How to recognize a clavicle fracture in a child and how to treat it?

Children are very active creatures, they learn through the games of adult life, and activity during the period of growth is the main component of the health of the child’s body. However, mobility and inability to avoid dangerous situations quite often lead to childhood injuries.

Clavicle fractures are not the least of them. Every parent should know the signs of a collarbone fracture in order to take timely action.

Classification of clavicle fractures in children

Features of a clavicle fracture in children

The peculiarity is that in children the clavicle fracture occurs as a “green twig”. The fragments are held by the periosteum, and the bone bursts. Injuries to the clavicle are incomplete subperiosteal.

In older children, thin periosteum causes complete fractures with subsequent displacement of the fragments.

Types of fractures

About fractures

A fracture of the clavicle is not as common in infants under one year of age. In young children, subperiosteal (incomplete) fractures occur more often; in older girls and boys, complete fractures occur, accompanied by swelling, sharp pain during movement and its absence, and deformation of the shoulder girdle.

Sometimes it is difficult to understand whether a child’s collarbone is broken or not due to the fact that the baby’s condition is assessed incorrectly, and an incomplete fracture can only be diagnosed using X-rays.

The fracture is relatively easy to treat and almost always heals without complications, but parents need to know what signs can be used to identify a pearl in a child, how to provide pre-medical care and what conditions must be met in order to cure their child as soon as possible.

Causes of clavicle fracture in children

Among the main reasons:

1. Load on the shoulder.
2. Falling with arms outstretched.
3. Direct blow to the shoulder.

Injury is common in sports where there is a possibility of a hard fall or push. It may occur as a result of a collision with a car or other accident.

Newborns can also be damaged by:

• when they pass through the birth canal;
• there is a discrepancy between the size of the woman’s pelvis and the height of the child;
• Initially, the presentation was incorrect.

When damaged, rupture can occur in three areas:

1. Occurs in the middle third of the bone from a heavy fall or direct impact to the middle of the clavicle.
2. A fall or impact that transmits force to the outside or top of the shoulder, the part closest to the shoulder itself, can cause loss of integrity in the outer third of the collarbone
3. A rare type of injury, it occurs on the inner third of the collarbone . This is almost always the result of a direct impact to the front end, such as from an impact during a collision.

Causes of fractures in newborns

Why do children break their collarbone?

Strong pressure on the chest and a fall on the arm are the most common reasons leading to a fracture of the clavicle bone. A fracture of the collarbone in a child aged from several months to one year is very rare and usually occurs from parental oversight: when falling from a stroller, crib, or changing table.

A fracture of the collarbone in children in the first two years of life can occur during the first hesitant steps, when the child does not yet have perfect control of his body and does not coordinate movements well.

Children 3 and 4 years old usually break their collarbone due to the curiosity that accompanies getting to know the world around them, or being interested in roller skating, scootering, or cycling. Such injuries occur due to negligence and due to poorly developed motor skills.

A fracture of the collarbone in a five-year-old child occurs much less frequently than in younger children; it mainly occurs when falling from a height or during physical education, skateboarding, skating, rollerblading, or cycling.

Diagnosis of a fracture

An x-ray is ordered to determine the location and extent. This is necessary to determine the type of fracture and damage to the joint at the top of the shoulder, called the acromioclavicular joint. For a more detailed study, computed tomography is used.

During the diagnosis and physical examination, the doctor:

• pays attention to soft areas;
• looks for changes in skin color;
• looks for deformations;
• examines open wounds;
• touches the shoulder to determine if there is an associated injury;
• listens to the lungs with a stethoscope and observes changes in breathing;
• assesses the range of motion of the shoulder.

X-ray of a clavicle fracture

Your doctor may do a neurological exam to make sure your motor functions are normal.

Symptoms depending on the type of fracture

The most obvious symptoms will be pain in the affected area and difficulty moving the affected arm. You can recognize a fracture at home.

Other symptoms of a displaced injury include:

• swelling and bruising along the bone;
• increased pain when your patient tries to move the shoulder or arm;
• crackling sensation;
• deformation over the fracture;
• flexion or sagging of the child's shoulder down and forward.

With an open fracture, damage to the skin is clearly visible. The collarbone comes out, which is accompanied by severe pain, swelling and bruising.

Symptoms of a non-displaced fracture:

• swelling;
• pain;
• maintaining arm activity.

Displaced clavicle fracture

Displaced clavicle fracture

Displacement damage occurs through strong impact. Most often occurs during contact sports. Central damage occurs at the diaphysis because the middle third of the clavicle is the thinnest. Visually, one cannot help but notice that the shoulder girdle has become shorter, and the arm looks longer and hangs uncharacteristically.

