Types of Clavicle Fractures: Causes, Symptoms, and Treatment

Introduction:

The clavicle, commonly known as the collarbone, is a crucial bone that connects the sternum (breastbone) to the shoulder blade (scapula). It plays the main role in maintaining the shoulder joint's stability and improving the arm's smooth movement. Clavicle fractures are common injuries, often resulting from falls, sports accidents, or direct trauma to the shoulder region.

What Is the Anatomy of the Clavicle?

Before we explore the different types of clavicle fractures, it is essential to understand the anatomy of the clavicle. The clavicle is an S-shaped bone located horizontally above the first rib and below the shoulder joint. It has two ends:

• The medial end (sternal end) attaches to the sternum.

• The lateral (acromial) end connects to the acromion, part of the scapula.

• Because of its distinct position and shape, this bone can support the shoulder complex and transfer forces from the upper limb to the axial skeleton.

What Are the Types of Clavicle Fractures?

Each type of fracture has distinct characteristics and may require different treatment approaches:

1. Midshaft Clavicle Fractures: Midshaft clavicle fractures are the most common type, accounting for approximately 80 to 85 % of all clavicle fractures. These fractures occur in the middle of the clavicle, between the medial and lateral ends. They are often caused by a direct blow to the clavicle or a fall onto the shoulder.

Symptoms:

• Swelling and tenderness over the fracture site.

• Pain that worsens with arm movement.

• The displacement of bone fragments causes a visible deformity or bump at the fracture site.

Treatment:

• Non-surgical treatment is typically recommended for most midshaft clavicle fractures.

• Immobilization of the arm and shoulder using a sling or brace.

• Pain management with over-the-counter pain relievers.

• Physical therapy to restore range of motion and strength.

2. Lateral Clavicle Fractures (Distal Clavicle Fractures): Lateral clavicle fractures occur at the outer end of the clavicle, near the acromion. These fractures are less common, accounting for around 10 to 15 % of clavicle fractures. They are usually caused by a fall onto an outstretched hand or a cause of direct impact on the outer shoulder.

Symptoms:

• There is severe pain over the acromioclavicular (AC) joint, where the clavicle meets the acromion.

• Swelling and bruising around the AC joint.

• Difficulty in moving the arm, especially with overhead activities.

Treatment:

• The management of lateral clavicle fractures can be challenging.

• Non-surgical treatment with immobilization and a sling is typically the first approach.

• Severe cases may require surgical intervention to stabilize the AC joint using hardware (e.g., screws or plates).

3. Medial Clavicle Fractures (Sternal Clavicle Fractures):

Medial clavicle fractures are relatively rare and occur at the inner end of the clavicle, near the sternum. These fractures can result from significant trauma, such as a high-speed car accident or a direct impact to the chest.

Symptoms:

• Severe pain and tenderness over the sternal end of the clavicle.

• Swelling and bruising in the chest area.

• Difficulty breathing deeply or coughing due to the proximity of the fracture to the thoracic cavity.

Treatment:

• Stabilization and immobilization with a sling or brace.

• Pain management and close monitoring for any associated injuries, especially those involving the chest or internal organs.

• Surgical intervention may be required for complex or displaced sternal clavicle fractures.

How to Make a Diagnosis of Clavicle Fractures?

The diagnosis of clavicle fractures typically involves a combination of clinical evaluation and imaging studies:

• Clinical Evaluation: The orthopedic or healthcare provider will conduct a physical examination to assess swelling, tenderness, deformity, and range of motion.

• They will inquire about the circumstances surrounding the injury and any associated symptoms.

• Imaging Studies: X-rays are the primary imaging modality to diagnose clavicle fractures. Anteroposterior (AP) and lateral views are often obtained to assess the fracture's location, displacement, and alignment. In some cases, a computed tomography (CT) scan may be ordered to evaluate complex fractures or associated injuries, such as damage to blood vessels or nerves.

What Are the Complications and Associated Injuries With Clavicle Fractures?

Clavicle fractures, if not treated appropriately, can lead to several complications and may be associated with other injuries:

• Nonunion: In some cases, the fractured clavicle may not heal properly, resulting in nonunion. This occurs when the bone fragments do not rejoin, leading to persistent pain and instability.

• Malunion: If the clavicle heals in an abnormal position, it can cause functional deficits and cosmetic deformities.

• Nerve or Vascular Injury: Severe fractures or high-energy trauma can damage nearby nerves or blood vessels, leading to sensory or motor deficits and circulation problems.

• Rib Fractures: Trauma to the clavicle area may also result in rib fractures, especially when the force is transmitted to the chest wall.

What Are the Treatment Options for Clavicle Fractures?

Treatment choice for clavicle fractures depends on several factors, including the type of fracture, its location, the degree of displacement, and the patient's age and activity level. Treatment options are both non-surgical and surgical approaches:

Non-Surgical Treatment:

a. Immobilization: Most midshaft clavicle fractures and some lateral clavicle fractures can be effectively treated with immobilization using a sling or brace. This allows the bone to heal naturally while supporting the shoulder and arm.

b. Pain Management: In order to control pain and discomfort during the healing process, over-the-counter pain relievers like Ibuprofen or Acetaminophen are frequently advised.

c. Physical Therapy: After immobilization, physical therapy may be prescribed to regain shoulder range of motion, strength, and function.

Surgical Treatment:

a. Open Reduction and Internal Fixation (ORIF): Surgical intervention may be necessary for displaced, complex, or lateral clavicle fractures with AC joint involvement. During an ORIF procedure, the surgeon repositions the bone fragments and uses hardware (e.g., plates, screws, or pins) to stabilize the fracture.

b. Plate Fixation: This technique involves securing the fractured clavicle with a metal plate and screws to maintain alignment and stability.

c. Intramedullary Fixation: In some cases, a rod may be inserted into the clavicle's medullary canal to provide internal stabilization.

d. AC Joint Stabilization: Surgical reconstruction of the AC joint may be necessary when a lateral clavicle fracture is associated with AC joint disruption.

What Is the Rehabilitation and Recovery?

Recovery from a clavicle fracture can vary depending on the fracture type and the chosen treatment method. However, there are some general guidelines for rehabilitation and recovery:

Non-Surgical Recovery:

• Patients with non-surgically managed clavicle fractures typically begin gentle range-of-motion exercises as soon as pain allows.

• Gradual strengthening exercises are introduced under the guidance of a physical therapist.

• Full recovery can take several weeks to a few months, depending on the fracture's severity.

Surgical Recovery:

• After surgical fixation, patients may be required to wear a sling or brace for a period to protect the healing bone and allow for initial stabilization.

• Physical therapy is essential to restore strength, mobility, and function.

• The recovery timeline may vary but often extends over several months, with a gradual return to normal activities.

Follow-up Care: Regular follow-up appointments with the orthopedic specialist are crucial to monitor the healing process and address any complications or concerns. The timing for returning to sports or high-impact activities should be discussed with the treating physician and guided by individual progress.

Conclusion:

One common injury that can arise from different kinds of trauma is a clavicle fracture. Patients and healthcare professionals must be aware of the various forms of clavicle fractures, as well as their causes, symptoms, diagnosis, and available treatments. Early and appropriate non-surgical or surgical management can significantly impact the outcome and ensure the best possible recovery for individuals with clavicle fractures. Timely medical evaluation and ongoing care are crucial to achieving optimal results and minimizing the potential complications associated with these fractures.