The collarbone is one of the bones of the human body. It is quite long, but thin and tubular. In this regard, when exposed to it with a force exceeding its strength, a fracture occurs. The clavicle is injured in 15-25% of cases from bone tissue damage. Such a high percentage is due to the thinness and high vulnerability of this bone.
Anatomy of the collarbone
It refers to the bones of the shoulder, providing the relationship between the trunk and the upper limb, despite the fact that such a connection is mainly carried out with the help of muscles. The shape of the clavicle is S-shaped. Its inner end is called the thoracic, it accounts for about 5% of the bone, and the outer end is called the acromial (about 15%). The rest falls on the body of the clavicle. The middle of the body is the most worn.
It is located above the first rib of the sternum. As a result of a fracture of the collarbone, pieces of this bone can damage the nerves and vessels between the neck and arm, which canlead to dysfunction of the upper limbs.
Bone Functions
Unlike other tubular bones, the clavicle does not contain marrow. It has the following functions:
- transmission of nerve impulses to the axial skeleton from the upper limb;
- protection of the cervical-axillary canal from damage;
- provides a wide range of arm movement, including free scapular suspension.
Clavicle fracture in ICD
With the help of the reference book of the 10th revision, you can decipher the codes of the international classifier of diseases given in the sick leave. It is an international document that ensures the unity of methodological approaches and international comparability of results.
Fracture of the collarbone in the ICD-10 refers to the class "Fracture at the level of the shoulder girdle and shoulder." But if we consider in more detail, it is worth specifying the block. Such an injury belongs to the "Clavicle Fracture" block. The open form has the code S42.01. A closed fracture is designated S42.00.
Causes of broken bones
It may occur due to the following circumstances:
- injured;
- due to impact;
- due to fall;
- as a result of tissue erosion by metastases of a cancerous tumor.
The tone of the muscles attached to the collarbone is increased. This causes the debris to move.
The main reason is trauma. It is especially characteristic for the occurrence of a fracture of the clavicle in a child, as well as inathletes who are overworked. This bone becomes strongest after 25 years of age. Similar injuries occur in the form of clavicle fractures in newborns. The latter arise due to the presence of a narrow pelvis in the mother and the large size of the child.
Injury symptoms
Symptoms of a broken collarbone are:
- limited movement of the upper limb;
- displacement of the shoulder forward and its lowering with lengthening of the arm from the side of the injured collarbone;
- hemorrhage;
- shortening and deformation of the shoulder girdle;
- swelling, puffiness, redness and hyperthermia of the affected area;
- local pain aggravated by free hanging of the arm.
When a fracture occurs, the injured person cannot perform any actions with the upper limb, which leads to the fact that the elbow is pressed against the body. A symptom is the smoothness of the supraclavicular fossa. During palpation of the bone, crepitus of fragments is heard (a sound resembling steps on frozen snow).
If the subclavian artery is damaged by a bone fragment, the hand becomes white, cold to the touch, without probing the pulse. When the nerve is injured, paralysis of the fingers of the limb and its general sensitivity may be noted. If the blood vessels are damaged, then a hematoma appears in the collarbone area.
Due to the shock experienced, a brief loss of consciousness is possible.
In case of a bone fracture due to oncology, there is a deterioration in the general condition,temperature rises to 37.5-38 ° C, headaches appear.
Fracture of the collarbone in a child proceeds like a green branch. In this case, a partial fracture is observed due to the high elasticity of the bones. They remain held together by the periosteum when fractured.
Classification of fractures
The following types of injuries to the bone in question are distinguished:
- no offset;
- offset;
- closed;
- open.
During the formation of fragments, fractures can be:
- comminuted;
- unshattered;
- many splintered.
The following injuries are distinguished by the nature of the fracture:
- oblique;
- transverse;
- screw;
- T- and S-shaped.
The type and nature of the fracture determines the method of treatment.
Open fractures are observed when the skin is damaged, while there is a rupture of ligaments, tendons and muscles. This damage is defined through a wound through which bone fragments are visible, communicating with the environment.
