The main treatment for clavicle fractures is to restore its integrity by closed or open ( surgical) repositions ( comparisons) bone fragments. Although the clavicle is a small bone, its fracture severely restricts movement. Plaster immobilization, which is part of the treatment, should reduce the mobility of a large number of joints and therefore is massive, reaching in some cases 5-7 kilograms and covering more than half of the chest along with the arm on the affected side.

Anatomy of the clavicle

The clavicle is one of the bones involved in the formation of the shoulder girdle. In addition, it is the only bone that provides rigid coupling of the free upper limb with the body. In fractures of the clavicle, certain muscles attached to it are of particular importance, since they make adjustments to the position of the fragments during a fracture. Of particular importance is the knowledge of the relative position of large vessels and nerve plexuses, since they are often injured in comminuted fractures of the clavicle with displacement.

The structure of the clavicle

The clavicle is a small, flat, S-shaped bone. It has two surfaces - upper and lower, as well as two ends - thoracic and acromial. The upper surface is predominantly smooth, while the lower surface is bumpy and contains some physiological depressions and tubercles for the attachment of ligaments. The thoracic end is thicker than the acromial, but slightly narrower. At each end of the clavicle is an articular surface for articulation with the corresponding joints. The sternal end connects to the sternum to form the sternoclavicular joint, and the acromial end connects to the acromion of the scapula to form the clavicular-acromial joint.

joints

The clavicle and its joints have progressed significantly in evolutionary terms. During the phylogenesis development of a system, organ, skeleton, etc. on the scale of the entire animal world), its length increased and reached its maximum in humans. The joints also progressed, changing their shape and allowing the range of actions performed by the hands to be maximized.

The clavicle is built into the upper shoulder girdle using the following joints:

• sternoclavicular joint;
• clavicular-acromial joint.

sternoclavicular joint
This joint is classified as simple. It is formed by the saddle-shaped articular surface of the thoracic end of the clavicle and the clavicular notch of the sternum. Between the articular surfaces is the articular disc, which reduces the mismatch of the articular surfaces to each other. The articular bag is tightly attached to the edges of the articular surfaces. Thanks to this shape, the joint allows movement in three planes - vertical ( shoulder movements forward and backward), sagittal ( raising and lowering the shoulders) and horizontal ( rotation of the arms around its axis). The joint is held within its boundaries by means of the costoclavicular, interclavicular and sternoclavicular ligaments.

acromioclavicular joint
This joint is also simple. It is formed by the articular surface of the acromion of the scapula and the humeral end of the clavicle. Between the articular surfaces is located the articular disc, which increases the degree of their mutual correspondence. The joint capsule is strong and is attached along the edge of the articular surfaces. Although the joint is able to provide a large range of motion, this does not happen due to its position and strengthening of the acromioclavicular and coracoclavicular ligaments.

Nearby formations

Knowledge of muscle attachment sites, as well as their traction vectors, is important in the diagnosis of clavicle fractures and their complications. In the human body, four muscles are attached to the collarbone - the deltoid, trapezius, part of the pectoralis major muscle and the medial leg of the sternocleidomastoid muscle. The first two are attached to the humeral end of the clavicle, and the last two are attached to the sternal end. Since the above muscles have an opposite center of traction, in the event of a fracture, each of them pulls the fragment of the clavicle to which it is attached to its side. As a result, displaced clavicle fractures are much more common than displaced fractures of other bones. From below and behind the clavicle, the subclavian muscle closely adjoins, which does not play a big role in the displacement of fragments during a fracture, but can be injured if the integrity of the clavicle is violated.

Near the clavicle are such important blood vessels as the subclavian artery and vein. When any of them is injured, a massive outpouring of blood into the nearest space occurs. Due to the fact that the skin and subcutaneous tissue of this area can be greatly stretched, the total volume of blood loss can reach 2-3 liters. Given the fact that this blood loss is acute and occurs within a few minutes, there is a high risk of death if timely medical care is not provided.

Along with the vessels, often with fractures of the clavicle, the trunk of the brachial plexus or its individual branches are often affected. At the same time, both movements in the segments innervated by them and sensitivity disappear. Both in case of damage to the vessels, and in case of damage to the nerves of the brachial plexus, surgical intervention and careful, careful stitching of these structures are necessary.

Behind the clavicle is the upper pole of the lung. In some cases, when the clavicle is fractured, by means of a strong blow from the front, sharp fragments of the bone are displaced backward and the pleura of the lung is torn. This condition is called traumatic pneumothorax and leads to the collapse of the affected lung and its exclusion from the act of breathing. At first, shortness of breath is severe, which plunges the victims into severe panic. However, part of the lost function compensates for the second healthy lung, ensuring the preservation of the patient's life. After some time, this condition tends to worsen due to the accumulation of blood in the lumen of the pleural cavity and the development of purulent complications. Therefore, surgery to eliminate lung damage should be carried out as soon as possible.

Causes of clavicle fractures

The most common cause of a clavicle fracture is traumatic injury. Much less common are pathological fractures of the clavicle caused by bone erosion by malignant neoplasm metastases.

Traumatic fracture of the clavicle, in turn, develops through indirect and direct exposure. More often, indirect fractures occur when falling on an abducted arm, elbow, or when hitting the shoulder joint. In this case, the shock impulse is transmitted through a tight joint to a weaker and thinner clavicle, destroying it at the site of the greatest bend. Direct fractures of the clavicle are more typical for wartime, as they are the result of a direct blow.

Also, clavicle fractures are divided into closed and open, depending on whether there is skin damage from sharp bone fragments or not. According to statistics, the number of closed fractures dominates, probably due to the high density and elasticity of this area of ​​the skin.

By complexity, fractures are divided into simple and complex. Complex, in turn, are divided into non-splintered, two-splintered and multi-splintered. Impacted fractures of the clavicle are also classified as complex fractures, however, it must be admitted that they are extremely rare due to the nonspecificity of the bone structure for this type of fracture.

There are the following types of clavicle fractures along the fracture line:

• transverse;
• oblique;
• S-shaped;
• screw;
• T-shaped.

Clavicle fracture symptoms

In the first minutes after the fracture, the patient feels severe pain in the collarbone. Pain is also felt with the free hanging of the limb, as it provokes the displacement of bone fragments in different directions. For this reason, the patient is forced to hold his hand on the side of the lesion in order to reduce pain.

After some time, signs of local inflammation develop at the fracture site - swelling, redness, hyperthermia ( warming of the inflammatory focus), pain intensifies and dysfunction of the hand from the side of the injury progresses.

Diagnosis of a clavicle fracture

As a rule, the diagnosis of a clavicle fracture is not difficult, since this bone is located subcutaneously. On palpation, there is a violation of its linear continuity. Pathological mobility and the crunch of fragments are also present, however, these manipulations are not recommended, since they are associated with a risk of damage to nearby structures. Visually determined by the shortening of the shoulder girdle.

The position of the patient with a fracture of the clavicle is as follows - the body is slightly bent towards the lesion, the head is lowered and turned in the same direction. From the side of the fracture, the shoulder is lowered down and forward, the scapula is protruded backwards.

