1173185, Diagnostic Procedures and Differential Diagnosis, Rehabilitation for Conservative Management, Rehabilitation After Postoperative Treatment, Paladini, P et al. Causes, clinical manifestations, and treatment of fat embolism. 1. conservative vs surgical. Patients with clavicular fractures are best managed by an interprofessional team that includes an orthopedic surgeon, emergency department physician, primary care provider, nurse practitioner, and a physical therapist. You may see or feel a bump where the bone is broken, and sometimes your shoulder may look like it droops down lower than your other side. 2013 Jun 1;25(2):321-31. Download PDF. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. So for the athletic individual, operative intervention is routinely performed for displaced lateral fractures and is recommended for mid-shaft fractures that are completely displaced, shortened >2 cm or comminuted.[3]. http://www.youtube.com/watch?v=RKScXgsYXwk, Treatment and rehabilitation of fractures, http://chambalravine.blogspot.com/2013/07/biomechanical-principles-of-fracture.html, https://www.physio-pedia.com/index.php?title=Fracture&oldid=241449. Although a fall onto an outstretched hand was traditionally considered the common mechanism, it has been found that the clavicle most often fails in direct compression from a force applied directly to the shoulder. During forceful coughing, sneezing also patients need to take caution (as respiratory excursions may cause clavicle movement) by avoiding it as much as possible and also learning active-assisted coughing techniques if necessary. Nb. Stops additional bleeding; provides structural and biochemical support for the influx of inflammatory cells, fibroblasts, chondroblasts and the ingrowth of capillaries, Fat embolism syndrome (a piece of fat that released into the blood vessels causing blockage of blood flow). [9]. Neer classification of clavicle fractures. Typically, fractured clavicles occur as the result of a direct blow to the shoulder. Help the client understand, If the fracture is in the arm, you as the physical therapist may teach you how to apply and remove the sling. It is marked by 3 longitudinal ridges. Children can typically heal from a clavicle fracture in 3-6 weeks where it may take an adult 6-8 weeks. A fractured clavicle, or fractured collarbone, is a common sports injury that generally occurs from an impact to the shoulder of a fall on an outstretched arm. Search. Together, insufficiency and fatigue fractures are often grouped together as stress fractures. Most distal clavicle fractures are the result of a fall onto the distal clavicle or a direct blow to it. Return to full contact sports requires the athlete should demonstrate radiographic evidence of bony healing, no tenderness to palpation, a full range of motion, and normal shoulder strength. Remodeling can result in almost perfect healing, however, particularly if the alignment is not perfect, a residual deformity will remain. In most cases Physiopedia articles are a secondary source and so should not be used as references. Displaced mid-shaft fractures treated with conservative management can lead to refracture (over half of the cases) and delayed surgical intervention ( over quarter of the cases). osteogenesis imperfecta) and thus prone to fractures from force… Younger individuals often sustain these injuries by way of moderate to high-energy mechanisms such as motor vehicle accidents or sports injuries, whereas elderly individuals are more likely to sustain injuries because of the sequela of a low-energy fall. Helping your clavicle to recover after a fracture Information for patients. When refering to evidence in academic writing, you should always try to reference the primary (original) source. A patient may cradle the injured extremity with the uninjured arm. A figure-of-eight brace is often thought to prevent or reduce secondary fracture shortening during the time of fracture healing. Clavicle fracture usually occurs following trauma with a direct blow to the shoulder region, often following a fall. Search results Jump to search results. [3], Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. Begin normal light daily activities with the arm and shoulder. Sporting activities and work, demanding weight-bearing and the use of the arm, are usually suspended until the patient is free of pain with radiographic signs of progressing fracture consolidation, usually after 6-12 weeks. This process takes approximately a week, forming a primary callus which is non-mineralized and not readily visible on radiography. [1], Fractures of the clavicle is typically described using the Allman classification system, dividing the clavicle into 3 groups based on location which was later revised by Neer(in which Group II was further classified into 3 types).[1]. But it is associated with more discomfort and pain including nerve compression with temporary brachial plexus palsies and restriction of venous blood return. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Palpation of the scapula and ribs may reveal a concomitant injury. Whilst clavicular fractures may be very painful, yet they are rarely serious and in most cases, they are managed conservatively with a sling … Group III: Fractures of the proximal or medial third. An early mobilization rehab protocol can be safely recommended for both acute and non-union post-operative cases. Symptomatic non-union like shoulder girdle dysfunction neurovascular compromise. The physiotherapist’s role is to identify the cause of the problem and to select the appropriate procedure to alleviate or eliminate the cause of the loss of movement. Subjective – any information given to you by the patient: allergies, past medical history, past surgical history, family history, social history (living arrangements, social conditions, employment, medication), review of systems . If a pulmonary injury is suspected or identified, perform an arterial blood gas (ABG) test and obtain an expiration posteroanterior (PA) chest film. This continues to provide satisfactory results for undisplaced fractures but conservative management of displaced mid-shaft clavicle fractures results in increased rates of re-injury, increased return times to sport and suboptimal shoulder function, secondary to clavicular mal-union and shortening, with resultant thoracoscapular dyskinesia. Jay Cheon. The diagnosis of clavicle fractures is usually straightforward. While most clavicle fractures are treated conservatively, severely displaced or comminuted fractures may require surgical fixation[1]. metastasis, or bone cyst). Most clavicle fractures are treated without surgery. Non-ACJ-spanning plate fixation and open suture fixation appear to offer better sporting outcomes than other fixation which is likely due to the preservation of ACJ function. The coracoclavicular ligaments remain attached to the periosteum while the clavicle herniates through the torn periosteum causing a pseudodislocation. Complications of fractures. Kleinhenz BP, Young CC, Clavicle Fractures. Each fracture is unique. Treatment of clavicular fracture depends upon whether a fracture is displaced or undisplaced. There is commonly displacement of the fracture; the medial fragment is pulled upwards by the sternocleidomastoid while the distal fragment is pulled downwards by the weight of the arm. Pneumothorax (an accumulation of air in the space outside the lung), clavicle fractures, and injuries to the blood vessels are among the most commonly associated injuries. 1173185. The age of the person, for example, people with osteoporosis predisposes more to healing complications. Become an editor or join our volunteer programme to make your contribution. Fractures of the clavicle can be classified by its anatomical location (Table 1): Table 1: Correct postural habits and neck ROM are taught. Clinical techniques in small animal practice. Regain Range of Motion (ROM): Perform protected ROM 3. Clavicular Fracture - Physiopedia A clavicle fracture is also known as a broken collarbone. Clavicle fractures are very common injuries in adults (2–5%) and children (10–15%) and represent the 44–66% of all shoulder fractures. Shoulder active-assisted to active range of motion in a single plane with no more above than 90 degrees is recommended within the first 6 weeks. Nonuse of the arm on the affected side is a neonatal presentation. Search. The severity of bone fractured, the type of fracture sustained, and to what extent the misalignment of the fractured bone. This phase lasts many months, maybe years, and represents the gradual formation of compact cortical bone with greater biomechanical properties and allows for the reduction of the width of the callus. These are known as pathological fractures. Neurovascular injury or compromise that is progressive or that fails to revere after the closed reduction of the fracture. The AO classification of clavicular fractures along with the Neer classification system is one of the more frequently used classification systems when assessing distal clavicular fractures. Universities. Fractures can also occur, however, in a variety of other settings. Internal fixation with plates and screws. Most clavicle fractures heal without difficulty. However, a few patients may have chronic pain and limited range of motion of the shoulder. Gradual progression of cardiovascular endurance training can be started using brisk walking and static bycycle. Contribute. Robinson’s classification was more specific for different fracture patterns in the middle third, while Craig’s classification was more specific for fractures of the lateral third.[4]. [9] And studies concluded that there are no differences between these two techniques regarding healing time and the rate of nonunion for treating clavicle fractures. Classification. The primary goal of rehabilitation is to improve and restore the function of the shoulder for activities of daily living, vocational, and sports activities. Associated distal nerve dysfunction indicates a brachial plexus injury. Now that you are using your sling less, it is very important that you use your shoulder as normally as possible. The treatment will depend very much on the problems identified during your initial assessment, but may include a mixture of the following: Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. They are common in very young and very old patie… The forces involved in scapular fracture can also cause tracheobronchial rupture, a tear in the airways. Operative treatment of clavicular fractures: a prospective study. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). That is usually the journal article where the information was first stated. osteoporosis) or less frequently genetic abnormalities (e.g. According to the Systematic review done by Robertson and Wood, 2016, most patients with an acute clavicle fracture will return to sports activity, with around four-fifths of all patients able to return to their pre-injury level of sports activity. Bob and Brad Clavicle fracture Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. However, the vast majority (69-82%) occur in the midshaft, at or near the junction of the middle and outer third. [1], Many of the aforementioned fracture types can also go on to have additional complicating features (and many associated soft tissue injuries). www.emedicine.medscape.com/article/92429-overview#showall, M. Pecci, J. Kreher, MD, Boston university, Clavicle fractures, jan. 2008. Traditionally, the management of clavicle fractures has been through conservative management with sling immobilization and subsequent rehabilitation. How Does A Bone Break Heal - Bone Fracture Healing Process. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Simple or compound according to the penetration of the skin. Contact us. AO classification of clavicle fractures. Bowing, buckling, and greenstick fracture are types of fractures common in children. The odds ratio for progression of the clavicle fracture to >100% was 4.08 (P = 0.000194) when ribs 1-4 were fractured and not significant for rib fractures 5-8 or 9-12. Infection, that can lead to delayed, poor, or non-union healing. Indirect injuries are commonly associated with tears of the retinaculum and vastus muscles.Patella fractures make up about 1% of all skeletal injuries. Top Contributors - Elvira Muhic, Sofie Van Cutsem, Manisha Shrestha, Lucinda hampton and Kim Jackson. Approximately two-thirds of all clavicle fractures occurring in males. The Neer classification of clavicular fractures along with the AO classification system is one of the more frequently used classification systems when assessing clavicular fractures. Fractured clavicle fixation surgery is performed to re-position and re-align an unstable fracture of your collar bone. These fractures may be partial or complete and often require surgical repair or immobilization while they heal. In most cases, clavicle fractures are easily identified on plain x-ray. Clavicle fractures: a comparison of five classification systems and their relationship to treatment outcomes. It is the most common fracture of childhood. The bone may have a lesion that focally weakens a bone (e.g. Clinical features vary depending on the cause and nature of the injury and range from unconsciousness to the patient being able to use the limb, although complaining of pain. Due to its superficial subcutaneous location and the numerous ligamentous and muscular forces applied to it, the clavicle is easily fractured. So regular follow- up needs to be done to check whether the fracture site is properly unioned or not. Avoid heavy lifting for the full 6 weeks. Associated injuries should be ruled out, such as other … Doing an assessment for the patient is necessary also doing The problem-oriented medical record (POMR) system ( is based on a data collection system that incorporates the acronym SOAP: Also By Using specific exercises, the aim is to reduce any swelling, regain full muscle power and joint movement, and to bring back full function. With a suspected vascular injury, obtain a complete blood count (CBC) to check the hemoglobin and hematocrit values. Clavicle Fracture. Relative indications include shortening of more than 15 to 20mm and displacement more than the width of the clavicle. Dr Henry Knipe and Andrew Murphy et al. The entire skeleton may be weak due to metabolic (e.g. Objective – all information obtained through observation or testing, e.g. These cells lay down woven bone which stabilises the fracture site. The chief goal of this treatment is to achieve a healed clavicular strut in a normal anatomical position as possible. professional athlete vs debilitated elderly). Clavicle fracture surgery involves realigning the broken pieces of bone and holding them in place with special plates, pins, or screws. Conservatively treated fractures of the clavicular midshaft usually unite between 18 and 28 weeks after the injury. [3], The studies have reported that return to sports is between 6 to 12 weeks post-operatively and 3-4 months to those who are managed conservatively. Fractures usually fall within a set number of patterns: In general, the fracture has many classifications, according to the position of the ends of bone fracture, displaced or non displaced. Complete fracture: extends all the way across the bone (most common), Transverse fracture: perpendicular to the axis of the bone, Oblique fracture: orientated obliquely across the bone, Spiral fracture: helical fracture path usually in the diaphysis of long bones, Incomplete fracture: does not cross the bone completely (usually encountered in children), Bowing fracture: an incomplete bone fracture of the long bone in infants and children due to forces in the axial load, Buckle fracture: due to direct axial load, the cortex is buckled, often in the distal radius, Greenstick fracture: the cortex is broken, but only on one side. Decrease the use of arm sling (use during non-dependent position). Type II distal clavicular fracture (displaced). A fall onto the lateral shoulder most frequently causes a clavicle fracture. https://www.stoneclinic.com/broken-collarbone-rehab-protocol, https://www.youtube.com/watch?v=8uUT2Ozin5o&feature=youtu.be, https://www.physio-pedia.com/index.php?title=Clavicular_Fracture&oldid=240689, Are the