SHOULDER: COLLARBONE FRACTURE

source: PhysioRoom.com

• The collar bone (clavicle) is one of the most commonly fractured bones in the body. 
• It is attached centrally to the sternum (breast bone) and at its outer side to the shoulder complex.
• This arrangement means that the usual cause of fracture is when a person falls onto an outstretched hand and the force is transmitted up the arm, resulting in a collar bone fracture.
• Sometimes a direct blow to the clavicle can also result in a fracture.
• In the case of injuries to children, there is usually little displacement of the 2 fracture fragments and subsequent healing occurs quickly over a period 2 to 3 weeks.
• In older individuals, where more force is applied to produce a fracture, the 2 fragments often become displaced and are prominent through the skin. Once the fractured bone has been reduced back into place it will usually heal in about 6 weeks.
• Occasionally there are complications with this type of fracture, including a fragment of bone causing damage to blood vessels in the chest, or imperfect union of the two fracture fragments which leads to a prominent notch once healing has taken place.

• Because the clavicle is so close to the surface of the skin, the fracture is usually characterized by the protruding fracture fragments. 
• As with any fracture there is considerable pain, and bruising may be visible. 
• he patient will hold the arm immobile in an attempt to relieve the pain.

• Treatment of a clavicular fracture is dependent upon the degree of displacement of the fracture fragments. If the two pieces of bone are reasonably well aligned, it will usually be sufficient to immobilize the affected arm in a sling or a figure-of-eight harness.
• Where there is excessive displacement that prevents union and healing, the orthopedic consultant may choose to repair the fracture surgically using screws. However, this situation is rare as the clavicle has a very good capacity to heal.
• Throughout the healing process the patient should follow a series of exercises to maintain the range of movement in the elbow, wrist and hand of the affected limb.
• Once full range of movement has been achieved, unrestricted shoulder motion is permitted. A return to sport should be granted by the orthopedic consultant, based on functional ability and x-ray evidence.

• Throughout the healing process following a collar bone fracture, it is important that the patient maintains the range of movement in the elbow, wrist and hand of the affected limb by going through the movements of these joints every day.
• Once this has been completed the patient should progress to active abduction (moving the arm out to the side) flexion (arm up to the front) extension (arm back) and rotation of the shoulder (hand behind head, then hand behind back) within the limits of pain.
• Once full range of movement has been achieved, unrestricted shoulder motion is permitted. A return to sport should be granted by the orthopaedic consultant, based on functional ability and x-ray evidence.