Closed fracture of the clavicle is characterized by the preservation of the skin. This type of damage is more difficult to determine because it is not clear where the fracture is located.
Symptoms of displaced fractures
The following signs are observed with this type of injury:
- sagging broken collarbone;
- separation of bone fragments one after another;
- nerve damage with hand numbness;
- loss of motoractivity and sensitivity;
- violation of the functions performed by the arm and shoulder;
- changing the relief of the shoulder blade;
- bleeding inside the body and manifesting in the external form;
- pale skin;
- swelling of the injury site;
- severe pain radiating to the shoulder.
A displaced clavicle fracture causes rapid swelling because nearby vessels are injured, leading to bruising and bleeding.
He is the most difficult to treat, as there is damage to the ligaments, tendons, muscles and bones located in the vicinity of the injury. An open, displaced injury requires urgent surgery, as bone fragments can damage large vessels, causing severe bleeding that poses a potential threat to the patient's life.
Diagnosis
If you suspect a bone fracture, you need to go to the emergency room to see a traumatologist. He conducts an examination, palpation, auscultation, studies information about the patient, the nature of the injury, prescribes an examination using x-rays.
On an x-ray, the doctor will see the fracture and prescribe the appropriate treatment. If there is no displacement of the fragments, then a plaster or kerchief bandage is applied. In case of a displaced fracture of the clavicle, surgery is performed.
First Aid
Next to the bone are the lungs, nervous and circulatory systems. Therefore, improperly rendered first aid can lead to death or rupture of blood vessels.vessels, as well as damage to the upper lobe of the lung.
To take urgent action, you need to carry out the following sequence of actions:
- the victim must be given pain medication;
- in case of an open fracture, bleeding should be stopped by applying an aseptic dressing;
- prepare the casu alty for transport.
The last action is also carried out in a certain sequence:
- a tight roller is placed in the armpit, which can be made from a gauze bandage, napkin or towel;
- the arm is bent at the elbow so that the forearm and hand are parallel to the floor, which contributes to the least pain;
- a bandage is applied, which can be a kerchief or a Deso bandage, shirts, towels, sheets, scarves can also act as it, and the hand can also be hung on a scarf, after which the latter is tied to the neck;
- the victim is transported to the emergency room in a sitting or half-sitting position.
When providing first aid, do not do the following:
- fix the hand with a cord or thin ribbon;
- straighten an injured limb;
- pull the victim by the arms or try to tilt him forward;
- transport the victim in a standing or lying position;
- touch wounds and the site of injury and try to straighten bone fragments.
Bandaging
After the delivery of the victim to the emergency room, the doctor-the traumatologist, having studied the x-ray, can conclude that it is necessary to fix the hand. A bandage for a broken collarbone allows you to keep the damaged bone in a static position, which will reduce pain and prevent the fragments from moving.
The following types of dressings are used:
- Corset for fixing a damaged bone. It has some rigidity, although it is not without comfort. The shoulder is supported in the desired position, the load on the spine is minimized. The fracture heals quickly.
- Titova's Oval. They are placed in the armpit, the arm is fixed to the body with plaster bandages. The forearm is hung with a scarf.
- Cravat bandage. It is used when transporting a patient to an emergency room, does not provide complete immobility.
- Delbe rings. Two dense rings with a certain size, depending on the age of the victim, made of cotton and gauze. Superimposed in a sitting position with the shoulders laid back. Rings are placed on the shoulders and tied back with a tourniquet or bandage.
- Velpo bandage. Currently, it is practically not used. It is performed with bandages.
- Deso bandage. It is used to fix the arm in order to reduce pain syndromes and prevent displacement of fragments. Used by ambulance crews with regular or elastic bandages.
Therapy
Clavicle fracture treatment can be performed using therapeutic techniques and techniques. They are determined by the type of fracture, its severity, the amount of damage andthe age of the victim. If the fracture occurred without displacement, conservative treatment is prescribed, carried out at home. If an open wound is noted, then inpatient treatment is carried out. The hand is fixed for two months with a bandage.
Therapy can be done in the following areas:
- spa treatment;
- massage;
- exercise therapy;
- physiotherapy treatments;
- drug treatment.
Last done using:
- chondroprotectors;
- calcium and phosphorus supplements;
- immune-boosting drugs;
- antibiotics for an open fracture to prevent wound infection;
- painkillers.
Physiotherapy techniques include:
- hydrotherapy (taking warm s alty baths);
- laser therapy;
- treatment with magnets;
- ultrasound therapy;
- UHF.
Exercise therapy and massage are carried out during the period of remission with complete healing of the fracture.
Children with fractures of the bone in question are mainly treated with a Dezo bandage or Delbe rings.
Surgery
Sometimes it is impossible to avoid surgery for a broken collarbone. It is called osteosynthesis. During the surgical intervention, bone fragments are removed, the clavicle is fastened with mechanical devices.
The most demanded is the operation carried out withusing plates and screws. So, if the injury is in the region of the acromial end, then hook-shaped plates or blocking screws are used. Also, a pin can be inserted into the bone using a special fixing device.
Surgery for a displaced clavicle fracture is used for an unstable fracture of the long bone or for damage to the joint.
Disadvantages of surgery:
- improper fusion of bones may occur, which is most often observed with a multi-comminuted fracture, due to the complexity of the operation or the wrong choice of metal structures;
- may develop osteomyelitis, which can cause bones to heal improperly.
Rehab
Depending on the general state of he alth, age, severity of injuries, the amount of damage received, the recovery period after an injury varies. On average, it is 3-4 months, while the full period is 180-250 days.
All metal parts after the operation are removed from the body after six months or a year. After full recovery, the doctor prescribes the passage of rehabilitation measures:
- physiotherapy treatments;
- sodium chloride and hydrogen sulphide baths;
- amplipulse therapy;
- massage;
- shock wave therapy;
- exercise.
During rehabilitation, you need to eat foods rich in calcium.
For a quick recovery, a special orthosis helps. It is made of elastic material with inserts of knitting needles, corset, splint andbandage and used after removing the cast.
Consequences
They appear in cases where the injury was serious enough, and the doctors did not have the necessary qualifications for the appropriate treatment. Basically, the consequences of a fracture of the collarbone do not occur.
These may include:
- unable to work for a long period of time;
- development of arthrosis (non-use of plaster casts);
- shortening of the arm due to improper fusion;
- development of osteomyelitis;
- accumulation of pus in the wound;
- her infection with an open fracture and the same - sutures during surgery;
- formation of scoliosis (especially in children);
- violation of posture;
- formation of false joints;
- secondary displacements during reflex muscle contraction;
- paralysis of the fingers due to nerve damage;
- their loss of sensitivity;
- plexitis (affects the nerve plexus);
- significant blood loss;
- damage to sharp fragments of nerves, soft tissues and blood vessels.
Very large newborns have breech presentation flaccid paralysis, which occurs as the fetus passes through the birth canal. In case of improper bone fusion, the child may lose the ability to control the hand. At best, an aesthetic defect will occur.
In case of an incorrectly consolidated fracture, an artificial fracture is created, after which the fragments are assembled intocorrect sequence.
Adequate fixation of fragments during surgery does not require the use of external fixators after surgery, movements in the shoulder joint can be carried out almost immediately. Full recovery after surgery is possible if the fragments are in the correct position and fixed for the period necessary for their fusion.
In order to avoid some of the consequences, it is necessary to adopt the correct posture during sleep. It is best to sleep on your back. Sleep can also occur on the stomach. But you can not be on your side during sleep, and above all - on the damaged side, which can cause displacement of fragments.
In closing
Fracture of the collarbone mainly occurs in its thinnest part. To treat this phenomenon, physiotherapy, exercise therapy, massage, various baths, and magnets can be prescribed. In the event of an injury, the victim is delivered to the emergency room, while the hand must be tied around the neck with a scarf.
He is undergoing an X-ray examination, the results of which establish the need for the use of hard bandages or surgery. As a rule, the prognosis is favorable, but you need to follow the recommendations given and listen to the advice of a doctor.