most common fractures during childhood. sustaining a fall; a direct blow or ; a car accident; Frankly, broken collarbones are most common in children in young adults. running)  can result in the accumulation of microfractures faster than the body can heal, eventually resulting in macroscopic failure. Alignment may or may not be necessary depending on the degree of displacement, the importance of correct alignment (e.g. Evidence-based information on management of fractured clavicle from hundreds of trustworthy sources for health and social care. In first few weeks ( 2-4 weeks), POLICE principle can be used in acute undisplaced clavicle fracture which is further explained below in context of clavicle fracture. Lateral clavicle fracture is more complicated than mid-shaft clavicle fracture so the outcome of mid-shaft fracture is better than that of lateral clavicle fracture. Available from: Hershey K. Fracture complications. A clavicle fracture is also known as a broken collarbone. Most commonly fractures occur in the setting of a normal bone with acute overwhelming force, usually in the setting of trauma. This article will briefly review clavicle anatomy and function, as well as clavicle fracture classification, epidemiology, an… 2003 Dec. 31(12):30-6. . To help patients make informed decisions regarding treatment options and return-to-play decisions, it is essential for the clinician to understand the risks and benefits of these treatment options. Return to sport following clavicle fractures: a systematic review. Whereas, in displaced lateral clavicle fracture routine removal of metalwork was performed for ‘hook’ plate fixation, screw fixation, cerclage wire fixation, and tension band wire fixation but not for ‘non-ACJ-spanning’ plate fixation and suture fixation. However, the management of these injuries can present a challenge, particularly when trying to minimize long-term dysfunction, pain, or deformity. This is due to two factors: firstly this is the thinnest part of the bone, and secondly, it is the only part of the bone not reinforced by attached musculature and ligaments 3. General: epiphysis, physis, metaphysis, diaphysis; specific features: e.g. range of joint movement, muscle strength . Use of arm sling as mentioned above ( need to use most of the times). Learn more about the rehab, recovery time, & exercise protocols for broken collarbone, fractured clavicle, or other shoulder injuries repairs. So rehabilitation protocol may also vary based upon individual co-morbidities. The patient may appear with the following signs and symptoms: Diagnose can often be made by a client's history and physical examination.[6]. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. PHASE ONE: 0 – 4 Weeks Post-Injury Program GOALS: 1. https://radiopaedia.org/articles/fracture-1, https://radiologykey.com/types-of-fractures-in-children/, Fracture healing physiology and the quest for therapies for delayed healing and nonunion, http://www.youtube.com/watch?v=od8oU5OLMGU. Examples of early treatment include. Therapy/Advice for 1-2 weeks Post injury: Therapy/Advice for 3-6 weeks Post -injury: Therapy/Advice for 6-12 weeks Post-injury: Start a more aggressive strengthening program, cardiovascular endurance training as tolerated, and progressive sports- specific training are addressed. CLAVICLE FRACTURE REHABILITATION PROTOCOL: Jordon Young Institute, CLAVICLE FRACTURE STABILIZATION Post –Operative Rehabilitation, https://www.ncbi.nlm.nih.gov/books/NBK507892/. When describing a clavicle fractures note the location of the fracture along the shaft. Group I: Fractures of the middle third or midshaft fractures (the most common site). Immobilisation can be achieved in a variety of ways depending on the location, morphology of the fracture, and device of fixation. Scar management if the patient had surgery to fix the fracture, Return to sport preparatory work and advice where required. “Treatment of Clavicle Fractures.” Translational Medicine @ UniSa 2 (2012). Severe displacement caused by comminution with resultant angulation and tenting of the skin severe enough to threaten its integrity and that fails to respond to closed reduction. Occult fractures may also be present. The middle third of the clavicle is fractured in 69% of cases following the distal third in 28% of cases, and the proximal third in 3% of cases. Medscape. Venous stasis, discoloration, and swelling indicate a subclavian venous injury. Type II distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. This leaflet gives you the advice and exercises to help your clavicle (collar bone) to recover after your fracture. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. If all clavicle fractures are considered together, the vast majority heal with nonoperative management, which includes use of a simple shoulder sling. Healing complications: malunion, delayed union, or nonunion. Level of evidence: 1 Grade of recommendation: B. Reddy YT, Reddy SS, Reddy V, Vadlamani KV, Suresh M. Fanter NJ, Kenny RM, Baker III CL, Baker Jr CL. [2] About 87% of reported cases, a clavicle fracture results from a fall directly onto the lateral shoulder. Lädermann A, Abrassart S, Denard PJ, Tirefort J, Nowak A, Schwitzguebel AJ. Laboratory studies are ordered in clavicle fractures according to the severity of trauma. Rehabilitation protocol may vary slightly in first few weeks based upon the primary treatment approach i.e. Fracture healing may take more