Clavicle Fracture With And Without Displacement - Treatment, Rehabilitation, Types Of Bandaging

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Video: Clavicle Fracture With And Without Displacement - Treatment, Rehabilitation, Types Of Bandaging

Video: Clavicle Fracture With And Without Displacement - Treatment, Rehabilitation, Types Of Bandaging
Video: Clavicle Fractures Classification - Everything You Need To Know - Dr. Nabil Ebraheim 2024, March
Clavicle Fracture With And Without Displacement - Treatment, Rehabilitation, Types Of Bandaging
Clavicle Fracture With And Without Displacement - Treatment, Rehabilitation, Types Of Bandaging
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Clavicle fracture

Content:

  • Displaced clavicle fracture
  • Clavicle fracture in children
  • Consequences of a clavicle fracture
  • First aid for a fracture of the clavicle
  • Clavicle fracture treatment
  • Recovery period

The skeleton is the support of the body. The load on the bones is very high. Muscles and ligaments are attached to them. Under unfavorable circumstances, bone tissue is destroyed, and a fracture is formed. The method of treatment and the duration of the recovery period depend on which part of the body has suffered, the characteristics of the damage and the state of health of the patient.

The clavicle belongs to the tubular bones. Otherwise, they are called long, because their length is greater than their width. The clavicular bone connects the scapula to the ribcage. This small bone looks like an antique S-shaped curved key, hence the name.

If we consider the origin of the word "key", then it is close in meaning to "lock". A stick - a stick - serves as a support for walking. So, the clavicle is a support for the shoulder blades and sternum. The clavicle is located just above the first rib. This bone is clearly visible and easy to palpate.

Displaced clavicle fracture

Clavicle fracture
Clavicle fracture

The cause of the collarbone fracture is the excess of the force of mechanical action over the strength of the bone. This can happen to people with epilepsy. If their bones are weak and the muscle twitching during an attack is very strong, then a fracture occurs. More often than not, such serious damage is caused by injury. Injuries are inevitable when practicing contact sports: football, hockey, boxing and others, as well as cycling and motorcycling. There are many injuries after a traffic accident. Newborns can also get injured when passing the birth canal.

Types of clavicular fractures: outer, middle and inner third of the clavicle. The thinnest and most curved part of this bone is the middle. That is why midline fractures account for the lion's share of the total number of collarbone injuries.

There are many classifications of fractures. They differ in the basic characteristics taken as a basis. According to one of them, fractures can be accompanied by displacement of fragments or not. Parts of the clavicle move without separation or in width, length, at an angle. Displacement always complicates the treatment process, there can be unpleasant consequences.

Symptoms of a displaced clavicle fracture:

  • shoulder pain;
  • swelling;
  • cyanosis or pallor of the skin;
  • bleeding (external and internal);
  • deformation of the shoulder contours (lowered and protrudes forward, the injured arm "sags", it seems longer);
  • the hand does not obey, the fingers are inactive;
  • nerve damage;
  • numbness of the hand;
  • bone fragments go over each other;
  • "Sagging" of the scapula, it protrudes more strongly;
  • violation of the integrity of the dome of the pleura with closed fractures.

The site of injury swells quickly, because bone fragments are quite sharp and easily rupture adjacent blood vessels. This is the reason for the appearance of hematomas. The displacement of the fragments increases the pain.

The patient holds the forearm and elbow of the injured limb with his healthy hand, presses it to the body. The hand moves with difficulty, because the clavicle is a support for the bones of the upper limb. Shoulder movement is limited due to pain. On palpation of the fracture site, pathological mobility and crepitus of fragments can be determined.

Distinguish between complete or classic (with a rupture of the periosteum at the site of injury) and incomplete fractures. The offset can be of several degrees:

  • complete, in which the fragments are not held by the periosteum;
  • incomplete - bone structures are displaced, but continue to be held by the periosteum.

For a fracture with displacement, only a rigid bandage is applied. More elastic splints are contraindicated. Before the procedure of applying the plaster, the patient must be given an anesthetic, because the sore shoulder must be fixed in the correct position. Without anesthesia, the muscles are "protected", involuntarily, reflexively, their retraction occurs - contraction.

A displaced clavicle fracture is more difficult to heal, but there are times when it is accompanied by dislocation and damage to nearby bones. The process of treating an open fracture will also be difficult and difficult. Displacement usually requires surgery. Fragments displaced into an unnatural position pose a threat to the adjacent neurovascular bundles and skin.

Clavicle fracture in children

Clavicle fracture in children
Clavicle fracture in children

Fractures without displacement of fragments are characteristic of childhood. With proper treatment, they grow together in 8-10 days. About 1–2 weeks after the fracture, children can raise their arms freely.

In babies, the collarbone usually breaks in a "green line" pattern. This is a so-called incomplete fracture, when the bone does not break completely, because "Fragments" are still held together by the periosteum or periosteum. So, in nature it is very difficult to quickly break a young twig. It is so filled with juice, and its bark is so strong and elastic that it is impossible to do it right away without cutting tools.

The periosteum is a film of connective tissue that covers the bone. Due to its ability to regenerate, thickening of the bones occurs, as well as the formation of callus at the site of fractures. The nutritional holes of the periosteum supply the bone with blood, it is to it that the tendons and ligaments are attached. The strength of the periosteum in babies prevents the displacement of parts of the clavicle, and, therefore, helps to reduce pain.

Clavicle fracture reasons:

  • falling on the shoulder or arm from a height;
  • strong mechanical impact on the clavicular region, for example, impact during a fight or in a car accident;
  • birth injury;
  • muscle cramps (eg, in epileptics);
  • osteosarcoma is a malignant bone tumor.

Skeletal injuries during childbirth are not uncommon. They belong to the mechanical forms of birth trauma. In newborns, a fracture of the clavicle is caused by damage during childbirth. In early childhood, the cause can be an unsuccessful fall while playing, playing sports or riding a bicycle, skating. Fractures are most common in children and the elderly. In babies, bones are still not strong enough, and in older people they are fragile due to calcium deficiency.

Consequences of a clavicle fracture

Consequences of a clavicle fracture
Consequences of a clavicle fracture

The consequences can be as follows:

  • loss of hand performance during the rehabilitation period;
  • damage by sharp bone fragments to nearby vessels and nerves, as well as to the dome of the pleura and skin;
  • severe blood loss;
  • plexitis - inflammation of the nerve plexuses;
  • muscle paralysis;
  • secondary displacement, for example, due to muscle contractions or an improperly applied bandage;
  • the formation of false joints;
  • scoliosis - lateral curvature of the spinal column - with improper fusion of fragments of the clavicle;
  • non-union;
  • infection if the area around the wound with an open fracture has not been treated with antiseptics;
  • osteomyelitis - purulent-necrotic inflammation of the bone and adjacent soft tissues caused by pathogenic microorganisms;
  • suppuration of the postoperative wound;
  • arthrosis, accompanied by joint stiffness;
  • limitation of hand movements;
  • cosmetic defect with improper bone fusion.

A complication in the form of flaccid muscle paralysis occurs with obstetric trauma. This happens with very large newborns and with foot presentation. If you ignore the secondary displacement, the bones will grow together crookedly. This will necessarily later affect the ability to control the hand, its strength. In addition, when displaced, nerve endings are affected, which causes pain.

Causes of non-union of the clavicle:

  • multi-splintered fracture;
  • inadequate metal fixator;
  • excessive separation of the periosteum during surgery.

In case of non-union or incorrect fusion of the clavicle, it is possible to perform repeated reposition of the fragments and surgery. To identify complications in the adjacent soft tissues, in rare cases, computer or magnetic resonance imaging studies are prescribed.

Complications after a clavicle fracture are extremely rare. The severity of the possible consequences is determined by the severity of the disease and the literacy of the treatment.

First aid for a fracture of the clavicle

First aid for a fracture of the clavicle
First aid for a fracture of the clavicle

If a clavicle fracture is suspected, the limb should be immobilized as soon as possible to prevent possible movement of bone fragments. Prehospital stage, i.e. transportation of the patient must be carried out correctly. A set of first aid measures will help to avoid complications: damage to veins, lungs and / or nerves. Unprofessional intervention can irreversibly aggravate the situation.

To alleviate the patient's condition, analgesics are administered orally or intramuscularly. A small roller is placed under the armpit. The arm is bent at the elbow and tied to the body from shoulder to hand. The forearm should be parallel to the floor. The brush is passed through a bandage attached to the neck.

If there is no material suitable for a neck bandage at hand, then the edge of the clothing is folded up and fixed: T-shirts, shirts. It is important that the forearm is fully secured with a bandage. This is the part of the arm from the elbow joint to the wrist. This bandage is called a kerchief or headscarf. If the tape is not wide enough, the arm will be too mobile. This can lead to displacement of the fragments.

Why is a complete immobilization of a hand with a broken collarbone needed? When she is completely immobilized, the patient relaxes the muscles, the bone fragments put less pressure on the nerves and the pain recedes slightly.

If only a scarf, belt or just a cloth tourniquet is at hand, then proceed as follows. It is thrown over the shoulders, and between the shoulder blades, the resulting loops are connected with something. It is important that the shoulders are pulled back. In fact, Delbe's soft ring straps are obtained. The main requirements for the structure are rigidity and reliability. The fracture site can be numbed with ice.

You can't:

  • try to correct the "dislocation" on your own without making a precise diagnosis;
  • transport the patient while standing or lying, only sitting or half-sitting;
  • lean forward;
  • pull his hands;
  • fully straighten the injured limb;
  • fasten the upper limb with a too thin cord, rope or belt.

During transportation, it is better for the patient to lean back a little, this will prevent the displacement of the fragments. Knowledge of the course of first aid can be useful in life for anyone. Ideally, everyone should have basic knowledge and a set of emergency medical measures.

Clavicle fracture treatment

The success of the therapeutic course depends on many factors: the severity of the pathology, the amount of damage, the professionalism of the doctors and the age of the patient. In severe cases, surgery is required.

X-rays help diagnose a fracture. Usually it is carried out in two projections: lateral and straight. The first is necessary to clarify the position of the fragments relative to each other. The traumatologist chooses conservative or surgical treatment depending on the specific case. It is possible to compare bone fragments without surgery using reduction. This is a medical procedure performed under local anesthesia. This procedure avoids incorrect fusion of parts of the clavicular bone.

After being admitted to the hospital, the arm is immobilized for 3-8 weeks. For this, the patient is given a special fixing bandage. Pain relieves the course of analgesics.

The therapeutic course includes:

  • anesthetics;
  • antibiotics for infection of an open fracture or postoperative sutures;
  • fortifying, immunostimulating agents;
  • vitamins;
  • calcium preparations for strengthening bone tissue;
  • physiotherapy: electrophoresis, magnetotherapy, ultrasound, laser therapy, UHF therapy (ultrahigh frequency);
  • physiotherapy exercises, massage and warm salt baths at the final stage of treatment.

Children are usually not given a cast, but only with Delbe rings or a Dezo bandage. From folk remedies, comfrey can be recommended. This plant was actively used in ancient times to treat wounds and fractures. Comfrey has a very powerful healing effect. It is better to purchase ointments and balms based on it in pharmacies. this forest grass is poisonous. There you can also buy the herb of the golden rod (common goldenrod), which has very useful qualities for treating fractures.

You can take advantage of the anti-inflammatory and pain relieving properties of ivy bud (catnip). This plant should also be used with care.

It is advisable to eat foods rich in calcium:

  • nuts;
  • sesame;
  • rosehip;
  • milk;
  • soy;
  • fish;
  • bread;
  • bran;
  • cottage cheese;
  • greens;
  • persimmon;
  • beans;
  • cabbage.

It is easy to make your own vitamin mixture of honey, walnuts, two lemons and a glass of dried apricots and raisins. Dried fruits are pre-soaked in boiling water. Lemons are squeezed, the seeds are removed. Scroll everything with a meat grinder or grind with a powerful blender and mix with honey. Take such a vitamin mixture a teaspoon three times a day after meals. This is an unusually useful composition, it is good to use it both during periods of epidemics of an acute respiratory viral infection, and during pregnancy.

So, the main method of treating a clavicle fracture is fixation. After the healing of the damaged bone, a rehabilitation period is required. In addition to the complex of physical therapy exercises, the attending physician recommends swimming, warm baths with sea salt and massage.

Bandaging for a fractured clavicle

Bandaging for a fractured clavicle
Bandaging for a fractured clavicle

Bandages for matching and holding fragments of the broken clavicle differ in the degree of fixation. The hardest is the classic plaster cast, which is applied over the shoulder and chest. This bandage reliably protects against displacement of fragments, allowing you to monitor the area of the fracture. Fixation of the shoulder with plaster is contraindicated for people over 50 years old, because then a complication in the form of arthrosis develops. Manipulations with a sore collarbone are very painful, so local anesthesia is mandatory.

