Bandage for a displaced clavicle fracture: how to choose and wear?

The clavicle is a supporting support for the shoulder girdle, ensuring the function of the upper limb and its position. It is vulnerable to damage because it performs a special function, is located under the skin and has an unusual geometry.

Clavicle fractures are the most common injury among adults and account for 5% of the total number of fractures. The incidence is 29 cases per year per 100,000 population with a mean age of 33 years and a male to female ratio of 2.6:1. In men, the peak occurs between the ages of 13 and 20 years.

The main mechanism of injury is a fall during sports.

Fractures of the middle third of the clavicle are the most common and occur in 69-81% of cases, while injuries to the distal third occur in 16-28%.

Clinical examination

The evaluation of patients should take into account the mechanism of injury and possible associated injuries. When assessing a patient with high-energy trauma, the ATLS protocol should be followed. In case of open fractures, fractures of the middle third, concomitant fractures of the scapula, it is necessary to use additional imaging methods to exclude concomitant damage to the chest organs.

Patient complaints

The main complaint of patients with all clavicle fractures is pain in the shoulder joint , however, to obtain a complete picture it is necessary to examine the cervical spine, chest and evaluate the neurological status to exclude possible combined injuries.

Clinical examination

The examination should begin with an examination of the shoulder areas on both sides. A displaced fracture is characterized by the presence of a typical deformity with protrusion of the medial fragment as a result of the action of the weight of the limb and traction of the sternocleidomastoid muscle.

Shortening of a broken clavicle is manifested by a decrease in the width of the shoulder girdle as a result of protraction of the scapula. During examination, it is necessary to evaluate the condition of the skin, since in case of open fractures or significant skin tension, surgical treatment is indicated. With a direct fall on the shoulder, there are abrasions, which are often located in the projection of the deltoid muscle and acromion process.

Palpation should examine the sternoclavicular joint, subcutaneous surface of the clavicle, acromioclavicular joint, acromial process and spine of the scapula. Detection of specific areas of tenderness determines the need for imaging techniques.

Due to the pain syndrome, there is a restriction of movement, however, with an isolated fracture of the clavicle, passive internal and external rotation is possible. The presence of full passive rotational movements indicates the absence of dislocation in the shoulder joint. The proximity of the brachial plexus and the vessels of the subclavian region requires an assessment of the neurovascular status (examination of the pulse and sensory-motor characteristics of the limb distal to the site of injury).

Visualization

Minimal x-ray examination

should include a direct view with full coverage of the clavicle and acromioclavicular joint. Additional radiography with a radiator tilted 20° radially helps assess clavicle displacement and shortening.

If damage to the shoulder joint is suspected, radiography should be performed in direct and axial projection.

Performing a CT

with reconstruction gives a complete picture of the configuration of the fracture, displacement and shortening
of the clavicle .

Classification

There are several classifications of clavicle fractures . A more practical and constructive classification was proposed by Robinson. This Edinburgh system considers the displacement and comminuted nature of fractures as key features of therapeutic and prognostic significance, as well as inter-rater reliability.

Type I – Medial 1/5 (fracture medial to the first rib)

• IA: no offset
• IA1: extra-articular
• IA2: intra-articular
• IB: offset
• IV1: extra-articular
• IV2: intra-articular

Type II – Moderate 3/5 (Damage to the central 3/5 of the clavicle)

• IIA: without disruption of the cortical layer
• IIA1: no offset
• IIA2: angulation
• IIB: with offset
• IIВ1: simple
• IIВ2: splintered/segmented

Type III – Lateral 1/3 (Injury to the lateral part of the clavicle)

• IIIA: without disruption of the cortical layer
• IIIA1: extra-articular
• IIIA2: intra-articular
• IIIB: offset
• IIIВ1: extra-articular
• IIIB2: intra-articular

All types are further subdivided depending on the displacement, where subtype A is fractures with a displacement of less than 100%, subtype B is more than 100%. Groups are also distinguished depending on the splintered nature of the damage and the relationship of the fracture line to the structure of the joints.

Treatment of a clavicle fracture

Conservative:

Despite the fact that clavicle fractures are considered as indications for surgery, most of them respond well to conservative treatment, which consists of immobilizing the limb with a support or figure-8 bandage. When attempting to perform reposition with a tight figure-8 bandage, the risk of developing neurovascular compression and skin compression increases.

Surgical:

In exceptional cases, clavicle fractures require emergency or emergency surgery. Such situations include: open fractures and the threat of damage to the skin or neurovascular bundle from fragments. Surgical treatment helps to avoid complications such as chronic infection, skin necrosis and persistent dysfunction of the distal upper limb.

Indications for surgical treatment

Absolute:

• open fractures;
• fractures with risk of skin damage;
• threat of damage to the neurovascular bundle.

Relative:

• high risk of nonunion;
• concomitant fracture of the scapula;
• polytrauma.

Shoulder exercises

Therapeutic exercise allows you to quickly restore mobility and get rid of the consequences of injury. You will need to do special exercises regularly to achieve positive results soon. You can use a simulator to develop the shoulder joint . It will allow you to recover faster from injury and also prevent complications. It is recommended to understand in more detail what exercises you need to do to develop your shoulder. Physical therapy will have to be done daily and for at least two weeks.