time in nonoperative treatment. Progressive resistive exercises (isotonic) for scapular stabilizers, biceps, triceps and rotator cuff are prescribed after 6 weeks. Comprise up to 10% of all sport-related fractures and have the third-longest return time to sport with as many as 20% of athletes with such injuries failing to return to sport. A thick ridge adjoins the lateral border. Protect Clavicle: Arm sling for 6 weeks 2. Absence of pain on weight-bearing, lifting or movement, No tenderness on palpation at the fracture site, Blurring or disappearance of the fracture line on X-ray, A physical therapist may instruct the client how to walk with an, After a lower extremity fracture there may limit the amount of weight client can put on the leg. These features are : The average of none healing is about 6-8 weeks, but it varies depending upon many factors, including : A fracture is considered to be clinically healed based upon the combination of physical findings and symptoms over time. This course is the third in a series of courses examining the physiotherapy management of distal radius fractures following open reduction internal fixation (ORIF) surgery. Free active and active assisted range of motion of shoulder in all planes is usually allowed after 6 weeks with passive ROM as tolerable. Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: a case-control study. Studies have found, however, that in cases of specific fracture patterns and locations, not all clavicle fractures behave the same way. Radiographs confirm the diagnosis and aid in further evaluation and treatment. Nonoperative Treatment of Midshaft Clavicle Fractures in Adults. Decreased pulses may indicate a subclavian artery injury. That is usually the journal article where the information was first stated. Patients with distal clavicle fractures typically present with shoulder pain. Exam and Workup also do not raise concern for Pneumothorax at this time. Clavicular fracture in a collegiate football player: a case report of rapid return to play. Return to specific sports is determined by the physical therapist through functional testing specific to the patient’s demands according to which progressive sport-specific training is planned. Several studies have questioned the clinical relevance of distal clavicle nonunion, however. Which bone is fractured; long bone as the humerus, short bone as in carpal bones, flat bone such as scapulae and ribs, sesamoid bone as in patella, and irregular bone ( vertebrae and skull). However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Patient does not currently demonstrate complications of fracture such as compartment syndrome, arterial or nerve injury. Classification. The type of fixation, it is a cast, splint, or it is ORIF procedure. 1,16 Direct impact occurs at the acromion, usually with the arm in an adducted position, and force is transmitted through the AC joint to the CC ligaments and the distal clavicle. Tenting and blanching of the skin at the fracture site may indicate an impending open fracture, which most often requires surgical stabilization. Contact sports should be avoided for 3-4 months. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Self-mobilisation of the elbow and wrist out of the sling is required several times a day to avoid stiffening of the elbow and wrist. A common site for non-union. Jackson LC, Pacchiana PD. It is the most common fracture of childhood. index finger vs rib), and the patient (e.g. These fixation methods are necessary for lateral clavicle fracture as it involves acromioclavicular joint and various ligaments that may become injured during fracture.[3]. It allows micromotion between the two fractured sites and partial transmission of load, so promote secondary bone healing with callus formation, which is a relatively rapid bone healing. Patients heal at different rates depending on their general health and underlying illnesses. The involved arm will be placed in a sling or a figure-8 brace to secure it and support its weight for comfort. Inability to tolerate closed immobilization such as neurological problems of Parkinsonism, seizure disorders. Common complications of fracture repair. Non-surgical management forms the first-line treatment for undisplaced fracture. Analysis – a listing of problems based on what you know from a review of subjective and objective data. After a fracture, the lateral end of the clavicle is displaced inferiorly by the weight of the arm and displaced medially by the pectoralis major. Abrasion over the clavicle may be noted, suggesting that the fracture was from a direct mechanism. The range of motion of the shoulder should usually be limited to pendulum exercises for the first 1-2 weeks. Because the midshaft of the clavicle is the thinnest segment and does not contain ligamentous attachments, it is the most easily fractured location. Clavicle fractures are very common injuries in adults (2–5%) and children (10–15%) and represent the 44–66% of all shoulder fractures. The medial end is pulled superiorly by the sternocleidomastoid muscle. Fractures can occur at any part of the clavicle. Over the next few weeks, this primary callus is transformed into a bony callus by the activation of osteoprogenitor cells. [9] [1] Wear the sling during the day, except for exercises and personal hygiene.Patient's choice to wear at night or not but they need to be cautious.

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