Collarbone fractures with displacement of bone fragments are much more common. This is caused, first of all, by the different orientation of the traction of the muscles attached to it, as well as the S-shape of the clavicle itself, which ensures that the ends of the fragments overlap each other. In the fracture area there is a slight swelling, which corresponds to the sternocleidomastoid muscle shifted upwards under the action of the sternocleidomastoid muscle. The humerus fragment of the clavicle bone moves down, forward and rotates slightly around its axis, which makes it difficult to feel it.

Instrumental diagnostics is reduced to performing radiography only in direct projection. In doubtful cases, when it is not possible to accurately determine the places of displacement of all bone fragments, additional radiography is performed in the lateral projection or computed tomography of this segment in 3D reconstruction. The remaining methods are either too complicated and irrational due to associated complications, or outdated.

First aid for suspected clavicle fracture

Fracture of the collarbone is a serious problem, and at home it is hardly possible to achieve good results in its treatment. However, competent first aid reduces the likelihood of complications and reduces the recovery time after a fracture.

Do I need to call an ambulance?

You definitely need to call an ambulance. A few minutes after the fracture of the clavicle at the site of injury, swelling of the surrounding soft tissues begins to develop rapidly. The stronger the edema, the more technically difficult it is to carry out a closed reposition of the fragments, if any. Moreover, the likelihood that a patient will undergo an open reduction also increases with every minute of lack of appropriate assistance. Medical care involves surgical access to the fracture site and manual alignment of bone fragments. However, open reduction implies the risk of pathogenic microorganisms entering the wound and the development of purulent complications, such as wound abscess, phlegmon, and secondary osteomyelitis.

In addition to transportation, ambulance doctors take care of anesthesia of the fracture site and its high-quality immobilization. These simple manipulations are designed to reduce the risk of complications associated with transportation and subsequent treatment.

What is the best position to hold your hand?

The classic position in which it is considered correct to hold the arm in case of a clavicle fracture is to press the humerus against the body and maintain it lightly. However, if the patient feels pain when trying to adduce the shoulder and give it the above position, it is necessary to leave the limb in the position in which pain is minimal.

Is it necessary to give pain medication?

In medicine, there is an unshakable rule - "any pain must be eliminated." There are at least two arguments that support this rule. Firstly, the pain is unpleasant for the patient himself and changes his worldview for a certain time. This, in turn, leads to inaccuracies in the process of taking an anamnesis, subsequent diagnosis and difficulties during treatment. Secondly, at the biochemical level, pain provokes the release of biologically active substances that increase the inflammatory process, worsen the general condition of the body and reduce its resistance to harmful factors. As a result of the above influences, there is an increase in pain, which again and again commits the same vicious circle until it is eliminated by medication. Accordingly, painkillers are needed not only to reduce the suffering of the patient, but also to reduce the rate of progression of the disease.

At home, non-steroidal anti-inflammatory drugs are used as pain relievers. The most common representatives of this group are analgin, ketanov, spasmalgon, paracetamol, ibufen and others. However, it must be remembered that after swallowing a tablet or syrup, it takes 15 to 30 minutes for the medicinal substance to enter the bloodstream and begin to act. The action of the drug, administered intravenously or intramuscularly, develops faster, on average after 5 to 10 minutes, however, their effect is less long-lasting. In no case should you overdo it with pills or injections, citing the fact that they do not help. Otherwise, there is a high risk of an overdose of drugs and ending up in a hospital with a more life-threatening diagnosis than a broken collarbone.

Do I need to do immobilization?

Proper immobilization is the key to a speedy recovery. In this case, we are talking not only about a permanent plaster cast, but also about primary immobilization. Primary immobilization is also called temporary and has two goals. Firstly, the reduction of pain sensations by reducing the mobility of the injured segment, and secondly, the avoidance of such complications as damage to the nearby neurovascular bundle during transportation of the victim to the emergency room.

There are many ways to transport immobilize a broken collarbone. However, it is important to remember that the longer the bandage is on the patient, the weaker its supporting function becomes. Therefore, during long-term transportation, it may be necessary to periodically rewind the bandage to maintain a sufficient degree of fixation.

The most simple and effective dressings are the following:

• Delbe rings;
• 8-shaped bandage;
• scarf bandage;
• bandage Deso;
• bandage Velpo.

Delbe Rings
From improvised means, such as towels, shirts or bandages, two rings are formed around the shoulder girdle, one on each side. Rings should fit snugly against the skin, but not squeeze it. From the side of the back, a rope or bandage is passed through the rings, with the help of which the rings are slowly and carefully pulled together. At the level at which the patient says that the pain is minimal, a knot is knitted on a tightening rope. This method allows you to part the bone fragments to the sides, reducing pain. However, the disadvantage of the Delbe rings is that they do not carry out the lifting of the shoulder girdle, which is necessary so that the fragments of the clavicle do not deviate from the usual axis under the action of the muscles attached to them. This dictates the need for additional use of a supporting kerchief bandage, Dezo or Velpo bandage.


8-shaped bandage
This type of bandage, like the previous one, is designed to maintain the divorced position of the shoulder girdle and also needs to be supplemented with a supporting bandage. Start knitting a bandage should be with the imposition of 2 - 3 fixing tours at the level of the chest. During the passage of the bandage through the back, dense pads are installed under it at the level of the shoulder blades and armpits. When they are securely fixed, you can proceed directly to the bandage itself. Bandage tours are applied through the back. The transition of the bandage to the opposite side is carried out through the armpits. When the bandage passes to the front surface of the chest, the bandage does not cross it, but makes the transition through the back surface of the neck, after which it passes through the armpit from the opposite side to the back. Bandage should be tight to bring the shoulders into a divorced position in which the patient will feel comfortable. Each subsequent round should cover the previous one by a third or half in order to avoid layering of bandages and the formation of an area of ​​excessive soft tissue compression.

kerchief bandage
Bandaging with this type of bandage is the simplest, but its single use does not allow immobilizing the fracture well enough. The function of this bandage is to lift the upper limb and prevent it from sagging. Thus, the muscles that attach to the clavicle do not stretch and do not lead to divergence of bone fragments.

As a material for this bandage, it is better to use a scarf. In its absence, you can use any square piece of fabric with a side of at least 1 meter. The resulting square is bent diagonally and forms a triangle. The large side of the triangle from below wraps around the wrist from the side of the fracture, and the long ends are raised to the neck and tied on its back surface, after stretching the ends until the arm is suspended at a right angle to the humerus. Next, the bandage is carefully distributed over the forearm towards the elbow. The remaining free edge is folded over and pinned to the front or back of the dressing.

Bandage Deso
This bandage is made with a simple or elastic bandage. First, 2-3 fixing rounds are made at chest level, starting from the armpit of the healthy side, and clasping the shoulder from the diseased side. After that, from the armpit of the healthy side along the front surface of the chest, the bandage is led to the diseased shoulder girdle and is thrown over it. On the back side of the shoulder, the bandage goes down to the elbow, goes around it and follows into the armpit from the healthy side. Through the armpit of the healthy side, the bandage passes to the back, crosses it in an oblique direction and again bends around the sore shoulder girdle, only this time in the direction from back to front. Next, the bandage follows the front surface of the shoulder to the elbow, where it is thrown over again and returns to the healthy armpit along the back surface of the body. The final step is to complete another round around the torso and pressed shoulder and return to the starting position. Repeating this sequence one more time is sufficient for high-quality immobilization of the shoulder girdle in case of a clavicle fracture.