Exercises:

• Internal resistance. You should stand at the door, bend your arm at the elbow of the arm you are working on, and then rest your palm on the door frame. You should try to press your palm as hard as possible and remain in this position for up to 5 seconds. It will take 2 sets of 15 repetitions.
• External resistance. You will also have to stand at the door and bend your arm at the elbow, but rest with the back of your hand. The rest of the exercise is done in the same way as the previous one.
• Isometric flexion. You need to stand facing the wall, bend your arm and press it to your body. The fist of the affected limb should be pressed against the wall. You need to stay in this position for up to 5 seconds, and then rest and press it against the wall again.
• Isometric extension. You will have to turn your back to the wall, bend your elbows and lean on them. The problematic limb needs to press on the wall, hold this state for 5 seconds, then rest.
• Pillow compression. You need to take a pillow and place it between your forearms and chest. You need to squeeze the pillow with your hands and hold for 5 seconds. You will have to do 2 sets of 15 repetitions.
• Vertical wiring. You need to go to the middle of the room, stand straight and keep your feet shoulder-width apart. You should move your arms to the sides and try to raise them as high as possible, then fixate for 5 minutes and return to the starting position. The action should be repeated 10 times.

You should perform the exercise carefully and make sure that there is no acute pain. If it gets worse after exercise therapy, you should immediately consult a doctor.

Rehabilitation after a clavicle fracture

Most authors recommend permanent immobilization with a support bandage for 10-14 days in order to relieve pain after surgery before the onset of motor movements. Typically, patients gradually increase the load, removing the support bandage by 4-6 weeks, at which time movements on the upper floor are allowed.

As full range of motion is restored and x-ray confirmation of fracture consolidation is obtained, motor restrictions are usually lifted by 6-8 weeks, with the exception of contact loads. Return to contact sports and unrestricted use of a limb on the upper floor is delayed until 12 weeks.

Recovery period

Rehabilitation is absolutely necessary, because... Due to prolonged immobilization, the arm muscles partially atrophy. Exercises should be started as soon as possible. The load and type of activity is determined by the attending physician. Typically, the recovery course lasts from three to seven weeks.

The rehabilitation period can be divided into 3 stages:

1. during immobilization, perform passive exercises;
2. after the growth of callus and removal of the fixing bandage, use gymnastic sticks and expand the range of exercises;
3. introduction of strength loads using expanders, dumbbells, clubs, exercise machines.

For a speedy recovery after a fracture, physiotherapeutic procedures are continued, hydrotherapy and massage are used. An integrated approach guarantees high rehabilitation results. Thanks to electrophoresis, magnetic therapy, ultrasound, laser therapy and UHF, blood flows more strongly to the damaged area. Sufficient blood supply promotes rapid tissue repair.

How to develop a collarbone after a fracture?

Exercises after conservative treatment and surgery are slightly different. But in both cases they become more complex step by step.

A set of exercises for the postoperative period:

• breathing and general tonic exercises;
• light active-passive rocking in the shoulder joint (arm on a bandage);
• alternate tension and relaxation of the muscles of the shoulder and shoulder girdle;
• active movements in the elbow and wrist joints, as well as in the fingers and hand;
• pronation-supination (inward-outward rotation) of the forearm;
• shrugs;
• general strengthening exercises for all parts of the body;
• dosed walking and running;
• training hand speed and strength endurance;
• sports-assist exercises;
• exercises to restore coordination of movements;
• sports training.

First, the exercises are performed with outside help for several minutes. Then they are repeated more often and longer. From smooth and slow movements they move to jerks. In order to quickly develop a collarbone after a fracture, you need persistence and patience.

Causes of fractures in older people

The structure of bones is complex. The internal part consists of blood vessels and nerve fibers. Next is the bone marrow, which produces new blood cells. The outer layer consists of bone tissue, which is formed by special elements: osteoclasts, osteocytes and osteoblasts. The skeleton performs important functions - support for internal organs and movement, in addition, it allows us to support the body in the position that we want to give it.

Bone tissue has unique properties; it is not only strong and hard, but also light and elastic. Such properties are determined by its composition. The minerals it contains make it hard, while the organic substances make it flexible. This combination of components serves as a natural protection against destruction.

Over time, bones change their structure. They become less dense as minerals are washed out. Their structure becomes porous and loose. These pores only become larger over the years - a disease called osteoporosis appears. Bones become less strong. At first, a person does not know about this problem, since this disease does not cause pain. The diagnosis is made already when a person breaks something from a slight bruise or a fall from his own height.

Osteoporosis develops due to:

• genetic predisposition to this disease,
• metabolic disorders,
• problems with the gastrointestinal tract,
• development of rheumatoid arthritis,
• blood diseases,
• pulmonary obstruction,
• nervous exhaustion,
• nutritional deficiency,
• as well as taking certain medications.

Rehabilitation at Senior Group

So that after fractures of the collarbone, arm and other parts of the body there are no negative consequences, so that the patient does not end up bedridden, but can return to normal life, it is necessary to competently carry out not only treatment, but also rehabilitation. The Senior Group center provides professional care for patients with any injuries. This includes not only following medical recommendations, but also psychological assistance, proper nutrition, leisure and communication. The elderly person will not feel lonely, they will take care of him around the clock, and he will definitely get better.

Treatment and rehabilitation of an elderly person

There are two ways to treat it: conservatively and with surgery. The doctor makes the decision. It is based on the severity, location of the injury, as well as the patient's medical condition.

For a simple injury to the radius, not even a plaster cast, but a regular splint is applied. In case of complex injury (displacement, improper fusion), knitting needles are used. Once the bones have healed, the main goal is to restore mobility. This requires long-term rehabilitation. The complex of procedures includes physiotherapy and exercise therapy. The rehabilitation period may be prolonged in patients with arthrosis.

If the neck of the humerus is broken and there is no displacement, then the main task is to securely fix the bone. For this, a bandage is applied. In difficult situations, plates are inserted or applied. Sometimes it is necessary to return the bones to their correct position using a method such as skeletal traction, in which case the damaged limb has to be pulled out with weights. A person recovers for an uncomplicated injury for about one and a half months, for a complicated injury it takes longer.

When the humerus is fractured, a cast is used and the elbow is kept bent. Often with such an injury, displacements occur that require surgery.

If the collarbone is injured, reliable fixation is provided, and if necessary, surgery is performed.

Not only treatment is important, but also rehabilitation. One of the measures is physical therapy; the doctor must describe in detail a set of exercises that are designed taking into account the patient’s age, his condition, the nature of the fracture and other characteristics.

Physiotherapy procedures are also added. Magnetic therapy is most often used; it not only improves blood circulation, but also the flow of oxygen to the bones.

What bones and joints break most often?

The nature of fractures in an elderly person differs from the nature of a similar injury in a young person. The body of a younger person recovers on its own, and patients over 60 years of age most often have to undergo surgery.

Elderly people have certain weak points that are more likely to break. The bones of the hand and nearby are the first to suffer. The reason is the same - when a person falls, he reflexively tries to soften the blow to the head and body, protects himself by putting his hand forward.

The very first thing on the path of the strike is the hand. Therefore, the absolute record holder for the number of fractures is the radius bone.

Clavicle fractures are also common. Their cause is a fall on a hand or elbow. They can result from a fall on the shoulder. The impulse is transferred from a stronger bone to a thinner one, and it easily breaks at the bend.

The neck of the humerus is often broken. It can be injured not only when falling, but also when jerking. It also breaks when a person falls on his side with his arm pulled back or pressed to the body.

Less common than those described above, but still occurring, are supracondylar fractures. They occur when arthrosis develops in the elbow joint and the bone becomes more brittle.

Exercises for a shoulder fracture

Exercises must be performed during the immobilization stage of therapy, in the first 3 weeks after the fracture. The patient will need to exercise for 30 minutes approximately 6 times a day. In this case, the hand should be in a bandage before and after classes. Exercises can reduce swelling, increase blood circulation in the upper limb, and reduce the likelihood of blood clots.

You can perform pendulum-like movements with your hands, this will help you get rid of pain. To do this, you need to remove the bandage, then do a few rocking movements in a sitting or standing position. The hand must be raised forward.

It is also necessary to cross your arms in front of your chest, this also allows you to develop your upper limb. You can clap first in front of your face and then behind your back. It is important that this does not lead to acute pain. It is also helpful to rotate your torso with your arms clasped in front of your chest.

Such exercises must be performed every day and several times in order to see results. If you experience discomfort, you should inform your doctor so that complications do not arise. It is likely that he will change the training regimen, focusing on the individual characteristics of the patient.

Features of injury

Clavicular injuries caused by a sharp contraction of muscle tissue in the human body are quite rare. In almost all cases, this applies to those who suffer from epileptic seizures.

Modern traumatology offers a special classification of various types of injuries, depending on which the most adequate treatment is determined. At the same time, it is extremely rare for a collarbone to be broken due to the fact that a person receives a direct and strong blow aimed directly at the area where this bone is located.

Depending on the condition of the skin at the fracture site, the injury can have an open form (the integrity of the skin is broken) or a closed form (the skin remains unbroken).

If we take localization as the basis for classification, then in this case a fracture can occur in the following parts of the clavicular bone:

• average;
• internal;
• external

From an anatomical point of view, the middle third of the clavicle is more predisposed, since we are talking about the thinnest place of this bone tissue.

Mechanism of occurrence of injuries in the clavicle area

The nature of the fragments of the injured bone turns out to be the basis for determining the following types of clavicular fracture:

• transverse;
• oblique;
• splintered;
• oblique-transverse.

In its structure, the clavicle is a paired bone of the girdle, which, due to its location, is one of the most susceptible to various impacts. Visually, it turns out to be oblong, S-shaped.

The main purpose of this bone in the human body, as seen in the video in this article, is to provide a reliable connection between the torso and the upper limb, which is in a free state.

The main mechanism for the occurrence of a violation of the bone integrity of the clavicle may be associated with the following cases: