Fracture of the clavicle. Home treatment, terms of rehabilitation

Clavicle fracture - This is a severe damage to the musculoskeletal system, as a result of which the tissue of the S-shaped curved tubular bone is destroyed. Treatment of injuries of this type is carried out in a hospital of health care institutions.

Therapy of a clavicle fracture at home is possible only at the stage of the rehabilitation period, when medical specialists are already provided the patient with conservative or surgical care aimed at the speedy restoration of the integrity of the destroyed bones.

According to medical statistics, fractures of the right and left clavicle are among the most common injuries to the shoulder girdle. In this case, mechanical damage to this part of the musculoskeletal system can occur both from a strong blow and from a fall from a great height.

The increased vulnerability of the keys is associated with the peculiarities of its anatomical location and attachment in relation to other elements of the skeleton. One edge of the S-shaped tubular bone forms the sternoclavicular joint, which is responsible for full shoulder mobility. The second end of the clavicle connects to the tissues of the acromial process on the scapula.

A collarbone fracture can occur at home or while performing professional activities. The severity of the injury, as well as the type of injury, has a direct impact on the further treatment regimen.

The destruction of the structure of the bone tissue of the clavicle occurs in the area of ​​the diaphysis, from the side of the acromial process, or in the area of ​​its contact with the chest. The last part of the musculoskeletal system is least likely to suffer mechanical damage. The incidence of clavicle fractures is on average 22 cases per 100 thousand. population. People under the age of 20 are at risk for these injuries.

Views

Clavicle fracture (home treatment begins immediately after the completion of the stage of conservative therapy) is serious skeletal injury, which is classified according to the severity of the injury sustained, as well as its clinical signs manifestations.

No offset

A fracture of the clavicle without displacement of the bone tissue is one of the most common injuries to this part of the musculoskeletal system. This pathology is characterized by the presence of a violation of the integrity of the S-shaped bone of the tubular type without signs of a violation of its anatomical location.

This type of clavicle fracture is considered the least hazardous to human health. In the case of timely assistance aimed at fixing the damaged part of the body, bone healing occurs quickly and with minimal risk of complications.

Offset

A displaced clavicle fracture is a more serious injury to the S-shaped bone of the tubular type, characterized by more extensive and deep destruction of tissues with further disruption of their anatomical location in relation to other parts skeleton. Elimination of this type of pathology cannot be performed only with the help of the method of conservative therapy.

Patients with a fracture of the clavicle, which shows signs of displacement, require surgical treatment with fixation of bone tissue using metal structures.

Closed

A closed clavicle fracture is an injury to the S-shaped bone, which occurs with the destruction of its structure, but without concomitant damage to the soft tissues.

Most of the patients who have received this injury undergo standard conservative treatment with the plaster cast on the affected area of ​​the body. The only exceptions are closed fractures of the clavicle, accompanied by the displacement of the destroyed bone. In this case, surgery will also be required.

Open

An open fracture of the clavicle is one of the most dangerous and severe injuries of the musculoskeletal system. This type of pathology is distinguished not only by the destruction of the structure of the S-shaped bone of the tubular type, but also by damage to the blood vessels, soft tissues and the muscular system.

In order to diagnose an open fracture of the clavicle, no complex examination methods are required. In patients with similar injuries, there is a skin tear in the area of ​​the fracture. Violation of the integrity of epithelial tissues is carried out by the sharp edge of the fractured bone.

This type of pathological condition of the musculoskeletal system can occur due to a sharp and very strong blow inflicted on one or another part of the collarbone. Patients with such injuries require long-term and complex treatment.

In severe cases, physiotherapy rehabilitation may be required, aimed at restoring full mobility of the shoulder joint. Especially if, at the stage of postoperative healing, the patient has complications associated with an inflammatory process of an infectious nature.

Symptoms and Signs

Clavicle fracture (home treatment is possible only after a comprehensive examination at the institution health care) is damage to the skeleton, which is always accompanied by the presence of severe pain sensations.

Local symptoms

During an external examination of the patient, a pronounced swelling and edema of the epithelial tissues located in the front of the shoulder is found. At the time of palpation of the damaged area of ​​the body, the person feels severe pain that does not cover only the clavicle region, but also extends to the entire chest, paralyzing the muscles in the scapula region.

Depending on the severity of the injury, traces of local hemorrhage may appear. The shoulder that has been injured shows signs of deformation, is simultaneously lowered down and strongly displaced forward.

Patients with signs of a fracture of the clavicle have a shortened shoulder girdle. A peripheral fragment of bone tissue, together with the entire arm, is displaced downward, and also leads to the fact that the shoulder is wrapped inward. The central fragment of the clavicle is displaced upward.

