What Are the Most Common Clavicle Injuries?

The clavicle is S-shaped between the sternal stalk and the acromion, and it is the only bony support connecting the upper limbs to the trunk. The clavicle is located under the skin and is superficial. It is prone to fractures when exposed to external forces, and the incidence rate is 5% to 10% of systemic fractures. Occurs in children and young adults.

Basic Information

English name: fracture of clavicle
Visiting department: orthopedics

Multiple groups: Children, young adults
Common causes: Indirect and direct violence
Common symptoms: Swelling, subcutaneous congestion, tenderness, deformity, etc.

Causes of clavicle fractures

Both indirect and direct violence can cause clavicle fractures, but indirect violence is more common.

Clinical manifestations of clavicle fractures

Mainly manifested as local swelling, subcutaneous congestion, tenderness or deformity. The deformed fracture can touch the displaced fracture end. If the fracture is displaced and overlapped, the distance between the acromion and the sternal bone becomes shorter. Limbs on the injured side are limited in function, shoulders sag, upper arm against chest, dare not move, and support the elbow with a healthy hand to relieve pain caused by sternocleidomastoid muscle stretch. Tenderness of the fracture site at palpation can touch bone fricatives and abnormal activities of the clavicle. The malformations of young children's green branches are not obvious, and often they cannot complain about the pain, but their heads are often deviated to the affected side and their jaws are turned to the healthy side, which is helpful for clinical diagnosis. Sometimes the fracture caused by direct violence can puncture the pleura and cause pneumothorax, or damage the subclavian blood vessels and nerves, and the corresponding symptoms and signs appear.

Clavicle fracture examination

The auxiliary examination methods of this disease are mainly imaging examinations. Clavicle fractures often occur in the middle section. Most of them are transverse or oblique fractures. The medial stump is often shifted up and down due to the sternocleidomastoid muscle. The lateral end is shifted inwardly and downwardly by the gravity of the upper limbs. deformity.

1. X-ray inspection

X-ray imaging is needed to confirm the diagnosis when a clavicle fracture is suspected. Generally, 1/3 clavicle fractures are taken in anterior and posterior positions and a 45 ° oblique position toward the head. The shooting range should include the full length of the clavicle, the upper 1/3 of the humerus, the shoulder strap, and the upper lung field. If necessary, additional chest radiographs are required. Anterior and posterior images can show the up and down displacement of the clavicle fracture, and a 45 ° oblique image can observe the anterior and posterior displacement of the fracture.

Infantile clavicle fractures or green branch fractures are sometimes difficult to diagnose on the original X-ray, and can be re-examined 5 to 10 days after the injury, often showing epiphyseal formation.

For external 1/3 clavicle fractures, diagnosis is usually made by anterior and posterior and 40 ° tilted head X-ray images. Fracture of the articular surface of the outer end of the clavicle is often difficult to diagnose with conventional X-rays, and often requires tomography or CT.

X-ray images of the anterior and posterior 1/3 of the clavicle overlap with the mediastinum and vertebral body, making it difficult to show fractures. Taking an X-ray image tilted 40 ° to 45 ° towards the head can help find the fracture line. During the examination, it can not be satisfied that the soft tissue injury is diagnosed without a fracture on the X-ray orthotopic radiograph. It is necessary to carefully check whether there is an inner end of the clavicle or a local fracture sign in order to give a correct diagnosis.

2.CT inspection

CT examinations are mostly used for complex clavicle fractures, such as those involving the articular surface and acromion. Especially the fracture of the articular surface is better than X-ray examination.

Clavicle fracture diagnosis

The patient had a history of trauma such as abduction of the upper extremity or partial direct impact by violence. After the injury, shoulder pain occurred and the upper limb was afraid to move. X-ray film can confirm the diagnosis and show the displacement and comminution of the fracture.

Clavicle fracture treatment

Depending on the type of fracture and the degree of displacement, appropriate treatment should be selected.

Fracture of green branch

Most of them are children, and can be fixed with "8" bandages for those who have no displacement, and "8" bandages can still be used to maintain alignment after resetting. For older children who have a tendency to relocate, an "8" plaster bandage is appropriate.

2. No displacement fractures in adults

Fix it with "8" plaster bandages for 6-8 weeks, and pay attention to the shaping of the plaster to prevent displacement.

3. Fracture with displacement

All patients should be manually reset under local anesthesia, and then fixed with "8" plaster. The operation is as follows: the patient sits with his hands on his hips, his head raised, and his shoulders extended backward. The surgeon stands at the back of the patient. Hold the patient's shoulders anteriorly outside (or outside of the elbows) and apply force to the back and upwards. At the same time, use the front of the knee to support the patient's lower chest. Make the fracture ideal reduction. On this basis, the "8" plaster bandage was fixed. In order to avoid compression of the blood vessels and nerves in the axilla, during the whole process of wrapping the plaster bandage, the assistant should use the middle and index fingers of both hands to place on the patients' axillary arms in a crouched state. The plaster bandage is wrapped around the middle and index fingers of the assistant's hands and continues until the plaster bandage is formed. Under normal circumstances, the clavicle fracture does not require complete anatomical alignment, as long as the fracture is not severely displaced, good function can be obtained after the fracture heals.

4. Surgery

Indications for surgical treatment include open fractures; fractures with vascular and nerve damage; fractures of the outer or third of the clavicle with a fracture of the coracoclavicular ligament; displacement of the fracture; the fracture is not connected. The internal fixation method can be different depending on the type and location of the fracture, and select "8" wire, Kirschner wire or steel plate screws for fixation.