The advantage of this bandage over the others is that it simultaneously supports the arm and presses it against the body, which significantly reduces the mobility of the arm. However, there are also disadvantages. Firstly, the Dezo bandage does not allow you to maintain the shoulder girdle in a divorced state. Secondly, it is difficult to perform and without prior training it is not easy to perform. Thirdly, it is impossible to perform this dressing on your own without outside help, which is important when the victim is alone.

Velpo bandage
For this dressing, a simple or elastic bandage is used. Before starting the dressing, it is necessary to place the patient's hand on the side of the lesion on a healthy shoulder girdle. In this case, it will be approximately at an angle of 45 degrees to the shoulder. Dressing in this case should be started from the middle of the shoulder of the affected side. On the front surface of the body, the bandage is led to the opposite side and transferred to the back. In this way, 2 - 3 fixing rounds are performed. After that, from the side of the back through the shoulder girdle of the injured side, the bandage is thrown to the front surface of the shoulder. At the level of its middle along the lateral edge, the bandage passes to the back surface of the shoulder and is thrown over the elbow. Further, the bandage is carried out from the elbow to the side of the healthy side, spreads over the back and goes to the front surface of the body at the level of the middle of the shoulder from the diseased side. Having made the transition, the bandage thus fixes the loop on the shoulder and prevents it from accidentally falling off. After that, the bandage is again passed through the healthy side to the back, goes to the diseased shoulder girdle and the cycle repeats. Usually 2-3 cycles are sufficient for effective immobilization of the shoulder girdle in case of a clavicle fracture. The advantages and disadvantages of this bandage are similar to the Deso bandage.

Should I apply cold?

Cold has been used by people since ancient times to reduce pain in certain diseases and injuries. Nowadays, there is a wide variety of painkillers. However, the cold successfully complements and enhances their effect, and can also be used independently. The advantage of cold is that it has only a local effect and does not affect the surrounding tissues and body systems. Also, for people who are allergic to certain painkillers, cold is not likely to cause this side effect. Finally, a cold object is fairly easy to get, especially if the victim is in the city.

The mechanism of the analgesic effect of cold is that it reduces the temperature of the soft tissues in which various nerve receptors are located. When the tissue reaches a temperature of 4-5 degrees, most types of nerve receptors cease to perceive pain irritation, and the remaining ones significantly reduce the speed of the pain impulse to the brain.

In case of a fracture of the clavicle, the imposition of crushed ice is welcomed, and not a solid fragment. This is due to the uneven terrain of the area. The clavicle protrudes above the surface of the muscles, forming the supraclavicular and subclavian fossae. A solid object will not freeze the affected area as well as crushed ice will. It is important to remember that the application of cold must be strictly local, in other words, only over the fracture site. When the ice pack is shifted to the neck area, there is a risk of a sharp decrease in blood pressure and heart rate, up to cardiac arrest. The reason for this side effect lies in the irritation of the carotid sinus tangle located in the branching of the carotid artery.

Clavicle fracture treatment

The treatment of a clavicle fracture is to give the bone the correct position and fix it in it for a certain period. For fractures without displacement of fragments, in most cases, only immobilization of the shoulder girdle is performed. In case of fractures with displacement, it becomes necessary to return the bone fragments to the physiological position ( reposition) and only then immobilization of the fracture site is performed.

There are two types of reposition of bone fragments:

• closed reduction;
• open reduction.

Closed reduction
This method of fracture treatment involves the return of bone fragments to a physiological position through special non-invasive maneuvers. After closed reduction, temporary immobilization of the shoulder girdle is performed, and a control x-ray is taken. In the case of correct alignment of bone fragments, temporary immobilization is replaced by permanent plaster. In case of failure, at the discretion of the attending physician, either repeated closed or open reduction is performed.

Open reduction
This type of treatment has strict indications and consists in surgical access to the fracture and the correct comparison of bone fragments manually. After that, the fragments are fixed in the correct position. The process of fixing a fracture is called intraosseous osteosynthesis. With simple fractures of the clavicle, osteosynthesis is more often performed with a metal pin, which is inserted into the bone on one side, passes along it, and then is fixed in another bone fragment. In case of complex fractures, they resort to fixing fragments with metal plates and screws, which are subsequently tightened with metal wire for strength. Instrument for external osteosynthesis ( Ilizarov apparatus) is practically not used by traumatologists for clavicle fractures due to the inconvenience of its installation in this area and the high risk of septic complications.

Do I need to apply plaster?

Immobilization is an essential component of proper fracture management. Without it, at best, the fracture heals on its own, and there are much more worst cases. Firstly, there is a risk of damage to large vessels and nerve trunks in this area. Secondly, without proper immobilization, the bones can grow together incorrectly, which subsequently leads to a significant limitation of mobility and even disability. Thirdly, a large bone callus is formed, and the fracture healing time increases by 2-3 times compared to the norm. Fourthly, there is a risk that the bone will not heal at all, especially if there is soft tissue between its fragments. In this case, after a few months, the sharp bone ends become blunt and form a false joint, which is subsequently extremely difficult to treat.

Gypsum is the most commonly used material for fracture immobilization. Its advantages consist in high plastic properties, strength and, of course, low cost and availability. However, in recent decades, special polymers have been invented to replace gypsum. Their fixation ability is not inferior to gypsum, and their weight is several times less, which increases convenience in everyday life. In addition, their thermal conductivity is much less than that of gypsum, which means that the risk of chilling the fracture site is reduced.

Immobilization is indicated in almost all cases of clavicle fracture. The most commonly used for this purpose is thoracobrachial ( sterno-brachial) a plaster cast. However, in some cases, immobilization can be carried out not with plaster, but with soft bandages. The category of exceptions includes children with a subperiosteal fracture and the elderly.

How long is the plaster needed?

Gypsum is applied, on average, for a period of 4 to 6 weeks, depending on several factors. First of all, the timing of fracture union is affected by its complexity. The more bone fragments, the more difficult they are to osify. The quality of immobilization can also vary. With complex fractures with open reposition of fragments, with multi-comminuted fractures, it is technically difficult to ensure the immobility of the entire structure. The age of the patient is of some importance. Thus, in young people, adolescents and children, the rate of fracture healing is the highest. They slow down, on average, by the age of 40 and continue to regress towards old age. Certain comorbidities may increase the time it takes for the fracture to heal. These diseases include diabetes mellitus, hypothyroidism, parathyroid tumor, etc.

When is an operation needed?

Surgery in itself implies risks - the risk of anesthesia and the body's reaction to it; the risk associated with surgical manipulations in the area of ​​passage of large blood vessels and nerves; risk associated with postoperative complications. For these reasons, surgery is a last resort when other techniques are inapplicable or have not had the desired therapeutic effect.

Indications for surgical treatment are:

• open fracture;
• multifragmentary fracture with the risk of damage to the neurovascular bundle;
• damage to the neurovascular bundle;
• violation of the ratio of soft tissues due to a fracture;
• the risk of rupture of the skin with a sharp fragment;
• an improperly fused fracture requiring destruction and re-osteosynthesis.

