At 2 years old, how quickly does the collarbone grow together? How to recognize a clavicle fracture in a child and how to treat it? Surgical treatment of clavicle fracture

If a child has a direct blow to the location of the collarbone or falls on the shoulder, outstretched arm, elbow and there is a suspicion of a fracture of the clavicle bone, do not panic. A clavicle fracture in children is treated quickly and successfully, and competent rehabilitation eliminates all consequences.

Fracture without displacement

Take a close look at what symptoms you have, even if their external manifestations are minor. Young children have very flexible bones; a typical incomplete fracture, which traumatologists call a “green stick,” may occur. The inner layers of the bone break, but are not displaced due to the flexible periosteum. Safe and sound, it continues to hold together the damaged areas of the child’s collarbone.

There is no displacement, pain is minimal, the symptoms of a fracture are not clearly expressed, with the exception of hemorrhage in the area of ​​the injury. It is difficult to determine a closed fracture without displacement, so it is often mistaken for a regular bruise.

Gradually the bruise fades, after about two weeks a compaction appears on the clavicular bone - a callus, the damaged shoulder girdle becomes shorter. The bone will heal on its own, but not always successfully. There is still time to go to a traumatologist. He will prescribe x-rays, treatment and set the bone if the fusion is not happening correctly.

Displaced fracture

Symptoms of displacement can be identified even by an inexperienced person; they are visible upon a superficial examination. With a complete fracture, fragments of the clavicle bone are clearly visible under the skin. If a broken bone has broken through the muscles and skin, help should be urgent - these are signs of an open fracture.

You will also notice other symptoms:

• immediately after the injury, the child complains of very severe pain;
• cannot lift the injured arm, presses it to the body;
• the injured shoulder is lowered, unnaturally pushed forward, displaced inward;
• the forearm is swollen and swollen, hemorrhages are visible;
• the affected arm seems longer;
• the shape of the collarbone has changed;
• If the child moves his hand, a crunching sound is heard.

A displaced fracture can be complicated by damage to important nerves and blood vessels. To check for signs of damage, ask your child to move his fingers and hand.

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 for.
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.

Treatment

Reposition and fixation bandages

In the department, a pediatric traumatologist will deal with a fracture of the child’s collarbone. He will prescribe treatment on an outpatient basis, except in cases with open fractures, severe displacements, or the threat of damage to the lung, blood vessels, nerves, and skin.
When treating incomplete fractures and those with slight displacement, the doctor will apply a scarf bandage, Deso bandage, and Delbe rings.

It is very difficult to hold displaced bones until they heal completely. It is advisable to use only methods that will provide functional treatment. Deso bandages and adhesive plaster according to Sayre poorly fix the fragments, immobilize the shoulder joint, and provoke its immobility in the future.

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They are only good for temporary fixation. A plaster cast has similar disadvantages. Treatment of a displaced fracture involves more recommended methods: Beller splint, Delbe rings, double Cramer splint, fixation on the oval.

In case of an incomplete fracture, the bandages will remain on the child’s arm for 2-3 weeks, in case of displacement – ​​up to 4 weeks. Working capacity will be fully restored after a couple of months of rehabilitation.

Surgical treatment

Surgery for a clavicle fracture is rarely required. Only carried out in case of serious injuries:

• open fracture;
• severe displacement that cannot be eliminated by reposition;
• damage to the skin, nerves, blood vessels, lungs;
• neuralgic pain in the arm;
• excess callus.

The child will undergo the operation under general anesthesia. If the fracture is located on the middle part of the clavicular bone, osteosynthesis will be performed with knitting needles, a pin, or S-shaped reconstruction plates. If the acromial end has been damaged, a hook plate or a plate and locking screws will be required.

After the operation, the child wears a scarf for some time. In a week, the stitches will be removed and restorative treatment will be prescribed: electrophoresis, restorative massage, magnetic therapy and exercise therapy.

Rehabilitation period

In the first days, treatment of a fracture consists of active movements of the fingers and elbow joint. You can move your shoulder back, but be careful not to cause severe pain.

After a couple of weeks, the doctor will prescribe physical procedures that will help your baby reduce pain, relieve inflammation and improve bone healing. The rehabilitation complex will consist of:

• Magnetotherapy;
• Ultrasound;
• UHF with the use of anti-inflammatory ointments;
• Laser therapy.

After 3 weeks of treatment, you can increase shoulder movements as far as the fixing bandage allows, including movements of the shoulder girdle and shrugging. These exercises are aimed at warming up the collarbone joint.

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When the bandage is removed, the joints of the recovering arm will be relatively functional, and the remaining disorders will pass very quickly. To restore motor functions more actively, give your child massages and baths with sea salt.

