When people start discussing bone fractures, clavicle fractures are usually involved in the discussion because they are among some of the most common bone fractures seen in the medical community. The clavicle bone, also known as the collarbone, is one of the most exposed bones in the body and serves to strengthen the connection between the arm, shoulder, and rib cage while also protecting the important blood vessels underneath. Because of its exposed location, it is a common fracture seen from birth all the way through childhood and adulthood into the senior years. Because it is so common, patients need to make sure they understand a few important facts about a broken clavicle.What is a Fractured Clavicle?
Patients who have suffered a fractured clavicle may also be told that they have suffered a broken collarbone. These are two terms for the same injury; however, not every clavicle fracture is the same. The medical community has broken up clavicle fractures into three different types based on their possible complications and treatment implications. The three types include:
A Fracture of the Middle Third: The length of the clavicle is divided into three different parts including the lateral third (closer to the arm), the medial third (closer to the neck), and the middle third (in between the other two segments). A fracture of the middle third is the most common broken clavicle, occurring in around 80 percent of all clavicle fractures. This common fracture has the lowest statistic rate of complications.
A Fracture of the Lateral Third: A fracture of the lateral third occurs in around ten to 15 percent of patients. This is a dangerous clavicle fracture because it has the opportunity to damage a number of surrounding structures depending on whether or not the fracture has been displaced. In addition, many fractures of the lateral third will require surgery to repair the clavicle and any associated structures that may have been damaged in the process.
A Fracture of the Medial Third: This is a fracture of the portion of the clavicle that is closest to the neck. It is a highly unusual fracture making up only a couple percent of the total number of fractured clavicles. If the fracture has been displaced, it has a chance to damage large blood vessels and possibly the patient’s airway, making it very dangerous. If these complications are present, the patient could require emergent surgery.
Clearly, these fractures all have their own possible complications and treatment implications. For this reason, it is vital for patients to understand the different types of clavicle fractures and the problems they can present.How are Clavicle Fractures Caused?
When patients suffer a broken collarbone, they often want to know how this fracture developed so that they can understand how to prevent this injury from happening again. Because a broken clavicle can develop at any age, the way these fractures develop is dependent on the patient’s age. For example, a newborn baby can suffer a broken collarbone as it is passing through the vaginal canal. Baby bones are thinner and weaker. Therefore, they can suffer a broken collarbone simply due to the squeezing of the vaginal walls or the compression of the physician or nurse delivering the baby. Because of the size of a baby’s collarbone, these injuries usually require nothing more than a sling.
When children break their collarbone, it is usually due to a traumatic injury. For example, children falling off of a trampoline or out of a tree break their collarbone on a regular basis. It is natural for children (and adults) to try and land on their side instead of their back or stomach to protect their head and vital organs. On the other hand, this kind of fall exposes the arm and the collarbone to impact. For this reason, children suffer broken collarbones regularly. They can even break their collarbone by simply falling out of bed.
In addition to children, elderly patients fall as well. As people age, they lose the ability to maintain their balance. Furthermore, elderly individuals often have degenerative bone conditions such as osteoporosis or osteopenia. Because they fall more often and their bones are weaker, they run the risk of fracturing their collarbone.
Car accidents are another common cause of broken collarbones, particularly if a car is t-boned. If a car is impacted in its side, it exposes the driver or passengers’ arms, and collarbones, to being impacted. Because of the exposed nature of the collarbone, it always runs the risk of being broken in a car accident. For this reason, many people will suffer a fractured clavicle in an auto accident.The Symptoms of a Broken Clavicle
When patients visit the physician either in the emergency room or the clinic for a fractured clavicle, the visit will always start with a history. The physician will ask about how the accident occurred and whether or not the patient has broken their clavicle before. After, the physician will ask the patient about the symptoms that they’re experiencing. A few common symptoms of a broken collarbone beyond pain and swelling include:
Inability to Move the Arm: The clavicle plays an important role in the motion of the shoulder and the arm. Patients who have a broken collarbone will not be able to raise their arm over their head because of the pain. Patients with a severe injury may not be able to move their arm at all.
Cracking, Grinding, or Pressure Sensation: In addition to pain, patients will be reluctant to raise their arm because of the awkward sensation they feel when they do so. Some patients will describe a grinding or cracking sensation when they move their arm because the clavicle may be displaced out of its proper location. This could lead to grinding or cracking when the shoulder or arm press against a broken clavicle. Some patients may feel an increased pressure in that location.
The Physical Exam of a Broken Clavicle
Once the physician has taken the time to collect all of the information on a patient’s medical history and their symptoms, they will move on to the physical exam. The physician will listen to the patient’s heart and lungs like any other visit; however, they will focus on the fractured clavicle. There are a few common physical exam findings that they will look for on their exam, including:
Swelling, Tenderness, and Bruising: These are common physical exam findings with any fractured bone and this holds true for a broken clavicle as well. There may be swelling over the fracture site as the body rushes fluids to the fracture location to expedite the healing process and limit your range of motion. When the physician palpates over the fractured clavicle, the patient may experience a slight increase in the amount of pain, called point tenderness. Furthermore, there are many different blood vessels that run through the shoulder that could have been damaged by the fracture. This could lead to bruising over the broken collarbone.
Deformity Of the Fracture Site: Physicians may notice a small bump over the fracture location. When the clavicle fractures, there could be muscles that pull the different bone fragments in different directions. For this reason, part of the clavicle may be pulled toward the skin surface, leading to a deformity over the fracture location. Sometimes, this may not be visible due to swelling in that location; however, this is a common finding with clavicle fractures.
The Shoulder May Sag: The physician will want to look at both shoulders to check and see if one of the shoulders is sagging. Because the clavicle plays an important role in the movement of the arm, it’s not unusual for patients to have the shoulder on the fractured side sag a little bit lower because the clavicle is no longer able to do its job correctly.What Kind of Imaging Studies Will I Need?
Once the physician has gone through their history and physical exam, the next step will be to order a few imaging scans. While a clavicle fracture is relatively common and quickly diagnosed during a physical exam, imaging studies are still going to be necessary to classify the fracture and look for injuries to other structures that are in the area.
Ultrasound: An ultrasound scan is used in two distinctly different scenarios when it comes to a fractured clavicle. First, an ultrasound is used to fully diagnose a clavicle fracture in a newborn baby. Because babies are smaller and their bones aren’t fully developed yet, a fracture can be quickly diagnosed on an ultrasound scan, saving babies from being exposed to radiation. An ultrasound can also be used in adults to check for any rapid bleeding, particularly in fractures of the medial third, in the emergency room if patients were involved in a traumatic accident.
X-Ray: This is the battle-tested method of diagnosing fractures all over the body and the collarbone is no different. X-rays have been used for decades to accurately diagnose fractures. It will be used to localize the fracture and provide information to physicians and surgeons regarding potential complications and treatment options.
MRI: As discussed above, certain fractures have a higher chance of causing complications than others. In rare instances, clavicle fractures have the chance of damaging muscles, tendons, ligaments, blood vessels, nerves, and even the patient’s airway. These structures are less dense than bones and may require a more detailed image to ensure that they haven’t been damaged. This is where an MRI comes in. An MRI takes longer than an x-ray; however, it provides the detail that these structures require. They also don’t require any radiation to produce their image.Will I Require Surgery to Repair my Broken Clavicle?
Not every patient will require surgery to fix their broken clavicle; however, there are two questions that need to be answered. First, the question is whether or not the fracture has been displaced. If the fracture has been displaced, the bones will not heal correctly, referred to as a malunion. Displaced clavicle fractures are more common in the lateral third than in the middle third, meaning that they will require surgery more often. Broken clavicles that have not been displaced are commonly treated without surgery. In addition, other structures in the area may have also been damaged. If this is the case, patients will require surgery, sometimes emergently, to fix these structures. These complications are also more common in the lateral third and medial third than in the middle third.Some Patients May Require Rehabilitation
Because the clavicle is a smaller bone, it also heals relatively quickly. After the clavicle has healed, patients may feel like their arm is a little stiff due to having their arm immobilized for a long period of time. If the patient suffered a fracture that led to complications, patients may require a greater degree of rehab and physical therapy. For example, if the patient has torn muscles, nerves, or had their airway damaged, they will require an extensive amount of rehabilitation to learn how to use these muscles or, in severe situations, learn how to breathe again if their airway has been damaged. Pain medication can be used for basic pain management under a medical professional's direction.Complications of a Fractured Clavicle
Most patients with a broken clavicle will not have any complications at all; however, there are a few severe complications that patients should be aware of. A fracture of the medial third can damage some of the largest blood vessels in the body, leading to tremendous bleeding that could be life-threatening. A fracture of the medial third could even damage the patient’s airway, also threatening the life of a patient. A fracture of the lateral third could damage muscles or nerves, leading to additional complications with the motor function of the arm even after the broken clavicle has healed. While most fractured clavicles will heal without any of these complications, people need to know that these are serious complications that could occur with a broken clavicle.
Contact an Experienced Bone Fracture Attorney
I’m Ed Smith, a Sacramento Bone Fracture Attorney. A clavicle fracture is a common injury that could lead to serious complications. If you or a loved one has been involved in a traumatic accident, please call me at (916) 921-6400 or (800) 404-5400 for friendly and free advice.
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