During an attempt to make active movements with the hand, the destroyed parts of the bone come closer together, acute pain occurs, and their edges are on top of each other. Local symptoms are detected by a traumatologist or surgeon based on the results of a preliminary examination of the patient.

Damage to blood vessels and nerve bundles

In the presence of a closed clavicle fracture, injury to the great vessels and peripheral nerves is unlikely. In case of displacement of bone tissue, the integrity of the pleural dome may be violated. The destruction of large vessels caused by an open fracture of the clavicle is accompanied by profuse blood loss, which can only be stopped with the help of surgery.

In patients with similar symptoms, a bone is found that has broken through soft tissues, skin and damaged vital vessels. When the peripheral nerves are injured, the patient has an increased pain sensitivity of the tissues in the fracture zone, and there is also no full mobility of the upper limb.

Functionality of the hand with a fractured clavicle

A patient with a closed fracture of the clavicle, which has signs of displacement of bone tissue, or without such, using a healthy hand is able to hold the forearm and elbow of the injured limb, pressing it closer to torso.

Independent mobility of the injured hand is limited due to the presence of severe pain syndrome, which is localized in the region of the shoulder girdle with a lightning-fast spread to the upper part of the body. During an attempt to perform any action with an injured limb, signs of crepitus of bone fragments may appear.

Causes

Clavicle fracture (home treatment occurs on an outpatient basis after discharge from a trauma or surgical hospital department of the hospital) arises from a sharp or prolonged effect of external factors on the structure of the S-shaped bone of the tubular type.

The following are the most common causes that cause collarbone fractures of various types:

• a fall from a great height, when the main point of contact of the body with a hard surface of the ground is on the shoulder or upper chest;
• hitting the collarbone during a fight or sports training associated with power martial arts (boxing, kickboxing, wrestling);
• getting an occupational injury as a result of an accident (in this situation, a fracture of the collarbone may arise due to a violation of technical norms and rules at the time of performance of work with increased danger);
• road traffic accident with injury to the shoulder girdle and violation of the integrity of the bones of the clavicle;
• congenital and acquired pathologies of bone tissue, which are expressed in their increased fragility, reduced mineralization or too soft structure.

It is believed that the full formation of the clavicle is completed by the age of 20. In this case, we mean sufficient compaction of bone tissue, saturation with the required amount of mineral components.

In elderly people, a process of gradual demineralization of bones occurs, which leads to an increase in their fragility. That is why the main patients of trauma departments with signs of a fracture of the clavicle are children, adolescents and elderly patients.

Diagnostics

Clavicle fracture (home treatment without conservative or surgical intervention will lead to complications) is determined using several examination methods. The table below describes in detail the main diagnostic methods that are advisable to use in relation to patients with this kind of herbs.

Survey method	Diagnostics procedure
Visual inspection	The external examination procedure is carried out by a traumatologist or surgeon at the time of the patient's admission to the hospital. The doctor palpates the damaged area of ​​the body, determines the functionality of the upper limb, and then writes out a direction for the patient to undergo instrumental research methods.
X-ray	Radiography is considered the gold standard for diagnosing patients with signs of a clavicle fracture. In this case, the type of pathological state of this part of the skeleton does not matter. Clavicle X-ray is performed in 2 projections. First, a snapshot is taken of the front of the bone, and then the patient is rotated with the side of the shoulder. X-ray, performed in a section, makes it possible to assess the degree of displacement of the bone tissue, to detect the possible spread of fragments, as well as damage to the surrounding tissues. In public hospitals, this type of diagnosis is free. In private clinics, the average cost of an X-ray of the clavicle is 1200 rubles.
CT scan	CT scan is prescribed in very rare cases when a patient is admitted to the emergency department with signs of a fracture of the thoracic part of the clavicle. In such a situation, the attending physician is required to conduct a more detailed diagnosis in the field of fracture localization. CT allows you to see possible pathologies of the bone tissue of the chest. For example, the formation of a crack in the immediate vicinity of the fracture of the clavicle. The average cost of computed tomography of this part of the skeleton is 4500 rubles.

The most informative methods for diagnosing clavicle fractures are radiography and CT. Based on the results of the examination, the traumatologist or surgeon determines the scheme of further treatment aimed at the speedy healing of bone tissue.

Treatment and rehabilitation methods

Treatment of patients with fractures of the clavicle is carried out using conservative or surgical methods of therapy. The way a broken bone is restored depends on the nature and severity of the injury.

Conservative treatment of clavicle fracture

This type of therapy is used for patients who have been diagnosed with a closed fracture of the S-shaped bone of the tubular type without signs of its displacement.