Conservative treatment involves the imposition of one of the types of dressings:

  • eight-shaped with fixation of the shoulder girdle - such as Delbe, Borchgrevinka (Borchgeriving), Ombredan and others;
  • according to Smirnov-Weinstein;
  • according to Kaplan;
  • according to Voronkevich;
  • Deso;
  • Seira;
  • Titova's oval;
  • two Kramer tires;
  • on a wedge-shaped pillow;
  • Chizhin framework;
  • tires Kuzminsky.

The technique for applying these dressings is basically the same. The patient is put on a chair. He must rest firmly on the back. The bandage is done together. One person from behind spreads his arms over the shoulder of the patient so that the inner edges of the shoulder blades are as close as possible to the spinal column. He must keep his shoulders in a dilated position constantly during the dressing. The second doctor simultaneously slowly and carefully presses his thumbs on the apex of the angle formed by the fragments of the clavicle. After that, the hand is fixed with a soft or plaster cast. Plaster is used mainly after operations.

If, within three hours after the procedure, the patient's hands do not begin to grow numb, edema does not develop and there are no other unpleasant symptoms, the bandage is applied correctly. Otherwise, it is slightly weakened. Of the above types of dressings, preference is given to those that are sold ready-made.

The Dezo bandage is made as follows: the hand is bandaged to the body, while the shoulder is pulled back, and small pillows are placed on the armpit and forearm. When applying a plaster cast of Smirnov-Weinstein, one strip is thrown over the forearm of the injured hand and the healthy shoulder girdle, and the second - the sternum and shoulder.

Sometimes this type of bandage is also used. The sternum obliquely over the healthy shoulder is tied with bandages, and the opposite shoulder joint is raised with a built-in crutch. Such a device is often used for complex fractures of the clavicle. This bandage is removed after about 3 weeks.

The first 4 days after fixing the clavicle, the doctor conducts mandatory daily examinations. A control X-ray is taken a week later. Immediately after removing the dressing, it is also necessary to take an X-ray to detect secondary displacements, improper fusion, or complete non-union of the clavicle.

Delbe's rings for clavicle fracture

Delbe's Rings
Delbe's Rings

Delbe's soft ring straps are worn on the area between the patient's neck and shoulders, pulled tight and tied between the shoulder blades. Initially, this bandage was made using cotton wool and gauze. Modern dressings are much more comfortable and practical. They can even be washed. They are sold ready-made, perfectly regulated. The imposition of such rings gives the patient a minimum of discomfort.

The eight-shaped bandage got this name due to the fact that the bandages cross between the shoulder blades in the shape of a figure eight. To make such a bandage, a dense cotton pad is attached to the patient between the shoulder blades reduced to the spine. Flat rollers are placed on the shoulder girdle and armpits and the bandage is made as tight as possible. After applying a bandage, it is imperative to control the correct position of the fragments using an X-ray.

Delbe shoulder brace is produced by both domestic and foreign companies. It is made of a very durable and yet soft material. It is also breathable and has several degrees of belt tension. To select the right size rings, the patient's chest circumference must be known.

Functions of Delbe's hoop straps:

  • securing the shoulders in a divorced position;
  • fixation of the clavicular-acromial joint;
  • unloading of the clavicle ligaments;
  • retention of fragments in the desired position.

Traumatologists prefer Delbe's rings because of their ease of use and ease of adjusting the degree of traction.

Clavicle fracture surgery

In cases where conservative treatment is powerless, a surgical operation is performed. Many trauma surgeons and surgeons consider surgery to be the best therapy for a fractured clavicle. Metal structures are actively used. After the fracture has healed, they are removed. This usually happens after a few months, although the plates can only be removed after a year.

Surgical treatment involves carrying out one of the types of surgical intervention under anesthesia:

  • bone osteosynthesis with plates (including compression plates);
  • intraosseous osteosynthesis with stainless steel wires or a rod (for example, a pin, a rod or a Bogdanov-type nail, tie bolts);
  • with external fixation devices.