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.

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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.

Among many diseases and injuries, a fracture of the collarbone in a child is widespread. Doctors put it in third place after a fracture of the shoulder and forearm area. Children aged 2–4 years of age suffer, and cases of injury in newborns are not uncommon. The fracture is easily treated. Timely medical care and treatment can eliminate all consequences and prevent complications.

It is considered an isolated injury and appears in everyday life (at home, on the street) or at school during a physical education lesson or during active games. Less common is a combination of a clavicle fracture with other injuries, such as fractures of other nearby bones and muscle strains.

In children, a fracture of this type occurs due to indirect trauma: mechanical compression of part of the chest or a sharp fall on one arm. The fracture is localized in the place between the outer and middle regions of the clavicle, where the bone is most vulnerable.

Direct injury (a strong blow to the forearm) is less common.

Types of injury

Doctors divide a fracture into 3 types depending on its location:

• internal (when only the inner part of the bone is damaged, “green stick” type);
• external;
• middle third (occurs most often, because this part of the bone is the thinnest).

In addition, clavicle fractures occur:

• closed;
• open;
• without displacement (the bone is damaged, but has not moved);
• with displacement (bone shift is observed).

A complete fracture is observed in older children and can be transverse, oblique or comminuted. Experts characterize the injury by the direction of displacement of the fragments. Depending on the degree of injury, the weight of the limb, and the action of the muscles during displacement, the following picture may arise: one central fragment has moved upward and simultaneously backward, and the peripheral part has moved downward and forward.

Characteristic symptoms

Vary depending on the type of fracture.

Subperiosteal fracture - small, moderate swelling, possible bruising. There is no pain, the child walks calmly and does not complain. Parents mistake the swelling for a bruise due to an unfortunate fall. The signs are not dangerous, so the victim is taken to a traumatologist later, after 1–2 weeks. Then, instead of swelling, a characteristic bone callus is formed, which looks like a swelling.

A complete fracture is a sharp pain, swelling later forms, it is more pronounced if the injury is accompanied by displacement of fragments. The damaged shoulder girdle is smaller than the healthy one. The victim complains of pain, takes a forced position: leans towards the injured side, tries to hold his hand, pressing it to his chest or stomach.

From the back you can see how the scapula on the damaged side “sags”, the edges of the bone become more pronounced. A thorough examination and palpation reveals the ends of the fragments; the procedure is painful for the patient. The victim's movements are limited, each causing severe pain. Attempts to raise your arm high or stretch it to the side become extremely painful.

The injured limb is longer, the area with the damaged joint is smaller. If sensitivity in the hand or finger mobility is impaired, the injury may have caused damage to nearby nerves and blood vessels.

In children, of the above symptoms, only a slight swelling, similar to a simple bruise, and minor pain are encountered. Therefore, having received a fracture of the collarbone, children 5 years of age and younger can maintain freedom of movement with the injured arm and practically do not complain of pain. Doctors advise that if you receive even minor injuries, contact a specialist in order to identify a closed fracture in time.

First aid

While waiting for specialist help, you need to do the following:

1. Give the injured child analgesics (if he complains of acute intense pain).
2. Provide complete rest to the injured arm - bend it carefully at the elbow and apply a simple fixing bandage. Children as young as 4 years old can wear such bandages, understanding the importance of first aid. If the affected child is younger (2 years old or a newborn), you can apply a bandage by tying the arm more tightly to the body. If the fracture is open, apply a bandage using sterile bandages.
3. You cannot straighten the affected bone yourself. Such actions can provoke complications by damaging the skin, blood vessels or nerves. It is important to fix the injured arm more tightly and keep the child in one sitting position. Transport also while sitting, avoiding attempts to lie down, especially on the stomach.

Therapeutic measures

Injuries of this kind are dealt with by a pediatric traumatologist. It accepts patients, newborns, children 1 year and older.

The first procedure will be an x-ray. The image will show the severity and specifics of the injury. There is no need to worry. Even complex fractures accompanied by displacement heal quickly in young children.

After the x-ray, the doctor will determine whether the treatment will be outpatient or the patient will be hospitalized. If displacement of damaged fragments or an open fracture is detected, then the child is admitted to the hospital.

Subperiosteal and complete fractures (closed, without displacement) are treated by a specialist applying a Delbe ring, a thick gauze bandage or.

A dense bandage, formed from special wide bandages, is effective for children 1–3 years old. For older patients (4–6 years), the bone is fixed with a full plaster cast (plaster is applied).