Non-displaced clavicle fracture

With this type, the patient may feel pain and have slight swelling in the area of ​​the injury. The arm remains mobile, the bone breaks, but all the fragments are contained.

Closed clavicle fracture

Closed fracture

Closed is not characterized by damage to the skin. There is no tearing or exposure of the collarbone.

Open fracture

Open is always characterized by a rupture of the skin, followed by exposure of a bone fragment.

Diagnostics

First of all, when diagnosing a clavicle fracture, symptoms are taken into account. With a complete fracture, which is considered a classic form of injury, there is usually a tear of the periosteum. The main sign of a fracture in this case will be a feeling of pain in the injured area, as well as the appearance of swelling, which is caused by the divergence of the damaged bone.

An injured shoulder always looks shorter than a healthy one, since the impairment is located between the neck and shoulder joint.

The shoulder blade droops slightly, and its damaged edge begins to protrude much more sharply than usual. This occurs because the broken collarbone can no longer hold the shoulder blade in its natural position. The arm also shifts, it turns inward and protrudes a little forward, and normal movements cause a feeling of pain, especially if the child lifts it up from the side.

Expert comment:

“If you suspect a fracture of the collarbone, you should not postpone a visit to a traumatologist. Near the bone there are large vessels and a nerve bundle, which can be damaged by severe trauma and significant displacement of fragments. With a closed fracture, the bleeding is internal, which makes it difficult to assess the severity of the condition. Undiagnosed blood loss will lead to hemorrhagic shock, which threatens the child’s life. In rare cases, the pleura and lung may be injured. At the same time, there will be a clinic of increasing respiratory disorders. If there are changes in sensitivity in the hand, a decrease in tone and motor activity, then you definitely need to consult a neurologist.”

Natalya Shamko‎‎

Pediatrician-neonatologist.

If a clavicle fracture in children occurs according to the “green stick” principle, then the little patient experiences hemorrhage at the site of injury, impaired motor function, but practically no pain. In this case, the baby complains of inconvenience and discomfort.

At first signs, such a fracture looks like a simple bruise, but if no action is taken, then in just a week a dense tumor (callus) will appear at the site of the injury. In this case, you must urgently contact a specialist. An accurate diagnosis, as well as identifying the features of a fracture, is possible only after an x-ray.

Treatment methods

Treatment depends on the type and severity of the child's injury. Most can be treated with simple precautions until they heal, but when the collarbone fragments on each side of the break are severely displaced or where the collarbone is broken into multiple pieces, surgery may be required to heal properly.

Complex open ones, where the broken bone breaks through the skin, require immediate, aggressive treatment to reduce the risk of infection.

For damage where fragments remain aligned, the following methods are recommended:

• Ice. To help control pain and swelling. Ice packs should be applied to the affected area for the first 2-3 days after the injury. Be careful not to apply ice directly to your skin.
• Hand bandage. It is important to keep the arm immobilized by using a sling or wrap. This will help control the pain and keep the collarbone in position as it heals. Bandages, corsets and splints are also used.
• Drug treatment. The main anti-inflammatory drugs prescribed are Ibuprofen, Collagen-Ultra or Acetaminophen.
• Physiotherapy. While the child's arm is immobilized, it will lose muscle tone and the range of motion in the shoulder will decrease. Once the collarbones have begun to heal, your patient should begin gentle exercises. Once the clavicle has fully healed, your doctor may recommend a more intensive rehabilitation program to help restore strength and flexibility to the clavicle of the shoulder.

Collagen Acetaminophen Ibuprofen for pain relief

Special screws and metal plates used when significant displacement, connection or comminution has occurred do not require removal after the bones have healed unless they have caused irritation.

After surgery, doctors prescribe therapy to help restore movement and strengthen the shoulder.

For younger children, healing time can be quick - 3-4 weeks. For teenagers it is usually about 6-8 weeks. During this time, your patient should be able to easily reduce the risk of re-injury.

Treatment of traumatic fracture

The main goals of treatment are to achieve alignment of bone fragments and fix them in the correct position. If these conditions have been met, the collarbone will heal without any additional therapy within 1.5 months. Otherwise, bone restoration may not occur over a long period of time.

Currently, there are two main methods of treating traumatic fractures: conservative and surgical. The first method involves the comparison of fragments using a special procedure - closed reduction, which should only be performed by a qualified traumatologist. Surgery for a clavicle fracture (surgical method) is performed in the presence of complications, severe displacement, or when the skin is torn by parts of the bone (open fracture).

Conservative treatment

First of all, the doctor numbs the patient before performing closed reduction. For this purpose, a novocaine solution is injected into the fracture area. After the patient has stopped experiencing discomfort, the traumatologist proceeds directly to the procedure.

The optimal position for the patient is sitting with the head tilted towards the injured side. It ensures muscle relaxation and the return/approximation of the clavicle fragment to its original position. Closed reduction lasts, on average, 10-15 seconds. If after 2-3 attempts it is not possible to match the parts of the bone, surgery is recommended.

Plaster application

An important part of the treatment is the application of a plaster cast for a fracture, which will permanently fix the collarbone in the correct position. Most often, a Wenstein bandage is used, covering the chest, shoulder girdle and forearm on the injured side. Despite the fact that it significantly restricts the patient’s movements, it should not be removed without radiographic confirmation of the fusion.

On average, the recovery period lasts 1-1.5 months. During this time, it is necessary to monitor the patient’s condition and the healing process of the collarbone. Signs that should alert the patient:

• Reappearance and increase in swelling;
• Prolonged redness of the skin in the area of ​​the shoulder girdle (longer than 5-6 hours);
• Local increase in temperature over the fracture site;
• Increased pain in the collarbone area.

If these symptoms appear, you should consult a doctor - he will examine the patient and determine further treatment tactics.

Skin care while wearing a cast

Patients are often concerned about skin irritation that occurs shortly after the cast is applied. How to prevent or alleviate it? To do this, remember a few simple rules:

• Do not wet the plaster - this will cause it to soften and have a negative effect on the skin. If moisture gets on or near an immobilized limb, it is necessary to allow the liquid to evaporate naturally. You can speed up the process using a regular hairdryer;
• Protect the cast from impacts and abrasions - wear only loose clothing and do not lean on the cast while sleeping;
• If you are bothered by itching, you should not try to “comb” the skin under the cast with knitting needles, rulers, etc. Do not pour lotions or other liquids into the cast. This will only increase the discomfort. To reduce discomfort, use a hair dryer, directing cold air into the cast.
• Antihistamines (Cetirizine, Cetrin, Claritin, Suprastin) also have an antipruritic effect.

Surgery

Patients with a clavicle fracture are prescribed surgery if one of the following indications exists:

• Impossibility of performing closed reduction;
• Intra-articular fracture;
• The presence of rupture of soft tissues by bone fragments (open fracture);
• Significantly displaced/comminuted fracture;
• Damage to the subclavian vessels or brachial plexus nerves;
• Associated fracture of the scapula.

The main goal of surgical intervention is to connect bone fragments and eliminate complications, if any: stitch blood vessels/nerves, treat the wound, prevent the development of infection. To do this, a special metal plate is placed on the surface of the collarbone or its parts are fixed to each other with screws. Currently, intramedullary osteosynthesis (inserting a Kirschner wire inside the clavicle) is recommended only if it is impossible to perform the above-mentioned manipulations.

Rehabilitation after surgery occurs faster than with conservative treatment. The hand is fixed with a bandage for 1.5-2 weeks. The use of a bandage is not necessary. Plaster is applied only for comminuted fractures or when the doctor is not sure of the effectiveness of the osteosynthesis.

How long do fixation devices remain in the bone? There are no exact deadlines. As a rule, the Kirschner wire is removed 6-8 months after surgery. Bony plates and screws - no earlier than in a year. In older patients (after 50 years), these structures can be left in the collarbone, since surgery to remove them is an additional threat to the health of the patients.

Immobilization for clavicle fracture

Immobilization allows for faster recovery of the injured limb.

The most commonly used dressings include:

1. Dressing using the Delbe ring method . It consists of two fixing rings around the circumference of both shoulder joints. Excellent for children who rarely need a cast.
2. Deso bandage. An elastic bandage is used with its fixation around the chest in several wraps with fixation of the sore shoulder through the armpit.
3. Bandage using a scarf. Allows you to fix the arm in a bent position; it is used from the age when the patient begins to walk.
4. Velpeau bandage. It is made from an elastic bandage and fixes the hand of the injured arm on the shoulder joint at an angle of 45 degrees.
5. Bandage using the 8 method. It is a regular bandage using sealing pads in the area of ​​the armpits and shoulder blades.

Deso bandage

Delbe rings

Bandage using the scarf method

What is the clavicle bone?

The clavicle bone belongs to the shoulder girdle of the human body. This bone is responsible for the firm connection of the upper limbs with the rest of the body, and is perhaps the only one that provides such a function. The clavicular bone is a flat process in the shape of the English letter S. The bone is divided into several sections:

• area of ​​the chest area. Located in conjunction with the sternum, it is less susceptible to fractures;
• acromial end;
• the core of the bone, called the diaphysis. Most susceptible to traumatic conditions, cracks and fractures.

The traumatic condition of the clavicular bone is one of the most common injuries. According to statistics, about 10% of broken bones occur in the collarbone. If you look at the statistics by age, you can note that no specific age category has been identified. However, you can see these types of broken bones even in young children between the ages of two and four.

IMPORTANT! In no case should parents take any action on their own to treat a broken clavicular bone, as this can lead to adverse internal damage to the muscle fibers and blood vessels.

Surgery for a clavicle fracture

Surgical treatment of broken collarbones is necessary only in 5-10% of cases.

Surgery is indicated if there is:

• Skin damage: The broken collarbone has pierced the skin, an injury known as a compound fracture.
• Severe misalignment: two parts do not line up.
• Multiple trauma: when the collarbone is broken in more than one place.
• Shortening of the clavicle: more than 2 cm, caused by either overlap of clavicle fragments or destruction.
• Associated damage: To surrounding nerves or blood vessels.
• Disconnected : the injury does not heal even after 3 months.

Operation using a plate

To fix the collarbone, a special nail, rod or plate is used:

• A rod passes through the middle of the collarbone (known as the canal) to hold the pieces together.
• A specially shaped metal plate, made of titanium or steel, is placed over the top of the collarbone or sometimes around the front to hold the collarbone in the correct position.
• It is secured in place with screws.
• Whatever method is used, the patient is sent home the same day or the next day.

In most cases, the metal plate will remain in place permanently, but if it begins to cause problems such as pain, stiffness, or movement out of position, it can be removed once it has completely healed.

After surgery, treatment will be similar to the non-surgical treatment above. You will need to wear the sling for at least 3-4 weeks while the bones heal. An exercise program will be provided.

Callus on a broken collarbone

Callus occurs when the clavicle is fused without the help of a specialist. An X-ray must be taken to determine whether the fusion has occurred correctly.

Callus on the collarbone

Clavicle fracture during childbirth

Injury sustained by a newborn is treated with conventional fixation. The arm is bandaged to the body for seven days until fusion occurs.

The healthy side is applied to the baby's chest and they try to make sure that the newborn does not lie on the damaged side.

Bandage for fixing a fracture in an infant

First aid

Do not try to straighten the displaced parts of your child’s collarbone yourself! Between them are muscles, nerves and large vessels. With an awkward movement, you will injure them with sharp bone fragments, which is fraught with bleeding and the threat of muscle paralysis.

Such manipulations, as well as applying bandages, are carried out only by traumatologists. However, competent and timely first aid, which can alleviate the child’s suffering and protect him from additional damage, is still necessary. If you notice a fracture, you can:

1. Give the child paracetamol or analgin for pain relief.
2. Provide rest to the injured arm and protect it from further displacement of the bones. You need to place a ball of cotton wool or rolled fabric in the armpit area. Bend the child's arm at the elbow at a right angle. Tie it with a scarf to your neck and wrap it to your body.
3. If there is an open fracture, stop the bleeding with a pressure bandage. Treat wounds with a bactericidal agent.
4. Take the child to the trauma department. Make sure that the baby only sits during transportation.

Rehabilitation and recovery

It usually takes 6-7 weeks for children and 6-12 weeks for teenagers for the collarbone to completely heal. It takes approximately twice as long to regain full function. Most recover fully within three months and it is safe to return to sports.

Doctors recommend during the rehabilitation period:

1. Develop the shoulder joint.
2. Use massage.
3. Go for electrophoresis and magnetic therapy.
4. Take warm baths.

Rehabilitation procedures

In addition to the fact that while wearing a plaster cast, the child is recommended to follow a diet rich in foods that contain large amounts of calcium, after the cast is removed, he will have to work on physical exercises to restore the functions of the arm. However, this is only a small part of helping a child heal a fracture. In order to regenerate the bone structure and subsequent rehabilitation, the child may be prescribed several groups of physiological procedures:

• physiotherapeutic SUV irradiation or electrophoresis aimed at regenerating the bone structure;
• after removing the cast, massage sessions or magnetic therapy are possible in order to restore active blood supply to the damaged part of the body;
• the use of medicinal baths, which have a positive effect on the general state of the child’s immunity;
• internal improvement of the child’s general health, consumption of mineral waters and vitamin complexes.

The most important of all complexes will be a set of physical exercises to develop motor activity of the hand. It is compiled by a physical therapy specialist who, through an individual approach to the child, will work out all the necessary movements.

Exercise therapy and exercises for quick recovery

Specific clinical recommendations from doctors will help restore movement and strengthen the shoulder. Therapy programs usually start smoothly. Recovery exercises should be performed with caution.

Pendulum exercise - reduces immobility in the shoulder and elbow joints:

• The exercise should be done by bending forward with a straight back.
• You can hold on to a wall or table.
• The injured arm should hang and the shoulder should be relaxed and free.
• Circular movements are made clockwise and counterclockwise for 30-45 seconds in each direction.

Because the limb is attached to the scapula, inactivity can lead to weakened scapular muscles and poor posture.

Scapular retractions strengthen the muscles around the scapula and also prevent shoulder stiffness:

• The exercise should be done with a resistance band tied to a doorknob at waist height.
• Stand straight, arms at your sides and elbows bent to 90 degrees.
• Hold one end in each hand and move your elbows back, maintaining a 90-degree angle.

The horizontal shoulder abduction exercise helps increase range of motion around the collarbone:

• Perform the exercise when the pain has decreased and you can raise your arm 90 degrees.
• Place your hands on your shoulders and make gentle circular movements.

Exercises

Features of lifestyle and rehabilitation

The bandage applied by the doctor cannot be removed independently during the entire treatment period. The baby's physical activity should be limited. An exception is physical therapy exercises, which are necessary for proper restoration of muscle tone and mobility of the damaged area.

If the fracture was incomplete, the child will have to wear a fixing bandage for up to 3 weeks, but if there are displacements, the healing period usually increases to a month. Full functionality of a hand with a damaged collarbone will be restored only after 2-3 months of rehabilitation.

In the first days after applying a therapeutic bandage, the child should begin to move his fingers and elbow joint, but with caution, avoiding pain. After removing the fixator, the doctor will prescribe special procedures in the physiotherapy room, the purpose of which is not only to eliminate pain and discomfort, but also to speed up the healing process of the fracture, relieve the inflammatory process and improve the condition of the little patient.

For rehabilitation, the child is prescribed the following procedures:

• ultrasound therapy;
• magnetic therapy;
• laser therapy;
• UHF using special anti-inflammatory ointments.

UHF device

After a three-week course of treatment, the child will be able to move the shoulder within the limits of the applied bandage. At this time, therapeutic exercises are expanded, and in addition to moving the fingers and elbow joint, it is allowed to shrug the shoulders, pull them back and do other exercises to warm up the joint and restore its mobility.

After the doctor removes the applied bandage, the joints of the arm and injured shoulder will be relatively functional, and full mobility, subject to all the instructions of the specialists, will be restored very quickly. Often, at the end of rehabilitation, the child is prescribed a special massage and lotion or mini-bath with sea salt.

How to bandage a child with a broken collarbone?

An eight-shaped bandage is wound from an elastic bandage:

1. One end is fixed on the forearm, and the bandage is directed along the back through the diagonal armpit.
2. It is carried across the chest and captures a fixed angle.
3. Several wraps around the body on one side.
4. After three entanglements, a circle is made around the chest.
5. The bandage is transferred to the second forearm and drawn diagonally through the armpit to the second half of the body.

Figure-of-eight bandage for fixation

Consequences of a fracture

In 1-5% of cases the collarbone does not reunite. If there are no symptoms associated with it, no further treatment is indicated, but if there are persistent symptoms such as pain or decreased movement, surgery may be required. The collarbone can become overgrown in a misaligned position, which can lead to ongoing shoulder problems.

In approximately 30% of cases, hardware may subsequently need to be removed due to discomfort or loosening and misalignment.

Consequences

Longer treatment may be needed if the child has an open fracture or damage to the subclavian nerves and arteries.

Sometimes, due to complex injuries, the collarbone cannot restore its original length, so the forearm remains slightly shortened and deformed.

Incorrectly fused clavicular bone fragments and overgrown callus can put pressure on the nerve plexuses, causing chronic pain and minor difficulties during physical activity. The same phenomenon is observed with the formation of a “false joint” - the consequences of a non-united clavicle fracture.

• Recommended reading: fracture of the forearm bones in children

Even if the bones have not fused completely correctly, there are no significant disturbances in the functioning of the arm and shoulder girdle of children, except in cases where the shoulder girdle was immobilized for too long during treatment.