The operation is carried out in stages in the following sequence:

• After processing the surgical field, a skin incision is made under the clavicle and surgical access is provided.
• In the sternal fragment, a channel is formed with one end on the side of the fracture, and with the other end, which extends to the posterior edge of the clavicle. The channel should lie as far as possible in the compact substance of the bone for greater fixation stability.
• In the acromial fragment, the same canal is drilled, but ending bluntly ( not extending beyond the bone).
• Combination of fragments and giving them a physiological position.
• Pin insertion ( knitting needles).
• Structural strength check.
• Layered wound closure.

After surgery, the patient is first temporarily immobilized, and after 2-3 days - permanent. Drainage from the wound is removed within 24 - 48 hours if pus or scarlet blood is not separated from it. If the discharge of drainage is suspicious, then the period of observation of the patient is increased by a few more days. If, after the allotted time, the discharge through the drainage tubes is cleared, then permanent immobilization is allowed. In case of wound suppuration, an opening and treatment of the purulent focus is performed.

With good healing, the sutures are removed at the end of the second week. Partial movements of the upper limb are allowed at 3-4 weeks of treatment. At the same time, an X-ray image is taken to control bone fusion.

What is the recovery period after the operation?

Full recovery after a clavicle fracture takes, on average, 6 to 8 months. Pins, plates and screws are removed 6-12 months after the fracture, depending on the rate of its healing and the presence of complications. The main complications requiring repeated intervention and prolonging the recovery period include early destruction of the fixing apparatus and a violation of the relative position of certain parts of it, as well as the development of osteomyelitis.

What physiotherapy is indicated after a fracture?

Physiological methods of rehabilitation after a fracture undoubtedly bring visible benefits, since they have analgesic, anti-inflammatory, decongestant, myostimulating, trophic and other positive effects.

The following physiotherapy procedures are distinguished by time:

• used only during plaster immobilization;
• used only after removing the plaster;
• used regardless of whether there is immobilization of the shoulder girdle or not.

Physiotherapy used during plaster immobilization

The first time after the reposition of fragments and the immobilization of a plaster bandage, the tissue around the fracture site is edematous. An inflammatory process takes place in them, which is positive. It is irrational to reduce the intensity of this process, since the process of wound cleansing and callus formation slows down. In the case when the inflammation proceeds too rapidly, it may be necessary to suspend it. However, for this purpose, medications are used, rather than physiotherapeutic ones, since their effect is more rapid and lends itself to more sensitive correction. Physiotherapeutic agents in this period are used only for symptomatic therapy, namely the elimination of pain and the reduction of swelling.

Type of procedure	Mechanism of therapeutic action	Duration of treatment
UV irradiation in erythemal doses	locally Muscle relaxation, an increase in functioning capillaries, an increase in skin resistance to harmful factors, a decrease in tissue edema, a decrease in the sensitivity of pain receptors. General action Stimulating the synthesis of vitamin D, accelerating the formation of callus.	18 - 20 procedures. Daily. Starting with half the biodose, adding about 1/8 of the biodose daily.
Electrophoresis of painkillers	locally Movement and deposition in the subcutaneous tissue and muscles of a relatively large amount of anesthetic drug.	10 - 20 procedures. Daily. Low concentrations of analgesics. The duration of the procedure is 5 - 15 minutes.

Physiotherapy, applied only after the removal of the cast

Plaster immobilization is removed when the callus is sufficiently well formed and can withstand moderate stress on the bone. To give it greater strength, it is necessary to gradually increase the indicated loads in order for the corn to reorganize and grow into correctly oriented trabeculae ( bridges inside the bone, formed under the action of multidirectional loads on the bone). For this purpose, most of the existing physiotherapeutic methods can be used.

Type of procedure	Mechanism of therapeutic action	Duration of treatment
Massotherapy	locally Vasodilating effect, improving blood circulation in the fracture area, accelerating the reorganization of callus into structured bone tissue. General action Normalization of blood pressure due to the reflex effect on the vasomotor center of the brain.	10 - 15 procedures. Daily. Not earlier than 2 hours after eating. The duration of the procedure is 15 - 30 minutes.
High frequency magnetotherapy	locally Prolonged heat generation at a depth of several centimeters leads to an increase in the excitability threshold of nerve cells. Analgesic effect, relaxation of the musculature of blood vessels, reduction of spasm of skeletal muscles. Improvement of blood supply due to the formation of vascular collaterals in the area of ​​action. Strengthening local immunity. General action Decreased blood pressure, improved blood supply to internal organs, general sedative effect.	10 - 15 procedures. Daily or every other day. The duration of the procedure is 15 - 30 minutes.
Amplipulse therapy	locally Analgesic and muscle relaxant action. Pronounced vasodilating and trophic effect. Resorption of infiltrates, reduction of edema, strengthening of reparative processes. General action Strengthening the tone of the intestines, biliary tract, ureter and bladder. Elimination of bronchospasm, improvement of lung ventilation, stimulation of the glands of internal and external secretion.	8 - 10 procedures. 1 - 2 procedures daily. The duration of the procedure is 3 - 5 minutes with an elongated pulse shape.
UHF therapy	locally Heating of tissues, acceleration of cellular metabolism, improvement of microcirculation, relaxation of vascular muscles, reduction of edema. General action Reducing the tone of the sympathetic and increasing the tone of the parasympathetic nervous system, lowering blood pressure. Activation of nonspecific immunity, increase in the number of red blood cells. Increased motility and secretion of the stomach, intestines and digestive glands. Increased levels of glucocorticoids.	5 - 15 procedures. Daily or every other day. The duration of the procedure is 8 - 15 minutes. At a low intensity of radiation, it has an anti-inflammatory effect. With radiation of medium strength, metabolic processes are mainly stimulated.
Sodium chloride baths	General action Reducing the sensitivity of pain receptors, expanding superficial blood vessels, improving microcirculation, anti-inflammatory effect on the skin and joints. Normalization of blood pressure, improvement of cardiac automatism. Decreased blood clotting and platelet aggregation. Direct immunostimulating effect due to the release of biologically active substances. Decreased excitability of the central nervous system. Anti-stress effect.	12 - 15 procedures. In one day. The duration of the procedure is 10 - 20 minutes. The water temperature is 35 - 38 degrees. After the procedure, do not rub. Rest for 30-40 minutes, wrapped in a sheet.
Hydrogen sulfide baths	General action Reducing blood glucose by releasing protein-bound insulin. Acceleration of the synthesis of collagen and chondroitin sulfate by fibroblasts and, as a result, increased regenerative processes. Maintaining liver function, enhancing the inactivation of toxins. Expansion of superficial vessels, improvement of microcirculation, involvement of capillary collaterals. Regulation of blood pressure. Decreased pain and tactile sensitivity of the skin.	12 - 14 procedures. After 1 or 2 days. The duration of the procedure is 8 - 12 minutes. The water temperature is 35 - 37 degrees. After the procedure, do not rub. Rest for 30-40 minutes, wrapped in a sheet.
Ultrasound Therapy	locally Improvement of blood circulation and lymph circulation, strengthening of local non-specific immunity, increase in vascular skin permeability, resorption of skin scars. General action Stimulation of reparative processes, expansion of the bronchi, improvement of gas exchange, acceleration of peristalsis of the digestive tract. Increase in daily diuresis.	10 - 15 procedures. Daily or every other day. The duration of the procedure is 10 - 15 minutes. They start with sounding 1 - 2 fields of the body, and then, with good tolerance, increase to 3 - 4 fields per session.
Remote shock wave therapy	locally Isolation of biologically active substances, vasodilatation in the field of action. Improving blood supply and tissue nutrition. Stimulation of cell division of bone and cartilage tissue. Destruction of the nuclei of tumor cells. Destruction of kidney stones and gallstones. Reconstruction of the bone structure. General action Stimulation of nonspecific immunity, muscle relaxant effect.	5 - 7 procedures. In one day. The duration of the procedure is 3 - 5 minutes.