After the examination, doctors fix the patient's shoulder girdle using a rigid orthosis, or a plaster cast. The damaged collarbone, shoulder joint, and the entire upper arm are immobilized.

The average duration of complete bone tissue healing under conditions of using a plaster cast is 4 to 5 weeks, depending on the severity of the injury.

The main disadvantage of this type of treatment is the high risk of displacement of the fractured bones of the clavicle after the doctors have performed its immobilization. A similar situation threatens with improper fusion of bone tissue while maintaining a pronounced deformity of the shoulder.

Clavicle fracture surgery

Treatment of this pathology of the skeleton using the method of surgical intervention is advisable in that if the patient is diagnosed with a displacement of bone tissue, or there are signs of an open fracture collarbone.

Surgical therapy is carried out by performing external osteosynthesis using metal plates or by hardware immobilization of the limb.

Plate osteosynthesis

This type of surgical treatment involves an operation to tighten the clavicle bone tissue with forced fixation of its edges.

The algorithm of actions for performing a surgical operation is as follows:

1. The patient is transported to the sterile conditions of the operating room.
2. An anesthesiologist administers a drug to the patient, which is a general anesthesia.
3. After that, the surgeon makes an incision in the soft tissue covering the collarbone with signs of a fracture.
4. The doctor carries out actions aimed at restoring the physiologically correct location of the bone tissue, connecting the fractured edges of the clavicle.
5. Then the bone tissue is fixed with titanium plates, which are attached to the clavicle with special screws.
6. After bone immobilization, suture is applied to close the wound.

The metal structure ensures the immobility of the clavicle, prevents the displacement of bone tissue and the development of complications. The average duration of wearing the plates is 3 to 6 months. After complete healing of the clavicle, the metal structures are removed during the reoperation.

Hardware immobilization of the limb

This method of surgical therapy involves the use of the Ilizarov apparatus. Immobilization of the upper limb is carried out by simultaneously connecting the edges of the fractured bone, as well as limiting the functionality of the shoulder joint. Clavicle tightening is carried out using special needles that extend beyond the patient's body.

The connection of metal structures of this type is carried out using metal circles. A distinctive feature of the hardware immobilization of the limb is that the lower part of the upper the limb remains completely mobile, its functionality is not required, and the patient does not experience feelings pain.

The imposition of the Ilizarov apparatus is indicated for patients who have been diagnosed with a severe fracture of the clavicle with the formation of multiple fragments of destroyed tissue. In the process of wearing this device, not only the effect of clavicle fusion is achieved, but also the formation of callus is ensured.

For example, if, as a result of a fracture, a part of the bone was crushed with the formation of an interval up to 5 cm long. While wearing the device, new tissue grows with complete restoration of the functions of the clavicle. Limb immobilization using this method of surgical therapy is carried out under general anesthesia, and the duration of wearing the device is at least 6 months.

Rehabilitation

The period of restoration of mobility of the upper limb and shoulder joint begins immediately after the completion of the main part of conservative or surgical treatment.

In this case, the patient may be assigned to undergo the following physiotherapy procedures:

• physiotherapy exercises with exercises aimed at rotating the shoulder joint, raising the arm up using dumbbells weighing from 1 to 3 kg;
• warming up the fracture area using electrophoresis (in this case, medicinal solutions with anti-inflammatory properties can be used);
• tissue massage in the area of ​​the fracture;
• taking mineral baths;
• swimming in the pool, which allows you to develop the shoulder girdle, collarbone and the entire upper limb, which is in conditions of prolonged immobilization.

Rehabilitation is applied to patients who have suffered severe collarbone fractures. The appointment of a specific type of physiotherapy is carried out by the attending physician.

Possible consequences and complications

Clavicle fracture is a pathological condition of the skeleton that can cause the development of the following complications:

• improper fusion of the clavicle bones;
• deformation of the shoulder with its displacement forward, upward or downward;
• violation of hand mobility;
• osteomyelitis of bone tissue;
• a purulent-inflammatory process caused by a bacterial infection.

Timely access to a traumatologist or surgeon, obtaining qualified medical care guarantees a favorable prognosis for bone healing and restoration of upper mobility limbs.

A clavicle fracture is a severe injury to the bones of the shoulder girdle, which occurs due to a strong blow, a fall from a great height, or a collision with environmental objects. Treatment of this damage is carried out in the hospital of the trauma or surgical department.

Clavicle fracture is treated conservatively or requires surgery. After receiving medical attention, the patient is discharged. Further treatment takes place on an outpatient basis. Being at home, the patient observes the rule of immobilization of the upper limb, provides the body with good rest and quality nutrition.

Clavicle fracture video

Komarovsky on first aid for fracture: