the bone has broken into several pieces. Broken collarbone surgery usually includes placing fixation devices — plates, screws or rods — to maintain proper position of your bone during healing. Complications are rare, but can include infection and lack of bone healing.

Treatment for infants
If a baby has suffered a broken collarbone during labor and delivery, healing typically occurs without specific treatment. Pain control and careful handling of the baby are usually all that's needed.


Prevention

A broken collarbone often happens in an unplanned, unexpected instant. It's usually impossible to foresee or prevent that instant, but these basic tips may offer some protection.

* Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, can help build strong bones. In general, a regular diet with the recommended calcium intake is best, even after a fracture. For women, the recommended amount of calcium increases with age and with menopause. Talk to your doctor about how much calcium you need.
* Prevent falls. Falling onto your shoulder is the leading cause of a broken collarbone. To help prevent falls, wear sensible shoes. Remove home hazards. Light up your living space. Install grab bars in your bathroom and hand rails on your stairways, if necessary.
* Use protective gear. Wear appropriate safety gear when participating in football and other contact sports.
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