Physiotherapy not dependent on immobilization

These procedures mainly include preparations of trophic action, as well as mineral waters as a source of microelements for the successful healing of the fracture.

Type of procedure	Mechanism of therapeutic action	Duration of treatment
Electrophoresis of vasodilators	locally Movement of vasodilators into the subcutaneous tissue and muscles. During the course of treatment, a depot of the drug is created, which is slowly consumed over several months after the end of the procedures. Expansion of blood vessels leads to improved nutrition of bone tissue and acceleration of its regeneration.	10 - 20 procedures. Daily. Low concentrations of vasodilators. The duration of the procedure is 5 - 15 minutes.
Low frequency magnetotherapy	locally An increase in the speed of impulse conduction along nerve fibers, an increase in regenerative processes. Anti-inflammatory action by changing the activity of phagocytosis. General action General antispasmodic effect, decreased tone of blood vessels, slowing the peristalsis of the digestive tract. Improving the rheological properties of blood. Increasing the body's tolerance to physical activity and stress factors.	8 - 12 procedures. Daily or every other day. The duration of the procedure is 10 - 20 minutes.
Mineral water	General action Replenishment of electrolyte imbalance, reduction of acidity of gastric juice. Choleretic action, change in the acidity of urine, dissolution of kidney stones. Mucolytic and expectorant action.	The course of treatment lasts 25 - 30 days, 2 - 3 times a year. Water is consumed daily in the amount of 1 - 2 liters per day.

Only a traumatologist is involved in the treatment of a fracture of the clavicle, but a surgeon can also, if there is no corresponding specialist.

There are only two main treatment options:

• conservative;
• operational.

The doctor decides on one method or another, depending on the type of fracture and the degree of displacement. Often, comorbidity and damage to neighboring organs (lungs, pleura, subclavian artery and vein, nerves) also play a role. After the union of the fracture, a period of rehabilitation follows, it must be carried out competently, because it is not enough just to operate, the main thing is to get the person out and give him the opportunity to move normally. But, about everything in more detail.

Plaster on the shoulder and chest

The essence of conservative treatment is to compare fragments, under local anesthesia and subsequent immobilization, which can last from 3 to 7 weeks. For the purpose of immobilization, plaster bandages are used that cover the shoulder and chest, but they are very bulky and bring discomfort while wearing. The bandage reliably protects the fracture from secondary displacement, but it does not differ in comfort during operation.

INTERESTING! It is interesting that if in adults the clavicle grows together in two months, but in a newborn this fracture regenerates during the day. This is due to the fact that in a newborn, the bone consists of cartilage, which fuses very quickly and without the formation of a callus, in the future there will be no trace of it. As such, the child does not require rehabilitation, as well as fixation, bandages and swaddling are enough to prevent movement of the handle.

Bandages are also used, which are used for fractures without displacement, but if there is displacement and contraindications to surgery or plaster, they can also be used. And some dressing options (Delbe rings) can set the fracture if they are applied correctly. Also, the bandage can be used as both a first aid and a treatment option.

Types of dressings

Delbe rings and rules for their imposition

You can make this type of bandage from any material at hand, but gauze and cotton wool are most often used for this. A roller is being prepared, in the middle of which cotton wool is located and then the rings themselves. There is one ring on each side, it should fit snugly against the skin, without squeezing it. From the side of the back, they are brought together with a bandage, they do it very carefully and slowly, and then they are tied. So, the fragments diverge, and the pain decreases.

But just like any method has its drawbacks, this one is not without them. The shoulder girdle does not rise, and this is precisely the condition for the best comparison. Moreover, the attached muscles can dislodge the fragments during their contraction. The bandage Deso or Velpo helps to eliminate this drawback.

8-shaped or eight

Figure eight bandage

The shoulder girdle with this bandage is supported divorced, as in the previous version of fixation, but this method will also require additional fixation of the limb. In the area of ​​​​the armpits, cotton pads are placed, which are securely fixed. The bandage itself resembles the number "8" and passes through the armpits. Behind the bandage passes through the neck, while the shoulders are separated, but so that the person feels comfortable. Each subsequent round should overlap the previous one by a third or half, so the tissues will not be squeezed.

Using a scarf

This method is simple and not only in its application, but they will not be able to immobilize the fracture. The bandage will only lift the arm and hold it in that position, preventing the muscles from displacing the fragments.

bandage kerchief

As a material, a scarf made of fabric can be used. But it can also be made from gauze. You will need material whose sides are at least 1 meter. The square is folded in half diagonally, and the resulting triangle is used as a bandage. The large side of the triangle covers the wrist, and the long ends are fixed around the neck. The bandage extends over the entire forearm to the elbow, and the ends are fixed with a pin.

The Deso bandage is the most common and simple in its execution. You can perform it with a simple or elastic bandage. It all starts with two or three fixing rounds at chest level, from the armpit from the healthy side and clasping the sore shoulder. Further, from the armpit on the healthy side, the bandage goes to the elbow along the front surface of the chest and to the diseased shoulder girdle, spreading over it. On the back surface of the shoulder, the bandage goes to the elbow, bending around it, goes back to the armpit of the healthy side. After the head of the bandage should be on the back, passing in an oblique direction, and again thrown over the shoulder girdle from back to front. After all, along the front surface of the shoulder towards the elbow, after which, spreading, along the back surface it follows into a healthy armpit. The final result is the fixation of the pressed shoulder and the bandage is repeated. For normal immobilization of the fracture, two repetitions are sufficient.

The advantages are that the bandage both supports and presses the arm against the body, reducing its mobility. But, like any method, this one has its drawbacks. The bandage does not separate the shoulder girdle and this circumstance does not contribute to the reduction of fragments. It is also difficult to perform it without prior preparation (in order to understand the correctness and all the stages, it is better to look at the scheme of its imposition). Without outside help. To have someone support a limb is difficult to execute.

Velpo bandage

Velpo bandage

As in the previous version, you can use an elastic and simple bandage. But before applying it, the hand of the diseased limb is placed on a healthy shoulder girdle, with respect to the shoulder, the angle is approximately 45 degrees. They begin to bandage from the sore shoulder in its middle third. In the middle, the bandage passes to the opposite side and turns onto the back, so the limb is fixed to the body in 2-3 rounds. Further along the back, through the shoulder girdle from the damaged side, the bandage passes to the front surface, and then back through the elbow, and then to the healthy side and to the front. The shoulder is fixed and maintained at a certain level. Enough for reliable fixation from 2 to 3 cycles, the advantages and disadvantages are the same as in the previous version of the dressing.

Surgery

In order to carry out the operation, strict indications will be required:

1. In case of infringement of soft tissues between bone fragments.
2. There is a high probability that the bone will grow together incorrectly (this can often be seen with a late visit to the doctor).
3. Prolonged adhesion or unsatisfactory result of conservative treatment.
4. Damage to organs and the neurovascular bundle.

