Therapy of a broken collarbone
How is a broken collarbone treated?
The collarbone fracture / clavicle fracture can generally be treated conservatively or surgically. The decision is made on the basis of the X-ray image.
Conservative therapy
Most collarbone fractures can be treated conservatively, including the unshifted collarbone fracture, in which there is only an axial kink in the area of the collarbone, and the slightly displaced (slightly dislocated) collarbone fracture if there has been no significant reduction in the length of the collarbone. Theoretically, more displaced collarbone fractures can also be treated conservatively, but this often results in false joint formation (pseudarthrosis) and / or excessive bone callus formation. A remaining false joint formation leads to remaining pain in the fracture area, an excessive callus formation can compress the vascular / nerve route running under the collarbone and e.g. lead to circulatory disorders and sensory disorders in the arm.
In the conservative therapy of the broken collarbone, a special bandage is applied, which is like a backpack around both shoulders ("Backpack bandage"). The bandage is pulled tight on the patient's back and fastened so that the shoulders are pulled back. The fracture of the collarbone is established by pulling back the shoulders (repositioned) and held. The immobilization in the fracture area reduces the pain and accelerates the healing of the fracture.
Under no circumstances should the rucksack bandage be put on so tightly that a venous back pressure arises in the arms or that there are sensory and movement disorders of the arm.
Adults wear the rucksack bandage for at least, depending on the type of fracture 3 to 4 weeks, Children up to 6 years for 2-3 weeks. The wearing time is ultimately determined individually based on the X-ray controls. The fracture healing (fracture consolidation) and the fragment position can be checked with the aid of the X-ray image. If the fragment of the collarbone fracture is increasingly displaced (secondary dislocation) despite a backpack bandage, the fracture may still have to be surgically stabilized.
A problem with the X-ray assessment of the collarbone fracture is a fracture gap that can sometimes be seen for months despite the clinically stable osseous breakdown. Therefore, when deciding on how long to wear the backpack bandage, you should also take into account the clinical examination findings. Weigel and Nerlich (2004) recommend the following procedure: If the patient moves his shoulder painlessly and there is no longer any pressure pain in the fracture area, fracture stabilization can be assumed to be stable during exercise (not load-stable!), even if this is not in line with the radiological findings.
Problems with the Backpack bandage are often:
- Too loose or too tight fit
- Insufficient padding
- Low wearing comfort
- Handling unclear for the patient
All of these problems have a negative effect on cooperation (Compliance) of the patient and can jeopardize the result of conservative therapy.
Further treatment initially involves tightening the rucksack bandage every day in the first week. A first X-ray check should be carried out after approx. 1 week, then depending on the type of break and the risk of a possible break displacement. An X-ray check should be carried out again at the latest when the rucksack bandage is removed. After 6-8 weeks the Collarbone fracture be healed in a stable manner.
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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
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Operative therapy
The indication for surgical treatment of a broken collarbone should be cautious because the results are usually good if conservative therapy is carried out properly and the risks (see below) of conservative therapy can be avoided.
The indication for surgical therapy of the collarbone fracture is:
- Open collarbone fractures (rare)
- Accompanying vascular and nerve injuries
- Severely displaced fractures
- Impending fragment penetration of the skin
- Failure of conservative therapy
- Lateral fracture (fracture at the outer end of the collarbone, as here the healing potential of the bone is very limited and permanent functional restrictions can be expected)
- (Cosmetic reasons)
Plate fixation:
The bridging fracture plating (clavicle fracture) is the standard procedure for operative stabilization in a clavicle fracture.
The break is achieved through a skin incision running lengthways over the collarbone or vertically over the fracture zone ("saber cut"). The fracture zone is set up so that it is gentle on the bones and soft tissue and bridged with a metal plate. At least 3 screws should be inserted above and below the plate for adequate breakage stabilization.
The operation is ended with a subsequent x-ray check, insertion of a wound tube (Redon drainage) and layered wound closure.
