Clavicle fracture

Introduction to clavicle fracture The clavicle is in the shape of an "S" between the sternum and the shoulder, and is the only bony stent that connects the upper limb to the torso. The clavicle is located under the skin and is superficial. It is prone to fracture when subjected to external force, and the incidence rate is 5% to 10% of the total body fracture. It occurs mostly in children and young adults. The history of trauma caused by abduction of upper extremity or partial direct attack by violence, pain in the shoulder after injury, the upper limbs do not dare to move. X-ray films can be diagnosed and show fracture displacement and comminution. basic knowledge The proportion of illness: 2-4% Susceptible people: no specific population Mode of infection: non-infectious Complications: lung injury brachial plexus injury vascular injury

Cause of clavicle fracture

Violence (40%):

The position of the clavicle is superficial and prone to fracture. Indirect violence causes fractures to be more common. When the hand falls or the elbow touches the ground, the external force impacts from the forearm or elbow along the upper limb to the proximal end; the shoulder is more common, and the outer end of the clavicle is broken. More children and young adults occur.

Indirect violence causes fractures to be mostly oblique or transverse, and its parts are more common in the middle segment; direct violence causes fractures to vary depending on the point of force, mostly crushed or horizontal. Most children have broken branches.

Wrestling (30%):

The most common in children, about 50% of clavicle fractures occur in children under 7 years of age. Direct external forces, such as striking from the front, hitting the clavicle, or landing directly on the shoulder when falling, can cause clavicle fractures. When the fall, the palm of the hand touches the ground. The external force is transmitted to the forearm, the upper arm is transmitted to the shoulder, and then transmitted to the clavicle. The indirect external force and shear stress can also cause the fracture. The force varies from place to place, mostly for crushing or slashing. The typical displacement of the fracture and clavicular fracture is as follows: the proximal end is displaced by the sternocleidomastoid muscle, and the distal end is displaced by the weight of the limb and the pectoralis major muscle. Short overlap shifts.

Shift (20%):

The fracture occurs in the middle of the clavicle. Due to muscle traction and limb weight fracture fracture overlap displacement. In the proximal segment, the sternocleidomastoid muscle is pulled upward, and the distal segment is pulled downward and forward and inward due to the weight of the upper limb and the pectoralis major muscle.

Clavicle fracture prevention

The disease is mostly caused by traumatic factors, no special precautions, mainly to pay attention to production and life safety, to avoid trauma.

In addition, it should be noted that due to the pulling of the shoulder joint activity, the clavicular fracture is not easy to maintain the reposition position, malunion can occur, but the function is rarely impeded. Unless the operation is reset, the general patient does not need to be hospitalized.

Clavicular fracture complications Complications, lung injury, brachial plexus injury, vascular injury

1. Adjacent bone and joint damage

A shoulder lock can be combined, the sterno-sterax joint is separated, and the scapula fracture is broken. When the clavicular fracture is combined with the scapular neck displacement fracture, the fracture end is obviously unstable due to the loss of the bony support connection of the upper limb.

2. Pleural and lung injury

Because the clavicle is adjacent to the top of the pleura and the upper lobes, displaced clavicle fractures can cause pneumothorax and hemothorax, and the incidence of pneumothorax can be as high as 30%.

3. Brachial plexus injury

When the clavicle fracture is displaced, the brachial plexus root can be pulled. The injury site is often on the clavicle, the cervical vertebrae are horizontal, or the nerve root is from the spinal branch. The displacement of the fracture block can also cause the brachial plexus. Direct damage, the branches that make up the ulnar nerve are often susceptible.

4. Vascular injury

Clavicle fracture combined with large vessel injury is rare, can be seen in large violence, when the fracture is obviously displaced, even when the clavicle is deformed or the branch is broken, the often susceptible blood vessels have subclavian artery, subclavian vein and neck. Intravenous veins, radial artery and superior scapular artery injury sometimes occur. The pathological changes of vascular injury may be laceration, vascular embolism, extravascular compression or vasospasm.

Angiography is very helpful in diagnosing the location of the injury and the nature of the injury.

5. Fracture does not heal

Non-union of clavicle fracture is rare, and nonunion of clavicle fracture is more common in adults. The middle third is about 75%, and the outer one is not 25%. It is generally considered to be 4 to 6 months after injury. Clinical and X The line image failed to reach the normal fracture healing process, ie, the fracture was not healed.

6. Complications after surgery, such as fracture deformity, shoulder pain, inconvenience and so on.

Clavicular fracture symptoms Common symptoms Upper extremity abduction lifting difficult pneumothorax

Mainly manifested as local swelling, subcutaneous blood stasis, tenderness or deformity, the deformed part can touch the displaced fracture end, such as fracture displacement and overlap, the distance between the shoulder and the sternum stem becomes shorter, and the limb function of the injured side is affected. Limit, shoulder drooping, upper arm sticking chest does not dare to move, and support the elbow with a hand to relieve the pain caused by the tension of the sternocleidomastoid muscle, palpation of the fracture site, palpation and bone clavicle Abnormal activity, children's green branch fractures are not obvious, and often can not complain of pain, but the head is more oblique to the affected side, the jaw is turned to the healthy side, this feature is helpful for clinical diagnosis, sometimes caused by direct violence, Pneumothorax can be punctured in the pleura, or the subclavian blood vessels and nerves can be damaged, and the corresponding symptoms and signs appear.