By itself, a clavicle fracture is one that is better to operate than to treat conservatively (there is a high probability of prolonged or incorrect union, etc.).

IMPORTANT! The clavicle is one of those bones that can be difficult to compare, because although it is located superficially, it is difficult to grab it normally (like a shoulder or a hand), as well as compare it. The operation will allow you to match the fragments as ideally as possible and fix them in case of a fracture of the clavicle with displacement.

Intervention options

Metal osteosynthesis of clavicle fracture

There are many surgical procedures and each has its own advantages and disadvantages. So what can the attending physician offer his patient? The operation methods are as follows:

• intraosseous osteosynthesis;
• plate;
• screw;
• pin;
• external fixation device.

Intraosseous osteosynthesis

There are two options for this operation, and the method itself is slowly slowly disappearing into history, but is sometimes used.

1. Operation according to Klyuchevsky. It is carried out under the condition of a short central fragment.
2. Spizharny-Kuncher technique used for short peripheral fragments. In this case, the fragments must be exposed and the fracture site opened. Due to the fact that the bone does not have a cavity, a channel is formed in it using a drill and a drill. A rod with a rectangular or square section in the section is installed in the channel. Due to the rod, stability is achieved, the rod itself is fixed to the end of the bone.

plate

Most often, the plate is used for a fracture of the body of the clavicle (its central part). To do this, in the arsenal of doctors there are all kinds of platinum (S-shaped, hook-shaped, etc.). If the fracture occurred in the end area, use plates with hooks or those that can be blocked with special screws.

Pins and screws, external fixation devices

If there is a displacement of the bone and there are no fragments (oblique fracture), it can be fastened with a screw inserted into the bone. You can also insert a pin into the collarbone (a rod or tube made of a special material that can be fixed with screws for greater stability).

Fixation of a fracture with a pin

The pin may or may not be lockable. The lockable pin can be additionally fixed with screws that are passed through the holes in the clavicle and the pin itself. The non-locking pin can be smooth or threaded, which is more stable.

External fixation devices can also be widely used, especially for open fractures.

Rehabilitation

After surgical or conservative treatment, a person must be rehabilitated. At this stage, the severity of the injury and the age of the victim matter.

Share with friends!

Clavicle fractures are injuries to the human skeleton that often occur in athletes, restless children and aged people. Displaced fractures may require surgery with a plate. Injury can occur due to a strong blow, a fall from a height, against the background of osteoporosis. A fracture of the clavicle is determined by mobility in the area where it is usually absent, crepitation of bone fragments, swelling, pain, deformation of the shoulder line, displacement of the scapula.

Diagnosis is by examination and X-ray. To avoid further displacement of bone fragments, if a clavicle fracture is suspected, the area is immobilized with a bandage. Treatment is conservative or surgical. In some cases, intraosseous osteosynthesis is prescribed (according to Klyuchevsky or Spizhariom-Kyupcher). The rehabilitation period includes physiotherapy, massage, exercise therapy.

When providing first aid for a clavicle fracture, it is important to immobilize the limb as soon as possible, thereby preventing further movement of the broken bone elements. To do this, it is necessary to bend the injured arm at the elbow and fix it in this position, hanging it with a wide bandage around the neck or wrapping it to the body. Under the arm of the victim, you need to put an impromptu roller. After fixing the limb, the patient should be taken to the emergency room as soon as possible.

When providing first aid to a person with such a diagnosis, it is impossible:

• try to set protruding bone fragments;
• try to straighten the injured limb;
• tie it with a narrow bandage;
• pull on the injured hand.

It is possible to hospitalize such a victim only in a sitting position.

Fracture treatment

There are only two treatment options for a displaced fracture:

• conservative;
• operational.

The decision in this matter is made by the doctor, based on the severity of the fracture, the age of the patient and the presence or absence of complications. The least common in trauma practice is a fracture of the sternal end of the clavicle, in which an operation is always prescribed.

Conservative treatment

Conservative therapy involves the treatment of a displaced clavicle fracture without surgery. The essence of such treatment is the maximum immobilization of the affected limb. A patient under local anesthesia is compared with a bone to exclude variants of its incorrect fusion. Then the hand is immobilized with a special fixing bandage for up to 8 weeks. In addition to the bandage, the patient is prescribed:

• painkillers;
• antibiotics;
• vitamin complexes;
• calcium preparations;
• physiotherapy.

Surgery

If doctors consider useless conservative methods, surgical intervention is used. Although some traumatologists agree that surgery for a fracture of the clavicle as a treatment method is the most effective.

During surgical intervention, medical metal structures are used - they fasten and fix the bone in the desired position, and after a while they are removed. Fix bone fragments with:

All of them are sterile and made of inert materials. How long the wearing of metal structures lasts in the event of an operation - the doctor decides based on the condition of the patient's damaged bone, but, on average, the pin can be in the bone from 7 months to 1 year.

In surgical treatment, intraosseous is also used.

Intraosseous osteosynthesis

When choosing this type of surgery for a fracture of the clavicle, the broken bone is fixed using metal pins. The use of a needle contributes to a strong fixation of bone fragments in a physiological position. There are such methods of intraosseous osteosynthesis:

• according to Klyuchevsky - used in the presence of small fragments in the center of the clavicle;
• according to Spizhariom-Kyupcher - in the case of peripheral fragments.

The operation is performed under anesthesia.

Recovery

Since the entire period of bone fusion, the patient's arm is maximally immobilized, it happens that the muscles partially atrophy. Therefore, as a displaced clavicle fracture heals, rehabilitation is necessary, regardless of whether a fixing bandage was used for treatment, or a plate was placed.

The recovery period in the treatment of a displaced clavicle fracture can be divided into the following stages:

• the period of immobilization of the limb - smooth exercises are shown;
• after removing the bandage or the appearance of callus - special exercises with a gymnastic stick;
• after complete healing of the fracture, gradual force loads on the arm using simulators.

At any of these stages, physiotherapy and massage are shown.

Approaching the exercises with perseverance and perseverance, you can quickly develop an injured limb. It is important to do exercises regularly, gradually increasing the duration of classes and types of loads.

Physiotherapy procedures

Such procedures are necessary at all stages of the recovery period for a clavicle fracture, both with and without surgery. Often in such cases, the patient is prescribed courses:

• electrophoresis;
• magnetotherapy;
• phonophoresis.

The use of physiotherapy procedures helps to restore blood flow, improve reparative processes in the bone.

Massage

Massage is used from 2 days after the injury. The patient is stroked and kneaded the healthy part of the chest and back in a sitting position. The massage is used twice a day and lasts about 10 minutes. After removing the bandage, the injured arm is also gently massaged.

Physiotherapy

Its use allows you to strengthen temporarily idle muscles, promotes joint mobility and restores blood flow to the injured limb. When doing physiotherapy exercises, it is important to strictly observe the sequence of loads. The development of the clavicle after a fracture begins on the day the bandage is applied or from the moment the operation is performed. The first lessons are reduced to the development of the hand and gradually become more complicated over time, involving the arm and upper shoulder girdle in the process of performing therapeutic exercises.

Consequences

Since a displaced clavicle fracture is a serious injury, the consequences can be varied and depend on the nature of the injury, the right treatment method, and the body's regenerative abilities.

By seeking qualified medical care in a timely manner, complications can be avoided.