For young children, surgery (reposition) is performed under strong general anesthesia. For older patients, local anesthetic is sufficient. If the displacement occurs along the length, the doctor moves both forearms of the patient back and up. If the fragments are displaced at an angle or the fracture is transverse, the doctor uses a special technique (presses the displaced fragments with his fingertips, straightening them). After which the straightened area is fixed with a special tight bandage. The specialist chooses the type of bandage based on the type of injury.

If the fracture is displaced, the doctor uses a special splint, and sometimes direct surgery to return all displaced fragments.

Surgery is rarely required for these injuries. It must be carried out in the following cases:

• open fracture;
• severe displacement that cannot be corrected by repositioning;
• damage to the skin (nerves, local vessels, lung injury);
• neuralgic pain (radiates in the arm);
• pronounced bone callus.

The operation will be performed using general anesthesia for the child. Depending on the specifics of the injury (the middle part of the clavicle or its acromial end is broken), the doctor uses knitting needles, pins, and special hook- or S-shaped plates.

After the operation, the patient will have to walk with a tight bandage for the first time. A week will pass, the doctor will examine and remove the stitches. Prescribe special restorative treatment:

• massage;
• electrophoresis;

Rehabilitation and recovery

In the first days of the recovery period, the patient needs to develop the elbow joint and move the fingers. Pull the injured shoulder back, but carefully, avoiding severe pain.

After 1.5–2 weeks of treatment, the doctor prescribes special physiotherapy procedures that will help the little patient effectively reduce pain, relieve inflammation and improve the process of natural bone fusion.

The rehabilitation complex includes:

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

After 3 weeks of intensive rehabilitation, you can begin to increase the activity of shoulder movement as much as the applied fixing bandage allows: try to shrug your shoulders, move your shoulder girdle. These exercises help stretch the collarbone.

By the time the doctor removes the bandage, the joint of the previously injured arm will be sufficiently developed and the remaining damage will go away quickly. To make the recovery process more active, regular home massage and (use sea salt for them) will help.

Consequences

Closed fractures, treated in a timely manner, can disappear without a trace, leaving no consequences. Young children recover quickly.

Open fractures may require long-term treatment, especially if the damage affects arteries and local nerve endings.

Complex injuries can change the original length of the broken collarbone, so that the forearms will subsequently appear visually uneven.

If the fragments of a broken collarbone were fused incorrectly, it will form. It will put pressure on nearby nerve nodes, causing pain, and reduce the activity of the collarbone. This phenomenon is also typical for “” - when a fracture of the collarbone does not heal at all.

Timely medical care and carrying out all the measures necessary for full rehabilitation help to avoid many complications even with severe fractures accompanied by displacement.

– a common injury that ranks third in frequency after fractures of the shoulder and forearm. Usually the cause is a fall on the arm or compression of the chest. Less commonly, a fracture occurs when there is a blow to the collarbone. In young children, subperiosteal fractures are observed, in patients of the older and middle age groups - complete fractures. A complete fracture is accompanied by severe pain, deformation and swelling of the shoulder girdle. With subperiosteal fractures, there is no deformation of the shoulder girdle, and the pain is minor. The diagnosis is made based on examination data and x-ray results. Treatment is usually conservative, using various fixing bandages, and repositioning is performed if necessary. The operation is indicated for irreparable displacement of fragments and the threat of complications.

General information

Clavicle fractures in children account for 7.4-14% of the total number of fractures. It can occur at any age, but the greatest number of cases occurs between the ages of 2-4 years. It is usually an isolated injury and occurs at home or during sports activities. The combination with fractures of other bones and soft tissue injuries is rarely observed, as a rule, in road accidents or falls from a height.

Incomplete (subperiosteal) fractures may remain unrecognized or be diagnosed late due to poor symptoms. Clavicle fractures, both incomplete and complete, heal well and do not leave behind functional disorders.

Causes of clavicle fracture in childhood

In children, clavicle fractures most often occur due to indirect trauma: compression of the chest or a fall on the arm. The fracture is usually localized at the border between the outer and middle parts of the clavicle, since in this place the bone is thinner and its curvature is more pronounced.

Direct injury (a blow to the shoulder girdle) is quite rare. In such cases, the fracture usually occurs in the outer part of the collarbone.

Features of a clavicle fracture in children

In younger patients, fractures or subperiosteal fractures are more likely to occur. In traumatology, such injuries are called “greenstick” fractures, since in such a case the same thing happens as when trying to break a young tree branch: the inner part of the bone breaks, but the outer (periosteum) remains intact and holds the broken ends, preventing them from move. Usually such fractures are transverse. In some cases, fragments held by the periosteum may move slightly at an angle.

In older children, complete fractures of the clavicle are observed, which can be transverse, oblique, or comminuted. The degree of displacement of fragments can vary significantly. Due to the weight of the limb and the action of the muscles during displacement, a typical picture is observed: the central fragment moves up and back, and the peripheral fragment moves down and forward.

The prognosis is favorable. Movements are fully preserved. With adequate reposition of the fragments, the normal configuration of the clavicle is restored within several months.

A clavicle fracture is a fairly common injury in both newborns and young children and accounts for 13–15% of all bone fractures. During childbirth, damage can occur as a result of strong pressure, rotation, and discrepancy between the sizes of the pelvis and the child. Sometimes the collarbone is even specially cut if the shoulders cannot be born. At an older age, injuries occur even more often, because the baby becomes more mobile. You can break your collarbone by falling on your elbow or outstretched arm, or less often by a direct blow to this bone.

Broken collarbone in a child

The clavicle is an S-shaped tubular paired bone, has two ends: acromial (attached to the scapula) and sternal (attached to the sternum). Its middle part is called the diaphysis. This is where the collarbone most often breaks, as this is its thinnest place.

Approximately 2% of cases of clavicle fractures are combined with its dislocation. Even less common are combinations of such an injury with a scapular fracture and damage to the neurovascular bundle passing behind it. The subclavian vein and artery are very large vessels of the body; in case of injury, it is not possible to stop bleeding from them without surgery. Therefore, quick recognition of their damage is very important to avoid a tragic outcome.

Types of fractures: displaced, non-displaced and others

Depending on the location of the fragments, they are distinguished:

• displaced clavicle fractures. The clavicle fragments are displaced relative to each other. In turn, such fractures occur:
  • complete - fragments are separated;
  • incomplete - bone integrity is largely preserved;
• non-displaced clavicle fractures. These fractures heal better.

If the collarbone has damaged the skin with fragments, it is called an open fracture. Such injuries occur when there is a strong impact, such as a fall from a height or a car accident. In these difficult cases, surgery cannot be avoided.

But closed fractures are more common, when the skin remains intact.

According to the fault line, clavicle fractures are divided into several types:

• T-shaped;
• transverse;
• oblique;
• helical;
• S-shaped.

This division is very important, since the choice of an adequate treatment method depends on the type of damage.

Types of clavicle fractures - photo gallery

Fracture of the clavicle without displacement: the fragments are not displaced relative to each other Incomplete fracture of the clavicle with displacement - bone integrity is largely preserved Complete fracture of the clavicle - fragments are separated

Features of trauma in children

In newborns and preschool children, the collarbone tends to break like a green stick. When a bone is injured, it bursts, and the periosteum holds the fragments together, similar to a green branch. Thus, in children such injuries are periosteal in nature, that is, incomplete.

In school-age children, the periosteum is thin, so their bone fractures are often complete, with displacement of fragments.

Video: clavicle fracture in a newborn

Causes and risk factors

Most often, clavicle fractures occur from a fall on the hand or from a direct blow. A similar danger exists for every active child, but it mainly affects hyperactive children, as well as children involved in highly traumatic sports (basketball, football, gymnastics, cycling), and martial arts.

Other causes of clavicle fractures in children:

• car crashes;
• sudden muscle contraction in children with epileptic seizures;
• Osteosarcoma is a malignant bone tumor.

Risk factors for clavicle fracture in newborns

Childbirth is a complex process during which it is impossible to foresee all the nuances. But there are still some prerequisites for a clavicle fracture in a newborn baby:

Photo gallery: types of fetal presentations that can cause a clavicle fracture

How does a clavicle fracture appear?

Trauma is rarely diagnosed immediately after childbirth. This is due to the fact that this fracture is subperiosteal, without severe deformation, and it may well not be noticed during the period of stay in the maternity hospital.

Signs of Trauma in Newborns

At 3–4 days from birth, a spindle-shaped thickening can be noticed above the collarbone - a forming bone callus. There may be bruising and swelling in the area of ​​injury. The general condition of the child usually does not suffer, although there may be restlessness and crying when changing clothes, breast refusal and greater than expected weight loss. If the fracture is displaced, movement of the arm on the side of the injury will be limited. When moving the pen and probing the clavicular area, a crunching sound occurs (so-called crepitation) - the result of friction of the fragments against each other.

Symptoms in children of early, preschool and school age

Typically, a greenstick or willow twig fracture occurs in children under 12 years of age. It all depends on the child’s metabolism, in particular, on the degree of bone mineralization. Such an injury in a child will only manifest itself as signs of a bruise: the presence of a hematoma (bruise), swelling, and discomfort when moving the hand on the injured side.

