Clavicle - Fracture

Fractures of Specific Sites

Injuries to the skeletal structure may vary from a simple linear fracture to a severe crushing injury. The type and location of the fracture and the extent of damage to surrounding structures deter-mine the therapeutic management. Maximum functional recov-ery is the goal of management.

CLAVICLE

Fracture of the clavicle (collar bone) is a common injury that re-sults from a direct blow to the shoulder or a fall. Head or cervical spine injuries may occur with these fractures. The clavicle helps to hold the shoulder upward, outward, and backward from the thorax. Therefore, when the clavicle is fractured, the patient as-sumes a protective position, slumping the shoulders and immo-bilizing the arm to prevent shoulder movements. The treatment goal is to align the shoulder in its normal position by means of closed reduction and immobilization.

More than 80% of these fractures occur in the middle third of the clavicle. A clavicular strap, also called a figure-of-eight bandage (Fig. 69-5), may be used to pull the shoulders back, reducing and immobilizing the fracture. When a clavicular strap is used, the axillae are well padded to prevent a compression injury to the brachial plexus and the axillary artery. The nurse monitors the cir-culation and nerve function of both arms. A sling may be used to support the arm and to relieve pain. The patient may be permit-ted to use the arm for light activities within the range of comfort.

Fracture of the distal third of the clavicle, without displacement and ligament disruption, is treated with a sling and restricted mo-tion of the arm. When a fracture in the distal third is accompanied by a disruption of the coracoclavicular ligament, there is displace-ment, which may be treated by open reduction and internal fixation.

Complications of clavicular fractures include trauma to the nerves of the brachial plexus, injury to the subclavian vein or artery from a bony fragment, and malunion (poorly aligned healing of the fractured bone). Malunion may be a cosmetic problem (eg, when low-neckline clothing is worn).

Nursing Management

The nurse cautions the patient not to elevate the arm above shoul-der level until the ends of the bone have united (about 6 weeks) but encourages the patient to exercise the elbow, wrist, and fingers as soon as possible. When prescribed, shoulder exercises (Fig. 69-6) are performed to obtain full shoulder motion. Vigorous activity is limited for 3 months.