Collarbone injuries are common in both children and adults. The recovery period depends on many factors. Among them, correctly rendered first aid, the fulfillment of doctor's prescriptions, the complexity and type of fracture are distinguished.

If treatment is not started on time, a fracture can cause serious complications, up to complete atrophy of the key bone. It is very important that the surgeon immediately determines the type and complexity of the fracture.

For example, the recovery period for a displaced clavicle fracture can take up to 2 months. In addition to the main treatment, you need to visit exercise therapy rooms, do massage, acupuncture after the plaster is removed.

How to behave with a fracture of the collarbone, we will tell later in the article.

Types of clavicle fractures

Surgeons often note that patients with clavicle injuries are treated almost daily. This is one of the most vulnerable bones in humans. The age of patients, as a rule, fluctuates from 14 to 50 years.

Older people suffer from this problem much less often. The clavicle is a triangular tubular bone. It is quite fragile, therefore, in direct contact with the shoulder (severe bruise, direct blow, fall), in 90% of cases it breaks.

It is important to immediately contact a specialist, and not self-medicate. Only a surgeon can correctly determine the type of fracture.

The situation with the clavicles is complicated by the fact that almost every type of fracture is displaced. If the correct position of the bone is not restored, there may be problems with the functionality of the hand in the future.

The types of fractures are as follows:

1. No offset. In this case, hospitalization of the patient is not required, surgical interventions are not performed. The recovery period is on average up to 3 weeks. Treatment is carried out by medication, or a special tight bandage.
2. With offset. Pretty hard cases. Often, patients require immediate surgery. The recovery period is up to 2 months. In turn, displacements can be partial and complete (in the case of an open fracture).

Read also

Brain contusions are considered serious injuries as a result of which there is a change in the state of brain tissue ...

On fractures with displacement, you need to dwell in more detail:

• Partial. Happen quite often. Mostly with an unsuccessful fall on the shoulder. The clavicle breaks, but the periosteum remains intact, and does not allow bone fragments to move on and damage soft tissues and blood vessels.
• Full. They are extremely rare. In this case, urgent surgical intervention is required. Fragments of bone damage capillaries, skin, internal tissues.

It is important! Fracture of the collarbone is a serious ailment. You can't do it without a specialist. First aid measures are also important. It is necessary to fix the arm by wrapping it to the body in a bent form. This will prevent bone fragments (if any) from entering the tissues and blood vessels.

Treatment Methods

The method of treatment should be chosen by a specialist after a complete diagnosis and x-ray results. With injuries of the clavicle with a displacement in 90% of cases, doctors perform surgery.

The operation is performed only under general anesthesia. Often, neurosurgeons are connected to connect the capillaries and blood vessels.

Why surgery is needed:

1. Correct matching of bone fragments.
2. Reliable fixation.
3. Removal of bone fragments from tissues.

The operations carried out are considered technically complex. The bones are fixed with metal bolts or pins.

Earlier in medical practice, the Ilizarov apparatus was actively used. But recently, doctors have abandoned its use. There is a high chance of infection and suppuration.

Read also

A brain contusion has symptoms that are directly related to damage to its various departments. However, the most…

Patients after a clavicle injury are prescribed medication without fail. First of all, these are painkillers, homeopathy, drugs that strengthen bones.

And, of course, the collarbone needs to be fixed. In addition to gypsum, the following type of dressings are used:

• Delbe rings. Used as . Installation may only be carried out by a specially trained person, such as a traumatologist. On the back of the patient, several small rings are made from improvised materials. They are connected by a rope, which is fixed around the body. This method helps to immobilize the collarbone, the patient does not experience pain.
• Bandage Deso. Done with an elastic band. Ideal for normal non-displaced fracture. Also used after plaster removal.
• Bandage made of composite materials. The clavicle is fixed in the same way as with plaster. But the advantages are in less weight and small size, breathable fabrics.

It is important! The type of dressing, as well as the method of treatment, is in any case chosen by the doctor. It all depends on the severity and type of fracture.

Rehabilitation after a fracture of the clavicle

To restore the function of bones and muscles, the patient must undergo a certain rehabilitation. It begins, as a rule, almost immediately after the bandage is applied (in case the fracture is not open). Includes certain steps:

1. Overlay. The period of wearing a tight bandage or plaster takes at least 2-3 weeks. But on the 5th-7th day, the doctor may prescribe a special exercise therapy procedure. The patient's task is to make simple movements with the fingers, unbend and bend the wrist.
2. After removing the tight bandage, gymnastic sticks are used. They help develop the shoulder joint.
3. At the last stage, exercise therapy, massage and physiotherapy procedures, exercises in the gym with lifting dumbbells and weights are still used.

What procedures help to accelerate muscle recovery and hand functionality:

1. Special warm baths with medicinal herbs. Performed if there is no risk of tissue infection.
2. Massage. It is carried out only by an experienced specialist. The massage therapist must work in a hospital. It is undesirable to use the services of private specialists, this can lead to sad consequences.
3. Magnetotherapy.
4. Electrophoresis.
5. Acupuncture. It helps to restore proper blood flow. The procedure is mandatory after surgery.

It is important! It is impossible to independently develop the sternum and back after a fracture of the collarbone. The procedures are prescribed by the surgeon after a visual examination and X-ray.

Possible consequences and complications

If the clavicle fracture was without displacement, then you should not worry about complications. The bones grow together quickly, there are no problems.

The only thing to remember is that after the treatment of the fracture, it is worth going through a rehabilitation course. Without this, the functions of the hands will recover for a long time.

Collarbone injury is a common lesion of an important part of the skeleton. A broken bone is a common reason for athletes and young people who have been involved in collisions of various kinds to visit a traumatologist. Blows to the shoulder, chest area, unsuccessful position of the shoulder girdle during power moves in the fight provokes a fracture of the clavicle with displacement.

The recovery period after an injury is quite long, the use of various methods is required for the correct fusion of the affected bone. How to protect the collarbone from fracture? What methods are effective during the rehabilitation period? Let's figure it out.

Causes of injury

A fracture of the collarbone is a consequence of a fall on the arm or a direct blow to the shoulder, upper chest. The higher the impact force, the more severe the degree of bone damage.

A displaced clavicle injury is often encountered by athletes involved in sports associated with force: boxers, wrestlers, fans of martial arts. Quite often, teenagers and young people involved in street fights end up in the emergency room.

Less commonly, a fracture in the clavicle area is fixed by traumatologists in women and children. The main cause of injury in these categories of patients is a fall on a straight arm during ice or active games.

Classification

Depending on the affected area, doctors distinguish three types of fracture in the clavicle:

• injury closer to the shoulder - damage to the acromial end;
• fracture of the sternal process;
• injury in the middle part of the bone - a fracture of the diaphysis.

With a strong blow, severe trauma, multi-comminuted fractures occur, with a perpendicular and oblique fracture line. The displacement of bone sections in different places complicates the correct fixation of the clavicle before applying a plaster cast.

Symptoms

The following signs will help to suspect a serious lesion of the collarbone:

• soreness in the affected area. Negative sensations are aggravated by raising the hand;
• swelling of varying degrees. With internal hemorrhage, severe bruising, tissue swelling is significant, the color of the skin changes: the skin turns red, a bluish tint occurs;
• noticeable deformity in the clavicular region;
• it is difficult to move the hand, movements in the area of ​​the shoulder joint cause excruciating pain.

Diagnostics

An x-ray of the upper chest will help determine the degree of displacement, accurately fix the fracture site. On the basis of x-rays, the doctor determines the tactics of treatment, offers the best option for surgical intervention in a severe form of clavicle fracture.

In complex cases, pathological (multi-fragment) fractures with displacement, suspicion of wound infection, additional examination methods will be needed:

• blood chemistry;
• clinical analysis of urine and blood;
• biopsy of the affected area of ​​the clavicle.

The detection of atypical cells in the material taken from the bone indicates the development of a tumor. The combination of high ESR (from 20 and above) with a reactive protein level above 5 and elevated leukocytes - from 10x10
9 speaks of the development of tuberculosis or osteomyelitis.

General rules and methods of treatment

After an injury, the victim should contact the emergency room as soon as possible. The best option is to deliver the patient by ambulance doctors. The less movement in the fracture zone, the lower the risk of complications, especially with a noticeable displacement of bone fragments.

Taking analgesics will help prevent pain shock. Any formulations that are at hand will do: Analgin, Ketanov, Ibuprofen, Solpadein, Paracetamol, Pentalgin. You can not drink more than two tablets at the same time: possible side effects. The potent drug Ketanov, which blocks the production of prostaglandins and relieves pain for 6-12 hours, is forbidden to be taken more than once every 4 hours.

There are two ways to restore the integrity of the bone:

• conservative therapy;
• operation.

The choice of treatment for a clavicle fracture depends on several factors:

• the severity of the case;
• degree of displacement of bone fragments;
• the presence or absence of fragments;
• damage to neighboring organs and tissues (heart, lungs, nerves, subclavian veins and arteries);
• the presence of underlying pathologies.

It is important not only to operate on the victim, but to correctly carry out rehabilitation, restore the mobility of the injured shoulder. Incorrect fusion of bones often disrupts the functionality of the shoulder joint.

Conservative therapy

The task of the surgeon is to compare parts of the bone under local anesthesia, to eliminate the displacement of bone fragments. For fixation, a plaster bandage is applied.

The design is bulky, uncomfortable, it is difficult for the patient to do the usual things, but one cannot do without immobilization in the area of ​​the shoulder and chest. Fusion of the bone takes from three to seven weeks. In childhood, bone tissue regeneration occurs faster.

Surgical intervention

Surgical intervention is carried out according to strict indications:

• damage to the neurovascular bundle and nearby organs;
• pinching of tissues among bone fragments;
• low result of conservative treatment;
• advanced stage, low probability of proper bone fusion (the result of late seeking medical help).

Important! Many traumatologists and surgeons consider clavicle surgery to be the best treatment for a displaced fracture in severe cases. Fixation of the affected area with a plaster cast does not always provide accurate fusion of bone sections. The clavicle is located close enough to the surface, but only the time of the operation can be ideally matched and the displaced fragments can be fixed.

Types of surgery:

• an external fixation device is often used for an open fracture with a displacement, it allows you to correctly fix the fragments;
• pins and screws. With an oblique fracture and displacement of the bone, many traumatologists consider the introduction of a pin into the bone cavity the best option. For maximum stability, the locking pin is fixed with screws. The non-blocking pin is firmly attached to the bone: the thread provides stability, sometimes the surface is smooth;
• plate. In case of a fracture with mixing in the central part of the clavicle, fixation of fragments with a metal plate is most often used. Varieties: hook-shaped, S-shaped. If the clavicle is damaged at the ends, the plate is additionally fixed with screws.

The method of intraosseous osteosynthesis is used less frequently, mainly for short central or peripheral fragments. Attaching a rod with a square or rectangular section keeps the bone in the correct position, ensures the immobility of the fragments, and good matching of the clavicle sections.

With intraosseous osteosynthesis, the patient is allowed to actively move the shoulder only after the removal of the sutures. You will have to control the movements with your hand: an angle of more than 90 degrees is allowed only after two weeks after the operation.

Clavicle injury: recovery after surgery

The rehabilitation period is divided into three stages:

• immobilization of the problem area. A fixing bandage is needed for a period of two to three weeks. Physiotherapy exercises are allowed on the second or third day. The patient flexes and unbends the fingers, elbow, rotates the hand. Additionally, massage is prescribed: the procedure is performed on a healthy part of the back and chest;
• the next stage is the use of a gymnastic stick. A simple adjustment is required for flexion-extension plus abduction-adduction of the problematic shoulder joint. Other gymnastic devices increase the effectiveness of classes: ball, dumbbells;
• third stage. Exercises become more difficult, the load on the muscles increases, the range of motion increases. During classes, elements that increase resistance (elastic bandages, expanders), dumbbells, and exercise equipment are used.

The duration of the exercises, the strength of the load, the amplitude of movements are selected by the doctor. At first, you can not raise your hand above the elbow, make sudden movements. During classes, there should be no pain in the operated area. In case of discomfort, the exercise is interrupted, the doctor must know during which movements severe pain is felt. In addition to gymnastics for the fingers, hand, elbow and shoulder joints, breathing and restorative techniques are recommended.

Physiotherapy procedures

To enhance the effect of therapy, to accelerate the process of tissue regeneration, modern methods allow:

• magnetotherapy;
• massage;
• warm baths with coniferous elixir, decoctions of medicinal herbs;
• electrophoresis with calcium chloride.

Important! Choosing the optimal physiotherapy is the task of the attending physician. A referral is required to visit the physical room. It is impossible to independently prescribe and conduct therapeutic baths, warming up, and massage at home: there is a high risk of a negative result.

Massage

In case of a fracture, a therapeutic massage of a healthy part of the chest and back is recommended. The procedure is performed by an experienced doctor on the second day after the injury. The duration of the session is from 10 to 12 minutes. The movements are cautious, soft, kneading, stroking, rubbing the skin is carried out.

The procedure prevents stagnation of blood and lymph, reduces tissue swelling, and improves well-being. During the rehabilitation period, after removing the fixing scarf, the doctor massages the problem area.

Possible Complications

With conservative treatment, in most cases there are no problems, treatment and rehabilitation pass without negative consequences. In some patients, the clavicle grows together incorrectly, the displacement of bone fragments remains, and the surrounding tissues are negatively affected. The older the patient, the worse the original state of the bones is restored.

Consequences:

• the clavicle is shortened;
• it is impossible to fully restore the functionality of the shoulder.

At the address, learn about the treatment of osteoarthritis of the knee joint with folk remedies at home.

After surgical treatment, with a severe form of a fracture with displacement, complications are also possible:

• osteomyelitis or inflammation of the bone tissue. The problem arises against the background of infection. The main reason for the destructive process is non-compliance with asepsis requirements. Taking antibacterial drugs before surgery helps to prevent a dangerous complication;
• the appearance of a "false joint". This term means nonunion of the clavicle. Reasons: high invasiveness of the operation, multiple bone fragments, incorrect selection of a metal fixator.

The recovery period after a fracture of the clavicle with displacement will be successful if the patient seeks help in time and follows the rules suggested by the doctor. Immobilization for the prescribed period, exercise therapy complex, physiotherapy, therapeutic massage accelerate the regeneration of clavicle tissues, restore the functionality of the shoulder joint.

Specialist of the clinic "Moscow Doctor" about the fracture of the clavicle: