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

1 CLAVICLE ( collarbone ) fracture : infant , child , orAdolescentsGENERAL INFORMATIONP hysical ExaminationTheclavicle( collarbone ) is the bone that connects theInfantarm with the trunk. The CLAVICLE is one of the mostxSometimes when examining the infant gently, thefrequently broken bones in children (Fig. 1).broken bone can be felt crackling under the infant won t move the or AdolescentxOften the broken bone can be felt under the CLAVICLE may be the shoulder is moved, there is pain over of the CLAVICLE show the fracture , which can beas follows (Fig. 2):xIt can be fractured, but not through and through(this usually is referred to as agreenstick fracture )(A).xIt can be a through and through fracture but canhave one of the following appearances:xIt is not out of place (B).xThe CLAVICLE is bent at the fracture (C).xThe broken ends of the CLAVICLE have slid overeach other but are still touching (D).

2 XThe broken ends are widely separated from eachother (E).The above variations are important because they de-termine the type of therapy that is (upper arm bone)Scapula(shoulder blade)RibsSternum(breastbone) CLAVICLE (co llarbone)Figure bone anatomy of the shoulder SIGNS AND SYMPTOMSI nfantsxThe CLAVICLE may be there is swelling over the infant doesn t want to move the arm because ofthe pain. This is sometimes called pseudoparalysis, but very rarely is anything wrong with the or AdolescentsxThere is pain and swelling over the CLAVICLE usually shows some is painful motion at the shoulder , there is a history of a difficult or AdolescentxMost commonly, there is a history of a fall on anABCDE outstretched arm or a direct injury to the middle ofFigure most common types of fractures in an infant or 1999 by WB Saunders Company. All rights ( collarbone ) fracture : infant , child , or Adolescent157lTREATMENT:No Operationskin in the armpit, which can irritate the area.

3 Usesome gauze with ordinary rubbing alcohol on it toInfantkeep the area there are no symptoms, no specific orthopedictreatment is necessary. The infant should be handledlTREATMENT:Operationgently, operation is rarely required and only in thexIf there is pain on touching the fracture site or therefollowing instances:is pseudoparalysis, the arm is immobilized by pinningxWhen a nerve is caught in the fracture shirtsleeve on the injured arm to the body ofxWhen the fracture does not heal, usually becausebaby s shirt with a safety pin for 1 or 2 weeks untilthe broken ends were too far tenderness the fracture is an outer end (distal) fractureNote:The arm will be examined carefully and repeat-through the growth plate with significantedly for any neurologic problems, especially in thosedisplacement and who do not move the operation is done under general or AdolescentxAn incision is made that can be closed in axA bandage (called afigure of eight) is applied.

4 Thecosmetically pleasing of this bandage is to pull the shouldersback. It helps prevent the CLAVICLE from movingPOSTOPERATIVE CAREtoo the completion of the operation, your child will bexThe above therapy does not require an anesthetic; ittaken to a recovery room and observed. After theis done on an outpatient pressure, pulse, and breathing are normal, thexUsually the figure-of-eight bandage is kept on for 2child usually can be taken home that same If pain is still present after 2 weeks, theOccasionally, a 1- or 2-day hospital stay is is kept on for another week or so will be made for medicine,xUsually physical therapy is not on care, and the postoperative officexFull range of motion can be expected once the the fracture deformity of the CLAVICLE usually corrects itself:HOME CARE with medicine is required only occasionally.:HOME CARExSponge bathe. Let s discuss when tub baths orshowers are medicine is required only the dressings dry.

5 If they get wet, replace themxThe figure-of-eight bandage needs to be checkedwith clearn, dry day to see that it is snug. The buckles in theback need to be adjusted as OUR OFFICE IFxCheck the elbow, wrist, and hand to see that theymove as well as those in the unaffected is a change in color of the fingers, or thefingers or wrist cannot be moved as well as those onxCheck the fingers twice a day to make certain thereis no change in unaffected unusual signs or symptoms figure-of-eight bandage presses against the moistqCopyright 1999 by WB Saunders Company. All rights ( collarbone ) fracture : infant , child , or Adolescent