Fracture of the collarbone in a newborn during childbirth

Author of the article: Eduard Svitich - orthopedic traumatologist

Any fracture of the clavicle, regardless of the degree of displacement, is considered to be a fairly serious injury. Bone fragments with such damage can pierce the subclavian artery and vein, the lung, and injure the nerve plexus. In addition, an improperly healed clavicle fracture is manifested by a cosmetic disadvantage - a visible shortening of the shoulder.

Plaster casts for clavicle fractures are practically not applicable due to the large weight and the inability to fix the thin bone. Preference is given to lightweight and comfortable shoulder bandages that give the most noticeable results. Next, I will discuss the most important aspects regarding clavicle fractures and the main types of braces for treatment.

Osteosynthesis for clavicle fracture

A clavicle fracture is an injury that is among the top 10 most common.
Such cases account for 3 to 20% of all calls for fractures. The reasons for bone vulnerability are its structural features and specific location. In addition, the clavicle itself is quite thin, which increases the likelihood of fracture under significant mechanical stress in the upper body. One of the treatment methods - installing a plate for a clavicle fracture (titanium implant) - can be used both immediately after the injury and during recovery after an old injury. A plate implant is often used when displacement occurs.

The operation to fix a plate for a clavicle in case of a fracture is performed only under general anesthesia. Surgical treatment is possible in a trauma department. The patient should lie on his back.

Purpose

The bandage allows you to fix the arm, leg, head and other damaged part of the body. By limiting involuntary movements of the injured limb, pain decreases.

The scarf is made from gauze or other fabric. In emergency conditions, you can construct a device from a shirt or trouser leg.

Headband

The scarf reliably fixes the injured limb after treating the wound surfaces with antiseptic compounds. To use the fixator, no special knowledge or skills are required. Headscarves are used to fix the lower leg, mammary gland, injured arm, etc.

The scarf is applied as follows:

• The patient is in a sitting position. The hand and wrist should be above the elbow joint. The ends of the scarf are connected at the corners to form a triangle. The bandage is placed under the elbow near the shoulder joint.
• The top of the scarf is wrapped around the neck and down to the sore limb. The remaining end on the other side is wrapped around the forearm. The node is fixed on the damaged side.
• The fabric near the elbow remains slightly pulled back for better positioning of the arm. The bandage is fastened with tape or special devices. Blood circulation is not impaired, the patient feels relief.

General recommendations

There are two types of dressings: open and closed. Products differ in the way they are applied.

A closed bandage is applied after rolling into a roll, and an open bandage is applied in the form of a scarf. The open type of product is made of sterile fabric. Do not apply a bandage at an angle to the wound, so as not to provoke intense bleeding. Do not pull the product tightly.

Differences between a bandage and a scarf bandage

There are no fundamental differences between these products. Both devices are made in the form of a case in which the arm bent at the elbow is located. The scarf is secured with strings, and the bandage is secured with wide straps.

A scarf is a piece of fabric measuring 80x80x115-130 cm, folded in half in the shape of a triangle. This is an indispensable device in emergency situations when providing first aid.

The factory bandage has a more advanced design. The product is made of soft, breathable fabrics. Models are equipped with additional clamps and are easy to use.

The bandage immobilizes the limb, relieves muscle tension and relieves swelling.

General rules for overlay

When applying an immobilizing orthosis, the following recommendations must be followed:

• Do not apply a bandage to the wound.
• The bandage is tightly fixed to the damaged surface and tied tightly.
• A sterile bandage is applied to the wound surfaces.

Types of bandages to support a fractured arm

The device for a sling for a broken arm is the most difficult. The fixation must be carried out by a doctor, otherwise there is a risk of improper bone fusion. Bandages for immobilization for fractures are applied only after x-rays.

As first aid, it is allowed to use a scarf in the form of a triangular piece of fabric.

Types of dressings:

• First aid splints.
• Deso bandage.
• Delbe rings.
• Splints.
• Plastic version of plaster.

Treatment with connection to the plate

Titanium plates for clavicle fractures are mainly used:

• With a diaphyseal fracture. It can be oblique and simple. Suggests extension of the fracture. It is treated conservatively or surgically. During surgical therapy, either plate or intramedullary fixation is used. The latter option is preferred for the recovery of young active people, when it is important to return full activity and mobility of the upper body and limbs as quickly as possible.
• For displaced injuries. Preference is given to an S-shaped plate for the clavicle (hook-shaped).
• For damage to bone tissue and joints. Here, too, a hook-shaped plate is used on the clavicle , especially when there is intra-articular damage with the formation of a large number of bone fragments. The main feature of such a plate is that after complete fusion of bone tissue, it must be removed.

Features of fixing products

Wearing such an orthopedic product helps prevent the formation of hematomas, since the vessels in the shoulder area will not be subject to further ruptures. In addition, the retainer has a compression effect and helps reduce swelling.

The shoulder bandage is shown:

• when diagnosing arthrosis, arthritis, and peritonitis;
• after wearing a plaster cast, postoperative rehabilitation (arthroscopy);
• for dislocations, sprains, ruptures of ligaments, tendons, and muscles.

For prevention purposes, it is recommended for inflammation in muscle tissue, such as myositis, pain syndromes, and chronic inflammation in the joint.

For sprains, bruises, and the risk of inflammatory processes in tissues, it is recommended to use fixatives with warming properties.

Indications and contraindications for clavicle osteosynthesis

Osteosynthesis of the clavicle - the connection of bone fragments in an anatomical position using a plate fixation structure - has indications for both fresh injuries and old ones.

• Indications for restoration ( plate osteosynthesis ) for fresh clavicle injuries are: open fracture;
• closed fracture in case of damage to the neurovascular tourniquet;
• a complex fracture in which interposition of soft tissue is observed (when it is sandwiched between bone fragments, which prevents comparison of fragments - reposition - in a closed way);
• high risk of skin injury from sharp bone edges;
• the vertical location of one of the fragments, which, when displaced for the purpose of reposition, can affect the nerves or choroid plexuses.

Operations to connect bone fragments to a plate during a fracture (osteosynthesis) are carried out urgently if the injury is fresh and is accompanied by a risk of damage to blood vessels and nerve endings. In other cases, surgical treatment can be delayed and is carried out as planned after a comprehensive diagnosis.

Contraindications

Contraindications to functional restoration with the help of plates ( clavicle osteosynthesis ) are only relative (the decision is made by the doctor, the operation can be prescribed after the problems that make it impossible to carry out have been eliminated). These include:

• serious condition of the patient (multiple injuries);
• acute infectious diseases;
• severe inflammation and suppuration in the shoulder girdle area.

How is clavicle osteosynthesis performed?

The main recommendation for restoration with plates for osteosynthesis : sufficient length of the lateral fragment. If it is insufficient, the structure may become loose after fixation. Since the metal “holder” is located in the external subcutaneous sections, this can lead to skin injuries during rehabilitation (plaster cast) and subsequently (clothing, straps).

The osteosynthesis of the clavicle itself is carried out using various plate instruments (depending on the nature of the injury). The choice of their type also determines the cost of the plate for a clavicle fracture , so it should be given sufficient attention.

Features of the procedure for connecting (osteosynthesis) the clavicle with metal plates for fractures :

• general anesthesia;
• position of the patient lying on his back:
• a small cushion is placed under the shoulder blade;
• the incision is made longitudinally, above the clavicular bone (the recovery zone is opened, blood clots are removed, fragments are compared);
• osteosynthesis of the clavicle is carried out in 3 stages - first, a titanium plate on the clavicle is modeled according to the curvature of the bone, then the model is applied to its surface (from above or in front) and fixed with screws to the bone fragments;
• The last manipulations are layer-by-layer fixation of sutures, installation of drainage (rubber drains) and application of an aseptic dressing.

Clavicle fracture. Surgery or conservative treatment?

Clavicle fractures are a common injury among snowboarders. This fracture also occurs in cyclists, and a little less often in skiers. This fracture can also occur in everyday life and is often associated with high-energy trauma. In general, clavicle fractures account for up to 6% of all bone fractures. And in 4 out of 5 cases this is a fracture of the body of the clavicle, i.e. middle third of the bone.

