break of collarbone

A broken collarbone is not a harmless minor injury. You can find out the most important information about symptoms, diagnosis and current treatment concepts here

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A broken collarbone can cause severe pain. The broken collarbone is clearly visible in the X-ray image (highlighted in red)

© SPL / Camazine Scott

What is a broken collarbone?

The shoulder girdle establishes the connection between the upper arm and the breastbone and is formed by the collarbone (clavicle) and shoulder blade. The collarbone is one of the bones that people break most often. "Five percent of all fractures are broken collarbones," says Dr. Peter Gutsfeld. They are usually caused by a fall on the outstretched arm or shoulder. The collarbone fractures (clavicle fractures) are divided according to their location in the lateral third (closer to the shoulder area), middle third (in the middle area) and medial third (closer to the sternum).

In the sketch: the position of the collarbone

© SPL / Pixologicstudio

Causes: How does a broken collarbone come about?

The cause of a broken collarbone is usually an accident. A distinction is made between direct and indirect trauma. In the case of direct trauma, for example, a traffic accident results in a direct force acting on the collarbone and it breaks. This is often an expression of a severe chest injury. In the case of indirect trauma, for example from a fall on the shoulder or an outstretched arm, force is transmitted to the collarbone, which can break it. If a child or a young person breaks their collarbone, the cause is usually a sports accident. "Skiing, snowboarding and cycling are typical sports," says trauma surgeon Peter Gutsfeld. In older people, falls on the shoulder, for example stumbling over a door threshold or the edge of a carpet, are often the cause of a broken collarbone.

Symptoms: what is the expression of a broken collarbone?

The injured person may experience severe pain when trying to move their arm or shoulder. The affected area often swells and turns bluish due to a bruise (hematoma). Another symptom: "The area feels unstable and it can crepit if you touch the collarbone with your hand," says Gutsfeld. Crepit means something like crunch. A step in the course of the collarbone may be visible in slim people.

Diagnosis: how does the doctor recognize a clavicle fracture?

The doctor can usually quickly infer a broken collarbone as soon as he examines the shoulder and the patient describes his symptoms. An X-ray then provides the final evidence. For special questions, a computed tomography (CT examination) may also be necessary. It is important to also assess the thorax, the lungs, the nerves and vessels and the adjacent joints to the sternum (sternoclavicular joint) and the roof of the shoulder (acromioclavicular joint). The affected shoulder should always be examined as well, as there are frequent accompanying injuries.

Therapy: conservative or surgical?

Whether a clavicle fracture has to be treated conservatively (without surgery) or surgically depends on various factors such as the location of the fracture, the position of the fragments in relation to one another, the type of injury or concomitant diseases.

  • Conservative care

Expert Gutsfeld emphasizes: "As a rule, children should be treated conservatively". Since misalignments can be compensated for during growth, the applied bandage (Gilchrist bandage) only serves to relieve pain (analgesia). In adults, too, conservative therapy for clavicle fractures is usually used. In over 70 percent of cases there is a "simple" fracture in the middle area of ​​the collarbone, which can be treated conservatively. Here, too, the bandage essentially serves to immobilize and treat pain. Correction of the position of the broken collarbone can only be achieved incompletely in the so-called rucksack bandage, so there is the problem that the break can grow together crookedly. This can cause permanent misalignment (usually shortening).

  • Operative care

Surgical treatment is necessary for certain fractures at the end near the shoulder or for fractures close to the breastbone (rare fracture form). Surgery is also necessary if the ends of the fracture are very far apart (shortening is greater than two centimeters or the distance between the ends of the fracture is too great) or if there are multiple fragments (multiple-fragment fractures). Open fractures (visible bone ends protruding from the skin) or accompanying injuries to nerves and vessels also make an operation necessary.

The decision to operate requires a precise analysis of the fracture shape and should take into account the individual situation of the patient. There should always be a detailed discussion with the surgeon.

During the operation, the fracture ends are reattached to each other (reduction) and an angle-stable plate or, if necessary, a nail is used for stabilization, which is inserted into the medullary canal of the bone (intramedullary splint).

If the fracture has grown together well, the implant is usually removed again in a further operation. After the operation you are "pain-free again quickly and can return to everyday life and also quickly to sport," says the trauma surgeon. However, every operation also carries risks such as inflammation of the wound and bone. A so-called implant failure due to loosening of the plate or renewed breaking of the clavicle (refracture) after removal of the material should also be mentioned here.

The fracture ends rarely grow together properly after conservative or surgical treatment (pseudarthrosis). A complex corrective operation must then be carried out here in the event of complaints. In rare cases, a remaining malalignment, usually shortening after conservative therapy, is corrected surgically if this significantly impairs shoulder function.

Prevention: Can you prevent a broken collarbone?

You can only prevent a broken collarbone (clavicle fracture) to a limited extent, as it is usually caused by a fall, for example while exercising. In order to minimize the risk of accidents and thus the risk of broken collarbones, it is generally advisable to exercise caution when practicing sports in order to avoid falls.

In addition, fall training adapted to the type of sport is recommended. Wearing protectors only helps to a limited extent in the case of a broken collarbone, as you usually do not fall directly onto the collarbone, but rather the force is transmitted indirectly via the arm and shoulder. Nevertheless, protectors adapted to the sport should of course be worn, as they can at least partially soften the fall and partially protect the shoulder and arm.

Dr. Peter Gutsfeld

© Garmisch-Partenkirchen Clinic

Consulting expert

Dr. Peter Gutsfeld, specialist in surgery, special trauma surgery, orthopedics and trauma surgery, worked as a senior doctor in trauma surgery and sports orthopedics at the Garmisch-Partenkirchen Clinic until the end of 2016. In 2017, Dr. Gutsfeld to the Ohlstadtklinik of the German Pension Insurance North Bavaria.

Swell:

  • Christian M. Müller-Mai, Axel Ekkernkamp, ​​Fractures: Classification and Treatment Options, Springer-Verlag Berlin Heidelberg 2010
  • X. Ma, K. Wang, X. Chen et al., Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures. In: J Orthop Sci. 2019 Apr
  • H. Frima, M. van Heijl, C. Michelitsch et al., Clavicle fractures in adults; current concepts. In: Eur J Trauma Emerg Surg. 2019 Apr 3.
  • Siewert, Chirurgie, 8th edition, Springer Verlag
  • Deutsches Ärzteblatt, clavicle shaft fracture. Online: https://www.aerzteblatt.de/archiv/78729/Klavikulaschaftfraktur (accessed on May 10, 2019)

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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