CLAVICLE (COLLARBONE) FRACTURE: Infant, Child, or Adolescent

CLAVICLE (COLLARBONE) FRACTURE: Infant, Child, or
Adolescent
v GENERAL INFORMATION
Physical Examination
The clavicle (collarbone) is the bone that connects the
Infant
arm with the trunk. The clavicle is one of the most
• Sometimes when examining the infant gently, the
frequently broken bones in children (Fig. 1).
broken bone can be felt crackling under the skin.
• The infant won’t move the arm.
Child or Adolescent
Clavicle
• Often the broken bone can be felt under the skin.
(collarbone)
• The clavicle may be crooked.
• When the shoulder is moved, there is pain over the
Sternum
fracture.
(breastbone)
• X-rays of the clavicle show the fracture, which can be
as follows (Fig. 2):
• It can be fractured, but not through and through
(this usually is referred to as a greenstick fracture)
(A).
• It can be a through and through fracture but can
have one of the following appearances:
• It is not out of place (B).
• The clavicle is bent at the fracture (C).
• The broken ends of the clavicle have slid over
each other but are still touching (D).
• The broken ends are widely separated from each
other (E).
The above variations are important because they de-
termine the type of therapy that is necessary.
Humerus
Ribs
(upper arm bone)
Scapula
A
(shoulder blade)
Figure 1. Normal bone anatomy of the shoulder area.
B
COMMON SIGNS AND SYMPTOMS
Infants
• The clavicle may be deformed.
• Usually there is swelling over the fracture.
• The infant doesn’t want to move the arm because of
the pain. This is sometimes called ‘‘pseudoparalysis,’’
C
but very rarely is anything wrong with the nerves.
Children or Adolescents
• There is pain and swelling over the fracture.
• The clavicle usually shows some deformity.
D
• There is painful motion at the shoulder joint.
DIAGNOSIS
History
Infant
• Commonly, there is a history of a dif?cult birth.
Child or Adolescent
E
• Most commonly, there is a history of a fall on an
outstretched arm or a direct injury to the middle of
Figure 2. The most common types of fractures in an infant or a
the clavicle.
child.
? Copyright 1999 by WB Saunders Company. All rights reserved.
CLAVICLE (COLLARBONE) FRACTURE: Infant, Child, or Adolescent
157

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q TREATMENT: No Operation
skin in the armpit, which can irritate the area. Use
Infant
some gauze with ordinary rubbing alcohol on it to
• If there are no symptoms, no speci?c orthopedic
keep the area clean.
treatment is necessary. The infant should be handled
q TREATMENT: Operation
gently, however.
• If there is pain on touching the fracture site or there
• An operation is rarely required and only in the
is pseudoparalysis, the arm is immobilized by pinning
following instances:
the shirtsleeve on the injured arm to the body of
• When a nerve is caught in the fracture area.
baby’s shirt with a safety pin for 1 or 2 weeks until
• When the fracture does not heal, usually because
the tenderness disappears.
the broken ends were too far apart.
Note: The arm will be examined carefully and repeat-
• When the fracture is an outer end (distal) fracture
edly for any neurologic problems, especially in those
through the growth plate with signi?cant
infants who do not move the arm.
displacement and deformity.
• The operation is done under general anesthesia.
Child or Adolescent
• An incision is made that can be closed in a
• A bandage (called a ?gure of eight) is applied. The
cosmetically pleasing fashion.
purpose of this bandage is to pull the shoulders
back. It helps prevent the clavicle from moving
POSTOPERATIVE CARE
too much.
• At the completion of the operation, your child will be
• The above therapy does not require an anesthetic; it
taken to a recovery room and observed. After the
is done on an outpatient basis.
blood pressure, pulse, and breathing are normal, the
• Usually the ?gure-of-eight bandage is kept on for 2
child usually can be taken home that same day.
weeks. If pain is still present after 2 weeks, the
Occasionally, a 1- or 2-day hospital stay is necessary.
bandage is kept on for another week or so longer.
• Arrangements will be made for medicine,
• Usually physical therapy is not required.
instructions on care, and the postoperative of?ce
• Full range of motion can be expected once the pain
visit.
from the fracture disappears.
• Any deformity of the clavicle usually corrects itself
& HOME CARE
with time.
• Pain medicine is required only occasionally.
& HOME CARE
• Sponge bathe. Let’s discuss when tub baths or
• Pain medicine is required only occasionally.
showers are appropriate.
• The ?gure-of-eight bandage needs to be checked
• Keep the dressings dry. If they get wet, replace them
every day to see that it is snug. The buckles in the
with clearn, dry ones.
back need to be adjusted as necessary.
¥ CALL OUR OFFICE IF
• Check the elbow, wrist, and hand to see that they
move as well as those in the unaffected arm.
• There is a change in color of the ?ngers, or the
• Check the ?ngers twice a day to make certain there
?ngers or wrist cannot be moved as well as those on
is no change in color.
the unaffected arm.
• The ?gure-of-eight bandage presses against the moist
• Any unusual signs or symptoms develop.
158
CLAVICLE (COLLARBONE) FRACTURE: Infant, Child, or Adolescent
? Copyright 1999 by WB Saunders Company. All rights reserved.

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