COLLARBONE (CLAVICLE) FRACTURE
DESCRIPTIONA collarbone fracture is a complete or incomplete break in the outer third of the clavicle (collarbone). Frequently, this fracture extends into the shoulder joint and is associated with rupture of the shoulder ligaments. Appropriate health care includes: doctor's treatment; hospitalization (sometimes) for anesthesia and surgery to set the fracture; special shoulder harness to promote healing (sometimes).
SIGNS & SYMPTOMS
Severe pain at the fracture site; swelling around the fracture; visible deformity if the fracture is complete and bone fragments separate enough to distort the child's normal contours; tenderness to the touch; numbness or coldness in the child's shoulder and arm on the affected side if the blood supply is impaired.
CAUSESA direct blow or indirect stress to the bone. Indirect stress may be caused by twisting or a violent muscle contraction.
Falls from the top bunk of a bed are a common cause.
Contact sports such as football or soccer; history of bone or joint disease, especially osteoporosis; obesity; poor nutrition, especially calcium deficiency.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should build strength and protective muscle mass with an appropriate long-term conditioning program. The child should use protective equipment, such as shoulder pads, when participating in sports.
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of injured areas, including the child's shoulder joint and the joint between the shoulder and clavicle.
At the time of injury: shock; pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or connective tissues.
After treatment or surgery: delayed union or non-union of the fracture, which happens frequently in fractures of the clavicle because of its naturally poor blood supply; avascular necrosis (death of bone cells) due to interruption of the blood supply; excessive scar tissue at the fracture site, causing compression on nerves and blood vessels in the neck; arrest of normal bone growth in young children; infection in open fractures (skin broken over the fracture site), or at the incision if surgical setting was necessary; shortening of the injured bones; proneness to repeated collarbone injury; an unstable or arthritic joint following repeated injury; prolonged healing time if the child resumes activity too soon.
Your child should try to resume full function and normal range of motion within 3 or 4 weeks. Healing is complete when there is no motion at the fracture site and when X-rays show complete bone union.
Keep the child warm with blankets to decrease the possibility of shock. Cut away clothing, if possible. Don't move the injured area to remove clothing, Follow instructions for rest, ice, compression, and elevation (R.I.C.E.). Raise the lower part of the bed. See Appendix 39 for details. The doctor will realign and set the broken bones with surgery or, if possible, without. Manipulation to set the break should be done as soon as possible after injury -- in less than 6 hours, if possible.
Immobilization will be necessary. For this fracture, a figure-8 restraint usually works quite well.
Use frequent ice massage (See Glossary) on the child if there is no cast.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad, hot soaks, hot showers, or heat liniments and ointments.
Your doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants; narcotic or synthetic narcotic pain relievers for severe pain; stool softeners to prevent constipation due to inactivity; acetaminophen or aspirin for mild pain.
Your child should actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing. Normal activities can be resumed gradually after treatment. The child should not drive until healing is complete.
DIET & FLUIDS
No restrictions after surgery.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of a collarbone fracture.
Any of the following occur after surgery or other treatment: increased pain, swelling, or drainage in the surgical area; signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever); blue or gray skin color beyond the sling, especially under the child's fingernails; loss of feeling below the fracture site; nausea or vomiting; constipation.