Clavicle fracture, also called broken collarbone is a very common sports injury seen in people who are involved in contact sports such as football and martial arts as well as impact sports such as motor racing. A direct blow over the shoulder that may occur during a fall on an outstretched arm or a motor vehicle accident may cause the clavicle bone to break. Broken clavicle may cause difficulty in lifting your arm because of pain, swelling and bruising over the bone.
Broken clavicle bone, usually heals without surgery, but if the bone ends have shifted out of place (displaced) surgery will be recommended. Surgery is performed to align the bone ends and hold them stable during healing. This improves the shoulder strength. Surgery for the fixation of clavicle fractures may be considered in the following circumstances:
- Multiple fractures
- Compound (open) fractures
- Fracture associated with nerve or blood vessel damage and scapula fracture
- Overlapping of the broken ends of bone (shortened clavicle)
Plates and Screws fixation
During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause any irritation, they can be removed after fracture healing is complete.
Placement of pins may also be considered to hold the fracture in position and the incision required is also smaller. They often cause irritation in the skin at the site of insertion and must be removed once the fracture heals.
Patients with diabetes, the elderly individuals and people who make use of tobacco products are at a greater risk of developing complications both during and after the surgery. In addition to the risks that occur with any major surgery, certain specific risks of clavicle fracture surgery include difficulty in bone healing, lung injury and irritation caused by hardware.
Percutaneous elastic intramedullary nailing of the clavicle is a newer and less invasive procedure with lesser complications. It is considered as a safe method for fixation of displaced clavicle fractures in adolescents and athletes as it allows rapid healing and faster return to sports. The procedure is performed under fluoroscopic guidance. It involves a small 1 cm skin incision near the sternoclavicular joint, and then a hole is drilled in the anterior cortex after which an elastic nail is inserted into the medullary canal of the clavicle. Then the nail is passed on to reach the fracture site. A second operation to remove the nail will be performed after 2-3 months.
The shoulder is made up of the clavicle (collar bone), humerus (upper arm) and scapula (shoulder blade). The shoulder is a ball and socket joint where the ball of the upper arm bone articulates with the socket of the shoulder blade called the glenoid cavity. The shoulder blade is a flat triangular bone present on either side of the upper back. It articulates with the other two bones at the glenohumeral joint and acromioclavicular joint to provide stability and mobility to the arm. Scapula fracture refers to a fracture of the shoulder blade.
Scapula fractures can result from severe trauma such as a motor vehicle accident, a fall from a height, contact sports, a fall on an outstretched arm and direct blow on the shoulder during a fight.
Signs and symptoms
The signs and symptoms of scapula fracture are:
- Severe pain with movement
- Swelling on the back of the shoulder
- Numbness, tingling or weakness of the shoulder and arm
Scapula fractures are rare but can occur with rib or skull fractures and lung or spinal cord injuries.
To diagnose a scapula fracture your doctor reviews your medical history and performs a physical examination. Imaging studies including X-rays and a CT scan may be ordered.
Scapular fractures can be treated with nonsurgical or surgical intervention depending upon the type of fracture.
Nonsurgical treatment involves immobilizing the shoulder with a sling for 3 to 4 weeks, allowing the bones to heal on their own. Your doctor will prescribe medication to manage your pain. Physical therapy and stretching exercises should be started a week after the injury to reduce stiffness.
Scapular fractures that involve displacement at the glenoid articular surface, or fracture of the scapula neck or acromion process may require surgery to repair.
Surgery is performed to align and hold the displaced bones in their proper anatomical position until they heal. This is achieved with the help of screws and plates. The surgery can be performed traditionally by an open method or by a minimally invasive open reduction internal fixation surgery (ORIF). ORIF surgery as compared to open surgery is done by smaller incisions and thus recovery is much faster.
Surgery is performed to align and hold the displaced bones in the right position until they heal. This is achieved with the help of screws and plates. The surgery can be performed traditionally by an open method or by a minimally invasive open reduction internal fixation surgery (ORIF). ORIF surgery as compared to open surgery is done by smaller incisions and thus recovery is much faster.