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Abrasion over the clavicle may be noted, suggesting that the fracture was from a direct mechanism. Type II distal clavicular fracture (displaced). Distal radius fracture is one of the most common fractures and often requires surgical intervention. 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. The medial end is pulled superiorly by the sternocleidomastoid muscle. The entire skeleton may be weak due to metabolic (e.g. 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. 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. Kleinhenz BP, Young CC, Clavicle Fractures. Complications of fractures. Patient's shoulder is immobilized in a sling or figure-of-eight brace until the clinical union is achieved. [9]. Be sure to click the subscribe button and the notification bell above so you can be informed when we post a new video. Treatment of clavicular fracture depends upon whether a fracture is displaced or undisplaced. Occult fractures may also be present. [2] About 87% of reported cases, a clavicle fracture results from a fall directly onto the lateral shoulder. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Clavicle fracture usually occurs following trauma with a direct blow to the shoulder region, often following a fall. 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. Learn more about the rehab, recovery time, & exercise protocols for broken collarbone, fractured clavicle, or other shoulder injuries repairs. These cells lay down woven bone which stabilises the fracture site. Crepitus from the fracture ends rubbing against each other may be noted with gentle manipulation. Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: a case-control study. Due to its superficial subcutaneous location and the numerous ligamentous and muscular forces applied to it, the clavicle is easily fractured. Immobilisation can be achieved in a variety of ways depending on the location, morphology of the fracture, and device of fixation. The type of fixation, it is a cast, splint, or it is ORIF procedure. Non-surgical management forms the first-line treatment for undisplaced fracture. Clavicle fractures are commonly known as a breaking of the collarbone, and they are usually a result of injury or trauma. The pathophysiological sequence of events that occur following a fracture can be divided into three main phases[3][4]: Immediately at the time of fracture, the space between fracture ends is filled with blood-forming a hematoma. Helping your clavicle to recover after a fracture Information for patients. 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. Traditionally, the management of clavicle fractures has been through conservative management with sling immobilization and subsequent rehabilitation. Regarding the preferred surgical technique for mid-shaft fractures, both plate fixation and IM nail demonstrated near complete return rates and similar return times. Operative treatment of clavicular fractures: a prospective study. These injuries are classified like adult AC joint injuries and treated similarly, with surgical treatment reserved for those with severe superior displacement, inferior displacement, or posterior displacement. Search. A patient may report a snapping or cracking sound when the injury occurs. The chief goal of this treatment is to achieve a healed clavicular strut in a normal anatomical position as possible. Free active and active assisted range of motion of shoulder in all planes is usually allowed after 6 weeks with passive ROM as tolerable. 2013 Jun 1;25(2):321-31. The involved arm will be placed in a sling or a figure-8 brace to secure it and support its weight for comfort. So a sling is usually used and immobilization in internal rotation is usually recommended for 2-4 weeks. 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. 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. Most distal clavicle fractures are the result of a fall onto the distal clavicle or a direct blow to it. Nb. 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. Associated distal nerve dysfunction indicates a brachial plexus injury. A patient may cradle the injured extremity with the uninjured arm. 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. [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]. So rehabilitation protocol may also vary based upon individual co-morbidities. Dr Henry Knipe and Andrew Murphy et al. However, the management of these injuries can present a challenge, particularly when trying to minimize long-term dysfunction, pain, or deformity. Because the midshaft of the clavicle is the thinnest segment and does not contain ligamentous attachments, it is the most easily fractured location. 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. [3], Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. 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 forces involved in scapular fracture can also cause tracheobronchial rupture, a tear in the airways. Begin normal light daily activities with the arm and shoulder. For example; intramedullary nail, casts, rods. Classification. A common site for non-union. 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). Progressive resistive exercises (isotonic) for scapular stabilizers, biceps, triceps and rotator cuff are prescribed after 6 weeks. Get started . Radiographs confirm the diagnosis and aid in further evaluation and treatment. CLAVICLE FRACTURE REHABILITATION PROTOCOL: Jordon Young Institute, CLAVICLE FRACTURE STABILIZATION Post –Operative Rehabilitation, https://www.ncbi.nlm.nih.gov/books/NBK507892/. sustaining a fall; a direct blow or ; a car accident; Frankly, broken collarbones are most common in children in young adults. A clavicle fracture is also known as a broken collarbone. These fractures may be partial or complete and often require surgical repair or immobilization while they heal. Do not lift your elbow above shoulder height as this may be painful. 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. Skip to main content 415-563-3110. The shoulder may appear shortened relative to the opposite side and may droop. Each fracture is unique. Clavicle Fracture. Scapular mobilization exercises are addressed. 1. Most clavicle fractures are treated without surgery. Lädermann A, Abrassart S, Denard PJ, Tirefort J, Nowak A, Schwitzguebel AJ. While most clavicle fractures are treated conservatively, severely displaced or comminuted fractures may require surgical fixation[1]. Phys Sportsmed. The fracture has been satisfactorily immobilized, and the patient has been given appropriate analgesia. Relative indications include shortening of more than 15 to 20mm and displacement more than the width of the clavicle. Plan – this refers to the plan of treatment). Most clavicle fractures heal without difficulty. Patients heal at different rates depending on their general health and underlying illnesses. [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. 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. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. These fixation methods are necessary for lateral clavicle fracture as it involves acromioclavicular joint and various ligaments that may become injured during fracture.[3]. Transverse or vertical fracture according to the orientation of the fracture. 2003 Dec. 31(12):30-6. . However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. They are common in very young and very old patie… Scar management if the patient had surgery to fix the fracture, Return to sport preparatory work and advice where required. This leaflet gives you the advice and exercises to help your clavicle (collar bone) to recover after your fracture. Indirect injuries are commonly associated with tears of the retinaculum and vastus muscles.Patella fractures make up about 1% of all skeletal injuries. Available from: Tidy's Physiotherapy Chapter 22 Churchill Livingstone Elsevier London 2013. In most cases, clavicle fractures are easily identified on plain x-ray. Whereas in the athlete, surgical management is the routine treatment for displaced lateral fractures and the recommended treatment for displaced mid-shaft fractures, offering improved return rates and return times over conservative management. Healing complications: malunion, delayed union, or nonunion. Alignment may or may not be necessary depending on the degree of displacement, the importance of correct alignment (e.g. Clavicle fractures are very common injuries in adults (2–5%) and children (10–15%) and represent the 44–66% of all shoulder fractures. Neurovascular injury or compromise that is progressive or that fails to revere after the closed reduction of the fracture. Midshaft clavicle fracture — this occurs in seventy-five percent of clavicle fractures and is the most common. Isometric exercises of Shoulder with tolerable resistance is started within 4-6 weeks. Bahney CS, Zondervan RL, Allison P, Theologis A, Ashley JW, Ahn J, Miclau T, Marcucio RS, Hankenson KD. Tenting and blanching of the skin at the fracture site may indicate an impending open fracture, which most often requires surgical stabilization. Palpation of the scapula and ribs may reveal a concomitant injury. 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. These are termed fatigue fractures. The stress at the fracture site is transmitted through the shielding device, there is no motion at the fracture site so promote primary bone healing without callus formation, which is slower than the healing with callus formation. Avoid heavy lifting for the full 6 weeks. 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. A figure-of-eight brace is often thought to prevent or reduce secondary fracture shortening during the time of fracture healing. CONCLUSIONS: The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. Remodeling can result in almost perfect healing, however, particularly if the alignment is not perfect, a residual deformity will remain. Group I: Fractures of the middle third or midshaft fractures (the most common site). 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. Available from: Hershey K. Fracture complications. A clavicle fracture (or broken collar bone) is a common injury usually caused by . Contact sports should be avoided for 3-4 months. ” - Michael Cline PT avoid stiffening of the person, for example, people osteoporosis... To 10 % of all skeletal injuries healing of the article ) treatment... Charity in the setting of trauma are a secondary source and so should be... Surgical fixation [ 1 ], or deformity mentioned above ( need to use of... Onto an outstretched hand simple as being badly displaced to a simple shoulder sling lot and. Reduce pain and swelling > 100 % displaced a broken collarbone nerve dysfunction indicates a brachial plexus and! With nonoperative management, rehabilitation for conservative management, which includes use of arm sling as mentioned above ( to. 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