Complaints of pain in this case are rare. The child's general condition remains satisfactory.

The bruise gradually fades, and within two weeks a callus forms on the collarbone - a compaction indicating bone fusion. The damaged limb is shortened somewhat. If you find such a compaction on the collarbone, you should contact a specialist, since the bone will probably heal incorrectly, and at this stage it can still be corrected.

In case of a clavicle fracture with displaced fragments, the following symptoms will be present:

• unevenness above the collarbone; fragments of damaged bone can be felt under the skin;
• severe pain, swelling, bruising or bleeding in the clavicular area;
• the child tilts the body towards the injury, pressing the injured limb to the body;
• visually the arm turns inward, moves anteriorly and looks longer than healthy;
• the shoulder blade droops slightly, its edges become more noticeable;
• palpation of the clavicle area is painful, there may be a crunching sound (crepitus);
• small movements of the hand on the side of the injury;
• crunching is possible when moving;
• severe pain when raising the arm up;
• decreased sensitivity of the fingers on the damaged limb.

Diagnostic methods

The diagnosis is made based on the characteristic clinical picture. Methods to confirm a clavicle fracture:

1. Inspection. Helps to identify unevenness, hematoma at the fracture site, elongation of the limb, and the characteristic forced position of the body.
2. Probing. When you apply gentle pressure at the fracture site, pain will occur and crepitus (crunching) is possible. Fragments of the collarbone can be felt under the skin. If the nerves are damaged, there will be a decrease in sensitivity and mobility of the hand and fingers on the damaged limb.
3. X-ray examination of the damaged limb. It should be carried out in all cases where a clavicle fracture is suspected. The method helps determine the type and severity of the fracture and distinguish it from a dislocated collarbone. X-ray of the upper segment of the chest is performed in a direct projection.
4. Computed tomography or magnetic resonance imaging of the chest. May be necessary if there is a suspected rupture of the lung due to a fragment of the collarbone.
5. Angiography is radiography of vessels after the introduction of a special contrast agent into them - a method that allows you to “see” damaged vessels. Used for complex fractures, often during surgery.

Important! In the delivery room, the baby is examined by a neonatologist who can diagnose a clavicle fracture based on a combination of clinical signs, even without an x-ray examination.

What not to do if you have a broken collarbone

In case of a clavicle fracture or suspicion of it, it is prohibited:

• combine the fragments yourself. This can damage the neurovascular bundle, which is located downward and posterior to the collarbone, and provoke bleeding or muscle paralysis;
• independently adjust the “dislocation”;
• transport the child in a standing or lying position;
• pull, pull by hand;
• Fully straighten the injured limb.

Therapeutic measures in newborns

Usually, the neonatologist in the maternity hospital, after making a diagnosis, takes all necessary measures to treat the fracture. If for some reason the child’s parents notice the problem already at home, they need to do the following:

• take a piece of fabric and secure the child’s arm bent at a right angle with a so-called scarf bandage. It should be attached to the neck and not squeeze the baby’s delicate body;
• call an ambulance or take the child to the hospital yourself.

Clavicle fractures in newborns heal within 12–20 days. Surgical treatment is not required, nor is the application of a plaster cast.

The baby's hand is bandaged to the body for 7 days. A cotton wool roll (Dezo bandage) is placed in the armpit. You need to make sure your fingers don't turn blue. If this happens, the fixation is not so tight.

The child should not sleep or lie on the side of the fracture. During the healing period, application to the mother's breast is carried out only on the healthy side.

If there is bruising, vitamin K is prescribed for three days. For pain relief and anti-inflammatory effect, Traumeel S ointment is used topically. It also relieves swelling and promotes tissue regeneration.

Therapeutic measures in children of early, preschool and school age

Before the ambulance arrives or before going to the hospital in their own transport, parents must do the following:

1. Give your child Paracetamol or Nurofen (once!) in an age-appropriate dosage for pain relief. The effect will occur in 15–30 minutes. You will need to inform the doctor or paramedic in the ambulance, as well as in the hospital, about taking the drug.
2. Ensure complete rest for the injured limb: place a piece of rolled up fabric in the armpit, bend the child’s arm at the elbow at a right angle, tie it with a scarf to the neck and wrap it to the body.
3. Apply an ice pack or a heating pad with cold water to the site of a probable fracture for 20–30 minutes. Cold will reduce swelling and pain.
4. In case of an open fracture, stop the bleeding with a pressure bandage, treat the wound with Chlorhexidine or Furacillin solution.

It is necessary to transport a child with a clavicle fracture only while sitting or semi-sitting.

If an injury occurs to a child under the age of three, a Deso fixing bandage is usually applied in the hospital.

1. A rolled-up cloth or cotton-gauze pad is first placed in the armpit.
2. The arm is bent at the elbow at a right angle and brought towards the body.
3. First, the shoulder is bandaged to the chest.
4. Further rounds of the bandage are performed as indicated in the figure.
5. The moves are repeated until the limb is well fixed.

Delbe rings, soft fixation bandage, plaster

In children over three years of age, it is not always possible to ensure immobility using a Deso bandage, especially in cases of fractures with displaced fragments. Therefore, other types of immobilization are used:

• Delbe rings - two cotton-gauze rings are put on the hands to the level of the armpits and tightened on the back, for example, with a rubber tube. The bandage provides easy muscle traction, but does not always fix collarbone fragments. Delbe rings are applied for a period of three to seven weeks. Now they are made from more modern and elastic materials. These rings are also used as a posture corrector.
• eight-shaped soft fixing bandage - shaped like the number “8”, its ends are tied on the back. This bandage keeps the clavicle fragments from moving, but does not fix them rigidly.
• rigid plaster cast - allows you to hold bone fragments in the correct position, applied with preliminary anesthesia for a period of 14 to 21 days. X-ray confirmation of clavicle fusion is required before removing the cast.

Photo gallery: options for plaster casts for a clavicle fracture

The Titova oval is placed in the armpit. An eight-shaped soft bandage ensures that clavicle fragments are kept from moving. Delbe rings are made by hand.

Therapeutic splints, corsets, bandages for clavicle fractures

From a wide variety of dressings (there are more than 200 types), it can be difficult to choose those that would be both easy to apply and reliable for fixing fragments for a sufficiently long time. Therefore, sometimes they turn to therapeutic splints: Kuzminsky and Beler.

The Kuzminsky splint is applied by a doctor and an assistant, as it is quite cumbersome. After applying it, it is recommended to sleep on your back. It provides reliable retention of fragments. Using this splint, you can gradually (over 2–3 days) align displaced fragments of the clavicle.

Other tires (Rakhmanov, Chizhina, Böhler) have historical significance and are practically not used today.

Corsets and bandages for clavicle fractures are more modern orthopedic inventions.

They are made of lightweight, synthetic materials that do not cause allergies, provide good support for the limb in case of injury, and have a long service life. There are different sizes of these products. You can buy them at orthopedic supply stores.

In addition to their therapeutic purpose, corsets have the function of posture correctors.

Surgical treatment of clavicle fracture

There are certain indications for surgical intervention for a clavicle fracture in a child:

• open fracture;
• impossibility of combining fragments (with strong displacement);
• comminuted fracture;
• damage to blood vessels, nerves or lungs.

The operation is performed under general anesthesia. For older children, regional anesthesia may be performed. Local anesthetics - novocaine or lidocaine - are injected into the area near the brachial plexus. This allows you to completely eliminate sensitivity at the surgical site for some time.

Currently, the most common methods of osteosynthesis (clavicle restoration) are:

After osteosynthesis, the application of a Deso bandage and the administration of Paracetamol or Nurofen are usually required.

Advantages of surgical treatment of a clavicle fracture:

• after the operation, the child can move his arm already on the second or third day;
• the bandage is removed after 2 weeks;
• the operation ensures correct comparison of fragments.

Complications of surgical intervention occur in 1% of cases:

• Non-union of the clavicle (with incorrect selection of the fixator, comminuted fracture);
• infection (osteomyelitis) - if the rules of asepsis are not observed. To prevent this complication, the child is given an intravenous broad-spectrum antibiotic 30 minutes before surgery. In the postoperative period, the same drug is continued orally for 7–10 days.

In addition to complications, you need to remember to remove the fixators. This is a repeated operation, which is carried out at different times, depending on the type of metal structure (usually no earlier than a year later).

Consequences and prognosis

Usually in newborns, a clavicle fracture heals quickly and without a trace. In isolated cases, infection, severe pain (with nerve damage), and prolonged nonunion (with severe displacement and improper fixation) may occur. All these conditions are treated in a hospital setting.

The prognosis is favorable. Recovery occurs within 12–20 days; after a fracture of the collarbone, there are no physical or cosmetic defects left.

Prognosis and complications in older children

In older children, visual deformation in the area of ​​the injured collarbone and a shortened shoulder girdle may remain. It is known that when the bone heals within 1.5–2 months, a bone callus is formed. This is a physiological phenomenon, but there are cases when it grows excessively or becomes inflamed. In these conditions, there is chronic pain and limited movement of the injured collarbone.

The same phenomena can be observed during the formation of the so-called “false joint” - a pathological joint that forms at the site of inaccurate comparison of fragments of the clavicle. But more often such a growth is painless. If it causes discomfort, surgery is performed to remove it.

The prognosis is favorable. The normal length and shape of the collarbone, as well as full range of motion, are restored within 2–3 months.

A clavicle fracture is a common injury in both newborns and older children. It cannot be prevented. The younger the child, the faster the recovery from a fracture, since the bones break like a “green twig.” If treatment and rehabilitation are carried out promptly and competently, the consequences of a clavicle fracture in children will be reduced to zero.

According to health statistics, clavicle fracture is currently the third most common childhood injury. The maximum number of such injuries occurs between the ages of 2 and 5 years and usually occurs during active children's games (running, tripping, falling) or during sports activities. At this age, children do not yet have full control of their body; it can be difficult for them to coordinate movements.

Definition and classification of clavicle fracture

The peculiarity of such an injury is that, due to the flexibility of children's bones, fractures are characterized by blurred symptoms and are not always recognized in time.

Often a “green stick” fracture occurs, when the internal structure of the bone breaks, but its external part remains intact. Most often, such injuries are observed in children 2–3 years of age.

There are several types of clavicle fracture.

1. Closed. The integrity of the skin is not compromised, there are no open wounds. The only external sign is pathological edema, swelling and hematoma at the site of injury.
2. Open. It is characterized by the presence of a wound in which bone fragments are visually visible. This requires emergency medical care and hospital treatment.
3. Fracture without displacement. These are bone cracks without the fragments moving relative to each other.
4. Displaced fracture. Bone fragments shift and lose their physiological location.

Fractures in newborns require special attention. The main difficulty when examining such children is that when trying to palpate the baby’s collarbone, the risk of dislodging thin fragments is quite high. Therefore, diagnosis is based on a visual examination of the child and x-ray confirmation of the suspected diagnosis.

Newborn clavicle fracture - video

Causes and risk factors

A factor in the occurrence of a fracture in children is injury during exercise or sports activities:

1. Falling on an outstretched arm while running. In this case, the fracture is localized between the middle and outer parts of the bone.
2. Direct blow to the collarbone. It is less common and is characterized by damage to the outer area of ​​the shoulder girdle.

Causes of clavicle fracture in newborns:

Symptoms and signs depending on the type of damage

Signs of a fracture depend on its shape and location.

1. In case of incomplete damage (“green branch”), external manifestations are minimal. There is swelling and hematoma at the fracture site, the pain is mild. That is why this type of injury is often mistaken for a bruise, and parents do not seek help from specialists.
2. A complete closed fracture without displacement is characterized by a more pronounced pain syndrome, which intensifies when the arm is raised up. The forced position of the body that the child assumes is noteworthy - tilting the torso towards the injured bone while pressing the sore hand to the stomach. Upon visual inspection, you can notice that in the area where a fracture is suspected, the scapula moves downward, and the arm turns inward. Limb movement is limited.
3. In case of a closed fracture with displacement, pronounced swelling at the site of injury is added to the main symptoms. Palpation examination is extremely painful for the child, while under the doctor’s hand pathological mobility of fragments with a characteristic crunching sound (crepitus) is felt.
4. With an open fracture, a wound with bone fragments in it and bleeding is visually visible.
5. A clavicle fracture in newborns is considered the most difficult to diagnose. This is due to the physiological postpartum swelling and cyanosis of the baby’s skin. Suspicion of such an injury arises when the baby is very restless and constantly crying. Swelling is noticeable at the suspected site of injury. The healthy shoulder is located above the injured one.

Due to the difficulty of identifying such fractures, there is a danger of simply not noticing them. In this case, there is a high probability of improper bone fusion and subsequent deformation of the upper limb. You need to be especially attentive to young children and consult a doctor at the slightest suspicion of a skeletal disorder.

Diagnostic measures

When a clavicle fracture is suspected, a visual examination of a small patient is of primary importance. Look out for obvious signs of injury:

• swelling;
• pathological bone mobility;
• hematoma;
• unnatural hand position.

It is impossible not to take into account the child’s complaints of pain and discomfort.

After examination, in some cases, palpation of the damaged shoulder girdle is performed. But this must be done extremely carefully to prevent the fragments from moving. It is strictly not recommended to perform manipulation on newborns. Babies have very thin and immature bones, the displacement of which can lead to improper skeletal development.

To confirm the diagnosis, an X-ray examination is performed in a hospital setting, which helps not only to establish the fact of a fracture, but also to verify its shape. Subsequently, x-rays of the collarbone are performed several more times to monitor the correct healing of the damaged bone.

