Fracture of the Collarbone
The collarbone, also known as the clavicle, connects the sternum to the shoulder. Each body contains two clavicles, mirror images of each other along the centerline of the body. Classified as a long bone, being longer than wide, the clavicle uniquely lays anatomically horizontally unlike other long bones. Keeping the shoulder and scapula in place, away from the body, the clavicle functions to maximize range of motion of the arms. Acting as a ridged support for the shoulder the collarbone if overloaded with pressure, or receiving a impact at the right angle, or directly, such as falling with a outstretched arm can cause the collarbone to fracture. Particularly painful a collarbone fracture impacts the range of movement in the arm on the affected side of the body.
Open vs. Closed
Open– fracture has broken through the skin. Open fractures require trips to the emergency room to lower the risk of infection.
Closed– contained within the body a closed fracture does not pose risk of infection, however still potentially serious a closed fracture requires physician evaluation to understand the level of risk involved.
Proximal– closer to the midline or place of attachment. In the case of the clavicle the proximal side refers to the third of the bone closest to the sternum.
Distal – farther from the midline or place of attachment. In the case of the clavicle the distal end refers to the third of the bone closest to the shoulder.
Midshaft, or Medial – the center third of a bone. So, roughly the middle.
Intra-articular – inside of a joint. In the case of intra-articular clavicle fractures the fracture lays within the acromioclavicular joint, also known as the AC joint to keep it pronounceable.
Types of fractures
Comminuted fractures have more than two pieces that occur from splintering or shattering of the bone.
A transverse facture presents as a straight line across the bone perpendicular to the length of the bone.
Oblique fractures. Similar to a Transverse fracture running perpendicular to the length of the bone a Oblique fracture occurs at an angle.
Spiral fractures. Imagine a cork screw shaped fracture from the twisting of a bone.
Segmental fracture. Simular to a comminuted fracture, multiple pieces of bone have broken leaving floating pieces, but instead of splintering or shattering a segment of bone breaks cleanly in at least two places.
Non- Displaced Collarbone Fractures
A non-displaced fracture, independent of fracture pattern, most likely requires six weeks recovery in an arm sling immobilizing the arm during the healing process. Properly aligned with no gaps or overlapping pieces of bone the clavicle can heal relatively without compromising the body mechanics of the upper extremity.
Displaced Collarbone Fractures
Displaced fractures, usually caused by high energy impacts to the shoulder, can heal non-surgically in a sling under certain circumstances. Historically, all clavicle fractures were left to heal in a sling unless there was severe angulation which could cause serious damage to surrounding structures. Unfortunately, the results were mixed with an increase chance of non-union or mal-union outcomes. A non-union, defined by when the two pieces of bone heal but do not reconnect, increases the complexity of intervention if surgery is needed to suppress range of motion issues. A mal-union, presents when the bone fragments heal back together in a manner that is biomechanically hindering, such as bones healing twisted, or at an odd angle, changing the range of motion in the arm in a negative manner. Over time a mal-union wears away at the joints causing arthritis. A clavicle is displaced more than 15mm indicates discussing surgical intervention for patient consideration to achieve an optimal outcome.
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