The main threat with a clavicle fracture is either fusion in the wrong position or the formation of a false joint. At the same time, fusion in the wrong position is no better than a false joint. The fragments shift, overlapping each other. The bone shortens, the points of muscle attachment come closer. Normally, the muscle is tense, but if the fixation points get closer, the muscle “sags.” Muscle tissue degenerates and is replaced by connective tissue. When the collarbone is shortened by 1 cm or more, up to a third of the strength of the muscles of the shoulder girdle is lost.

• Evolution of treatment methods for clavicle fracture

Until the late 90s and early 2000s, there was an opinion that in 99% of cases, clavicle fractures should be treated conservatively. However, recently this view has been revised. This is due to several points. On the one hand, patients have become more demanding both in terms of quality of life after treatment of a fracture, and in terms of cosmetic effect after surgery. The second point: a regular x-ray of the collarbone gave only one projection, but computed tomography made it possible to look behind the bone and examine it from all sides. It is the widespread use of computed tomography that has made it possible to identify a large number of nonunions in cases that at the end of the last century would have been considered quite satisfactory due to the lack of CT data.

In 2007, the Canadian orthopedic community conducted a study focusing on shoulder function and pain scores after clavicle fractures. It has been shown that after surgical treatment, function is restored faster and more sustainably than after conservative treatment. But it is still not worth completely excluding conservative non-surgical treatment for clavicle fractures. There are a number of patients whose clavicle fracture can be successfully treated without surgery - in particular, young patients with minor displacement.

On the other hand, if the patient is middle-aged or older, and his primary displacement was 1 - 1.5 cm or even more, then in this case, as a result of conservative treatment, we will most likely get nonunion. Also, the choice of the optimal treatment method is influenced by the patient’s age, physical activity before the injury, profession, patient’s expectations, the speed of rehabilitation that the patient plans, etc. All this is discussed in a direct conversation between the patient and the doctor.

• Conservative treatment

The conservative method is offered to young patients with slight displacement, when the soft tissue sheath is not torn and is able to hold bone fragments. During conservative treatment, a soft eight-shaped bandage is applied for a period of about 6 weeks, which fixes the patient in the position of straightened collarbones and shoulder girdles. Both halves of the body are fixed, the arm on the side of the fracture is suspended. The figure-of-eight bandage is not rigid and does not greatly limit mobility. The patient should come for examinations to monitor the process of fusion and expansion of motor activity. With conservative treatment, you have to visit a doctor and have x-rays performed much more often than with surgical treatment.

• Minimally invasive surgery

Speaking about the surgical treatment of a clavicle fracture, any knowledgeable person will name an intraosseous nail. However, it is not always possible to perform intraosseous osteosynthesis with a nail. This technology was popular, but now its popularity is declining due to the unpredictability of the results. Orthopedists and traumatologists at the Ilyinskaya Hospital prefer minimally invasive technologies for the treatment of clavicle fractures and perform osteosynthesis of the clavicle with a plate, inserting it through pinpoint punctures of the skin. This high-tech X-ray-assisted operation allows achieving a good cosmetic effect and good internal elastic fixation.

There is one more important point. The fact is that with the standard approach, the surgical approach passes over two or three, depending on the individual anatomy of the patient, branches of the important supraclavicular nerve. Innervation in this zone does not affect function, but it does affect the sensitivity of the upper half of the chest, and in women, also the sensitivity of the mammary gland and nipple area. After the standard approach, even if the nerve branches were protected by the surgeon, three out of five women have decreased sensitivity in this important area, and many women are not suitable for this. The use of less invasive approaches eliminates contact with the branches of this nerve, and in our patients, along with rapid rehabilitation and rapid healing of clavicle fractures, sensitivity is also completely preserved. A minimally invasive approach to the clavicle, which avoids contact with the branches of the supraclavicular nerve, was developed and patented by a group of Russian traumatologists led by Andrey Volna. Currently, Andrey Anatolyevich Volna heads the department of traumatology, orthopedics and spinal surgery at the Ilyinskaya Hospital.

Clavicle surgery is performed under general anesthesia. During the operation the patient sleeps. We seat - we seat, not lay down! – the patient on the operating table in the “beach chair position”, the so-called “beach chair position”. The patient reclines, reclining, as if in a chaise lounge. This position allows you to achieve the most correct comparison of clavicle fragments without incision. The operation is performed under the control of a special X-ray machine (C-arm). By manipulating the fragments through small incisions and punctures in safe areas, surgeons give them the correct position. A metal plate is inserted into the incisions and secured with screws. After a year, it is discussed with the patient whether the plate should be removed or left. The cosmetic consequences of the operation are minimal - two small vertical scars.

The operation is usually performed on the day of hospitalization. The next day - dressing, the hand can be placed on the scarf in a comfortable position. The hospital stay lasts 1–2 days.

• Rehabilitation

Surgical treatment of a clavicle fracture is a virtually painless and comfortable treatment method for the patient. Functions are restored quickly after it. And if in the case of conservative treatment of a clavicle fracture we encourage exercise therapy, in the case of surgical treatment, on the contrary, we often even limit the patient’s physical activity. Since there is no pain, any person tries to recover faster... For competent and timely recovery at the Ilyinskaya Hospital, rehabilitation of patients after a collarbone fracture is carried out under the supervision of experienced rehabilitation specialists.

• Help for patients with pseudarthrosis - reconstructive surgery

One of the important areas of work of the Department of Traumatology, Orthopedics and Spinal Surgery of the Ilyinskaya Hospital is helping patients with pseudarthrosis. Including after clavicle fractures. Such patients come to us from different regions of the country. In this case, unfortunately, there is no longer any need to talk about minimally invasive surgery. If the clavicle fracture was treated incorrectly, then we have only one option left - bone transplantation and osteosynthesis. In 90% of cases, the bone fragment for transplantation is taken from the patient's iliac crest. And here it all depends on what kind of false joint has formed. There are complex cases with a defect after suppuration, then the graft has to be placed as a single block. And sometimes a very small fragment of the transplanted bone is enough just to “refresh” the area of ​​the pseudarthrosis. This is high-level reconstructive surgery.

• Consultations for previously operated patients

Very often, clavicle fractures occur in snowboarders. Not every place where there is a ski resort also has a clinic ready to operate on a fracture. In addition, not every insurance includes a ski injury - here you need to be very careful when insuring. If a patient comes to us after surgery, specialists from the Ilyinskaya Hospital conduct an X-ray or CT examination, and, depending on its results, determine the optimal rehabilitation or additional treatment regimen.

Types of implants

The choice of implant determines not only the price of the plate for clavicle fractures, but also the effectiveness of treatment. Current practice uses tubular and semi-tubular titanium plates for clavicle fractures . They are selected according to the nature of the injury.

• For a fracture in the middle third of the clavicular bone, the following is used for osteosynthesis: a reconstructive plate with a number of holes from 6 to 8;
• narrow dynamic compression plate up to 3.5 mm wide;
• Kun-cheru rod.

Why use an elastic bandage on your forearm and shoulder?

The elastic bandage "Intex" stabilizes the joint in the correct position and relieves ligaments , preventing dislocation and spraining during power loads. In addition, the muscles receive additional support, which allows you to safely improve your athletic performance.

After removing the plaster or splint after a shoulder fracture, the Intex compression bandage reduces the load on the shoulder and relieves post-traumatic swelling. The bandage not only stimulates the lymphatic system, which removes excess fluid from soft tissues, but also accelerates blood flow in the shoulder area. As a result, ligaments, bones and cartilage are restored faster.

Order plates for a clavicle fracture

You should find out how much a clavicle plate of the desired type, shape and class costs only from trusted suppliers of medical instruments for surgical treatment. There is a large selection of such implants - our specialists know everything about the products and, if necessary, will answer any questions.

In the company's catalog you can choose and buy a clavicle plate made of high-quality purified titanium for osteosynthesis for all types of fractures. All products are made on modern equipment using advanced technologies and taking into account the latest developments in the global traumatology industry.

find out the price of a clavicle plate by going to the page of the desired product. Here you can place an order, request a catalog of analogues for comparison, or professional advice. Get the necessary information in one touch (especially for your convenience, there is an “Ask a question” button on the page).