First aid and treatment of a child

Treatment of a clavicle fracture begins with the need for first aid. Correct actions by parents will alleviate the child’s condition and prevent the development of complications.

1. The upper limb must be provided with complete rest. A fabric folded into a small roller is placed in the armpit area, and the arm is hung on a scarf and bandaged to the body. This will help prevent the fragments from moving.
2. It is necessary to give a painkiller. Children's Paracetamol or Nurofen (Ibuprofen) helps well.
3. In case of an open fracture, a pressure bandage is applied to stop bleeding.

Under no circumstances should you try to set the fragments yourself. They are quite sharp and, without basic knowledge of traumatology, you can easily injure nearby muscles and nerve endings.

Use of fixing agents

Treatment of a clavicle fracture is easier in newborns. Their bones heal much faster than those of older children. The main therapeutic measure is tightly swaddling the baby with fixation of the injured limb. For this, special rollers made of gauze or cotton wool are used.

Therapeutic measures for older children depend on the type of injury. In case of an incomplete greenstick fracture, special bandages or bandages are applied to fix the limb. The Deso bandage is very popular - a method of fastening in which a roller is placed in the armpit, and the injured arm is bent at the elbow and tied to the body with a bandage.

The Deso bandage provides motor restrictions and a functionally advantageous position of the shoulder girdle area to accelerate the therapeutic effect and rehabilitation period

Another fairly common method of immobilizing a limb in case of damage to the shoulder girdle is Delbe rings, which are special clamps in the form of two dense circles. They are put on the shoulder joints and pulled together at the back. This is how the shoulders are in an expanded position, which contributes to a more correct position of the collarbone. In addition, the ligaments and muscles of the shoulder girdle are unloaded.

In case of a complete fracture with displacement of fragments, circular fixation is not enough. Then a more rigid fastening is used with the help of Beller, Kramer or Kuzminsky splints, which are applied in a hospital setting. Their wearing time depends on the complexity of the fracture and ranges from 2 to 4 weeks.

If there is a slight displacement of the fragments or there are none at all, treatment is carried out by casting the limb. This method is considered more reliable than tires, so it is used in almost 90% of cases.

For a simple fracture without displacement, a semi-rigid corset can be used. It is sold in special medical equipment stores and helps not only the proper fusion of bones, but also the correction of posture.

Surgical treatment

In case of an open fracture with displacement of fragments or damage to the vascular bundle, surgical intervention is performed. This operation is called osteosynthesis. During this procedure, general or local anesthesia is used, depending on the complexity of the injury. Special screws or plates are used to connect the bone fragments, after which a plaster cast is applied to the limb and is not removed for 1–2 months.

Several years ago, for such treatment, needles were used, which were inserted into the bone marrow canal, after which the fragments were tied to them using a special thread. Today this method is considered obsolete and is practically not used.

After removing the fixator (splint, plaster, bandage) and to speed up treatment, physiotherapeutic procedures are prescribed. Most often this is UHF with the use of special ointments, magnetic therapy and laser treatment. Complete fusion of the clavicle with restoration of all functions of the damaged limb occurs in 2–3 months.

During the rehabilitation period, physical exercise also plays an important role, which is carried out no earlier than 3-4 weeks after the start of treatment. The exercises begin with a simple shrug. Later movements with elbows and fingers are added.

At the end of the recovery course, a special massage and salt baths are prescribed.

Emergency care for a fracture - video with Dr. Komarovsky

Long-term consequences

With proper treatment and following all the doctor’s recommendations, healing of the damaged bone occurs quite quickly and does not bring any discomfort in the future.

But if timely assistance was not provided to a child with a fracture of the collarbone (or it was carried out incorrectly), there remains a high risk of developing long-term consequences of the injury.

One of these complications is the formation of callus. It is formed at the site of fusion of the damaged bone and looks like a small growth under the skin, visible to the naked eye. A small formation resolves over time, but a larger one remains, causing discomfort and pain.

During the treatment of a closed fracture of the clavicle with displacement, it is very important to limit the child’s excessive mobility, as this can lead to displacement of the fragments relative to each other and, as a result, malunion. This pathology sometimes causes dysfunction of the upper limb, up to its complete immobility.

Improper fusion of the clavicle sometimes leads to skeletal deformation. The arm turns inward, the shoulder blade becomes smoother, and the shoulder shortens.

A collarbone fracture is not the most severe type of injury for a child. But it is dangerous because it is not always possible to recognize it in time. Therefore, the attentive attitude of parents to the child is of great importance.

With correct first aid, timely contact with a traumatologist and strict adherence to all doctor’s prescriptions, treatment of a child’s clavicle fracture will not take much time and will minimize the possibility of negative consequences.