To fix the metal structures in the bone, canals are drilled. Types of plates for clavicle osteosynthesis:

  • reconstructive;
  • S-shaped;
  • hook-shaped;
  • with locking screws.

Intraosseous osteosynthesis of two types is performed:

  • according to Klyuchevsky, if the central fragment is short;
  • according to Spijariom-Kupcher, if there is a small peripheral fragment.

To fix the fragments, pins are also used: blocking or non-blocking. The first ones have additional fixation with screws. Channels are drilled into the bones, into which the pins are inserted. Inside these rods there are special holes for the screws required to fix the metal structure. Non-locking pins are available in either plain or threaded. The latter fix the bone more strongly (Rockwood pin).

Many doctors choose to perform surgery for a broken collarbone. It allows you to remove the fragments, firmly fasten the separated parts of the bone. After the operation, the rehabilitation period is somewhat lengthened. But many unpleasant complications are avoided.

On the subject: 12 popular ways for home treatment

Recovery period

Recovery period
Recovery period

Rehabilitation is absolutely necessary because due to prolonged immobilization, the arm muscles partially atrophy. Exercise should be started as soon as possible. The load and type of activity are determined by the attending physician. Usually, the recovery course lasts from three to seven weeks.

The rehabilitation period can be divided into 3 stages:

  1. during immobilization, passive exercises are performed;
  2. after the growth of callus and the removal of the fixing bandage, gymnastic sticks are used, the range of exercises is expanded;
  3. the introduction of power loads with the help of resistance bands, dumbbells, clubs, exercise machines.

For a speedy recovery after a fracture, physiotherapeutic procedures are continued, hydrotherapy and massage are used. An integrated approach guarantees high effectiveness of rehabilitation. Thanks to electrophoresis, magnetotherapy, ultrasound, laser therapy and UHF, blood flows more strongly to the damaged area. Adequate blood supply promotes rapid tissue repair.

How to develop a collarbone after a fracture?

Exercises after conservative treatment and surgery differ slightly. But in both cases, they become more complex in stages.

A set of exercises for the postoperative period:

  • respiratory and general tonic gymnastics;
  • light active-passive swaying in the shoulder joint (hand on a headscarf);
  • alternating tension and relaxation of the muscles of the shoulder and shoulder girdle;
  • active movements in the elbow and wrist joints, as well as fingers and a hand;
  • pronation-supination (inward-outward rotation) of the forearm;
  • shrugs;
  • general strengthening exercises for all parts of the body;
  • dosed walking and running;
  • training of speed and strength endurance of the hand;
  • sports support exercises;
  • exercises to restore coordination of movements;
  • sports training.

First, the exercises are performed with assistance for a few minutes. Then they are repeated more and more often. From smooth and slow movements, they move on to jerks. It takes persistence and patience to quickly develop a collarbone after a fracture.

Exercise therapy for a fracture of the clavicle

The physical therapy complex not only strengthens weakened muscles, improves joint mobility, but also increases the blood supply to the injured arm. Only a constant blood flow allows the process of callus formation to proceed actively. The golden rule of exercise therapy is adherence to the sequence of physical activity.

In fact, exercise therapy begins on the first day of bandaging. At first, it is limited to finger and hand movements. Exercise therapy successfully copes with the frozen shoulder syndrome. As mentioned above, exercises become more difficult gradually, in stages. First design the brush.

Some exercises for the fingers of the injured hand:

  • clench and unclench your fist, spreading your fingers every time. The thumb should be outside / inside the fist alternately;
  • connect alternately the pads of all fingers with the thumb;
  • click ("knock down a speck") with each finger in turn;
  • make "claws";
  • twist each finger, and then the whole brush clockwise and counterclockwise;
  • lower and raise the brush;
  • wave the brush left and right.

Then the elbow and shoulder are developed.

At the next stage, i.e. after removing the bandage, sitting or standing, perform the following set of exercises:

  • put your hands on your shoulders and alternately raise / lower your elbows;
  • in the same position, rotate elbows clockwise and counterclockwise;
  • raise and lower hands;
  • the same, but with the arms being pulled back in the upper position;
  • "Scissors" with straightened arms vertically and other exercises.

The clavicle is a support for the hand; a very powerful ligamentous apparatus is attached to it. A fracture of this important bone for the skeleton incapacitates the upper limbs. But with proper treatment, complications can be avoided and fully restored to work.

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Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.

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