Cranial fracture examination

No relevant laboratory examination, the auxiliary examination method of this disease is mainly image examination, clavicular fracture often occurs in the middle segment, mostly transverse or oblique fracture, the medial fracture end is often pulled up by the sternocleidomastoid muscle. When displaced, the outer end is inwardly and downwardly displaced by the gravity of the upper limb, forming an angle forming the convex surface, and the dislocation shortens the deformity.

1, X-ray inspection

X-ray image is required to confirm the diagnosis of clavicle fracture. Generally, the 1/3 clavicular fracture is tilted 45° obliquely before and after shooting. The shooting range should include the total length of the clavicle, upper 1/3 of the humerus, shoulder strap and upper In the lung field, if necessary, a chest radiograph should be taken. The anterior and posterior phases can show the up and down displacement of the clavicle fracture, and the 45° oblique phase can be used to observe the displacement of the fracture.

Infants with clavicle without displacement fracture or green branch fracture sometimes difficult to confirm the diagnosis on the original X-ray image, can be reviewed 5 to 10 days after the injury, often with osteophyte formation.

In the outer 1/3 of the clavicle fracture, the X-ray image of the anterior and posterior position and tilting 40° is generally used for diagnosis. Sometimes the shoulder X-ray image is taken to help diagnose the ligament of the sacral ligament and the stress X-ray image is taken. The patient is upright, and the weight of each wrist is 4.54kg (10 lbs). The upper limb muscles are relaxed and the shoulders are photographed. When the distance between the condyle and the clavicle near the fracture is significantly widened, the ligament of the sacral ligament is damaged. Articular surface fractures, conventional X-ray images are sometimes difficult to make a diagnosis, often need to take a tomographic image or CT examination.

The 1/3 anterior and posterior X-ray images of the clavicle overlap with the mediastinum and the vertebral body, and it is difficult to show the fracture. The 40° to 45° X-ray image of the head tilting is helpful to find the fracture line. Although the X-ray examination is more common, However, the rate of misdiagnosis is high. Therefore, when the examination is performed, it is not satisfied that the X-ray anterior slice has no fracture and is diagnosed as soft tissue injury. It is necessary to carefully check whether there is a clavicle inner end or a local fracture sign in order to give a correct diagnosis.

2, CT examination

CT examination is the best auxiliary examination method to determine the fracture. It can clearly show the location and extent of the fracture, especially for the fracture of the articular surface.

Diagnosis and diagnosis of clavicular fracture

diagnosis

The position of the clavicle is superficial, swollen after the fracture, tender or deformed, and may touch the fracture end. The injured shoulder sinks and tilts forward, the upper arm sticks to the chest and does not dare to move. The hand supports the affected elbow to relieve the pain caused by the upper limb weight.

Most of the children have green branch fractures, the subcutaneous fat is full, the deformity is not obvious, because the pain position can not be described, only the crying performance, but the head of the sick child is more oblique to the affected side, the jaw is turned to the healthy side, which is one of the clinical diagnosis features.

Differential diagnosis

In neonates and children of different ages, clavicle fractures sometimes need to be differentiated from some other lesions.

Congenital clavicle pseudoarthrosis

In the embryonic development, the two ossification centers in the clavicle are not integrated into the body. The neonatal manifestations include pseudo-articular activity and mass at the junction of the 1/3 of the clavicle, which occurs mostly in the right clavicle. Growth, local deformity aggravation, should be differentiated from the clavicle fracture caused by birth injury, X-ray image shows the formation of pseudo-articular at the 1/3 of the clavicle, and the two fracture ends are close to and appear as bulb-like mass, without clinical symptoms and Dysfunction, long-term follow-up has no effect on the development of clavicle length, acromioclavicular, and sterno-lock joints, and generally does not require special treatment.

2. Craniotomy hypoplasia

The disease of family hereditary intramembranous osteogenesis may involve the development of clavicle, craniofacial bone and pelvis, spine, hand and foot bone, resulting in corresponding malformations. The clinical manifestations are all or part of the clavicle, X-ray image and Congenital clavicle pseudoarthrosis is different, there is a large gap at both ends of the bone, the bone end is tapered, accompanied by a skull, a missing pelvic ring, and a small deformity of the maxillofacial bone.

3. Separation of the end of the clavicle

The clavicle at the inner end of the clavicle is ossified later, and the closure is the latest. Therefore, when the clavicle is injured at the inner end of the clavicle, the sternosacral joint dislocation or fracture is less likely to occur, and the epiphysis is more likely to occur. The epiphyseal separation is shown as a chest lock on the X-ray image. Signs of joint dislocation.

4. Acromioclavicular joint dislocation

Children's clavicular external fractures are sometimes difficult to distinguish from the acromioclavicular joints in clinical and X-ray images. If necessary, a tomographic image or CT examination is needed.

5. In addition, the disease is easily misdiagnosed as brachial plexus injury or rib acute osteomyelitis, so the diagnosis should be carefully examined for local bone rub, swelling and tenderness reaction, if there is suspicious X-ray examination.

6. Should also be differentiated from cervical deformity, cervical spine subluxation and cervical spinal cord tumor.

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