Prevot nailing
Prevot nailing is a relatively new procedure for the surgical stabilization of collarbone fractures. The bone cavity (Medullary canal) of the collarbone and a nail over the closed or open fracture zone into the lateral (lateral) End of the collarbone inserted. The nail acts as an internal fracture splint. In the literature, good results have been reported with this surgical method. Since various manufacturers now offer these nails, the name TEN (titanic elastic nail) is also used synonymously.
With both surgical procedures, early functional physiotherapy (physiotherapy) can be followed up. A backpack bandage is not necessary. A load on the arm (support, lifting, etc.) may not take place for 6-8 weeks, depending on the X-ray control. The inserted osteosynthesis material (plate, screw or nail) can be removed after approx. 18-24 months (plate) or 8-12 months (nail).
Read more on this topic at: Elastically stable intramedullary nailing (ESIN) with TEN (Titanic elastic nail) or STEN
After the operation
Sometimes conservative therapy for the fracture of the collarbone is not sufficient, so that a operative care the break is sought. Operative action is taken when the collarbone strongly shifted is, it is one open fracture acts, Vessels and annoy injured or by conservative immobilization crooked growing together of the collarbone is done.
During the operation, the fragments are removed with the help of Nails and plates fixed.
Followed by a physiotherapy to rebuild the muscles, as well as to restore the complete movement the affected shoulder. An additional supply with a backpack bandage is unnecessary.
The burden of the affected Arms by lifting or carrying heavy objects should vary depending on the outcome X-ray controlthat must be done in the course for approximately 6 - 8 weeks be avoided. The plates and nails used for fixation can be used again after the break has healed completely away become.
The broken collarbone in children
A broken collarbone, known in medical parlance as a clavicle fracture, is an injury that occurs particularly frequently in children and adolescents. With a share of around 85%, the fracture of the collarbone is the most common fracture in children up to 10 years of age. In most cases, it occurs in children as a result of a fall on the shoulder, on the outstretched arm or as a direct result of a difficult birth.
The therapy of a broken collarbone is usually conservative in childhood, so that surgical treatment can be avoided. The principle of conservative therapy includes immobilizing the broken collarbone with the help of an arm sling or, even better, with a so-called rucksack bandage. This is a bandage that is placed around both shoulders and tightened on the back. The pull that the bandage releases pulls the shoulders back.
This will straighten the broken collarbone and allow it to grow back as straight as possible. Conservative treatment with the aid of the backpack bandage usually takes 10-14 days for children. Thereafter, physiotherapy should take place to restore full shoulder mobility. In children, the fracture has completely grown back together and healed after about 3 weeks.
Please also read our topic: Collarbone fracture in the child
Duration
The duration of therapy for a broken collarbone depends on several different factors. On the one hand, there is a clear difference in the duration of therapy Children and adults. Children are almost always treated conservatively with a backpack bandage, which is suitable for 10-14 days must be worn.
Conservative treatment with the help of a backpack bandage in adults includes approximately 3 - 4 weeks. The final wearing time is however based on a X-ray control precisely defined. Based on this X-ray image In the course of therapy, the healing of the fracture can be precisely controlled and assessed.
If the fracture heals without complications under this therapy, the affected arm should follow up 6 - 8 weeks be resilient again.
As a complication of conservative treatment, however False joints,so-called Pseudarthroses, develop. These can too persistent pain in the area of the fracture and can lead to an increased formation of bone calcification Vascular and nerve tracts be narrowed so that Emotional and circulatory disorders may occur.
If these complications occur, therapy for a broken collarbone can help greatly lengthen and possibly a operative correction become necessary.
If the need for surgical correction is made, the affected arm should also be used for 6 - 8 weeks not be charged. If the x-ray check shows that the fracture has healed well and no complications have occurred, the material inserted for correction and fixation can be operated on again away become. Nails can approximate 8 - 12 months and plates after 18-24 months removed.
