What to do if your child's clavicle is broken

Children always like to jump around in their daily lives, and if they are not careful, they will get injured. The most common injury is clavicle fracture, which is quite common. After it happens, only conservative treatment can be carried out. After all, fractures in this area cannot be treated with any surgery. The fracture site can be properly fixed, which will make healing faster.

Clavicle fracture is one of the most common fractures, accounting for 2.6% to 12% of all fractures. In adults, 2% to 5% of fractures involve the clavicle, while in children, this proportion is as high as 10% to 15%. Among clavicle fractures, middle-shaft fractures account for 80% of all fractures, while the inner 1/3 and outer 1/3 account for 5% and 15% of clavicle fractures, respectively. The inner third of the clavicle protects important organs such as the deep brachial plexus, subclavian vein, axillary vein, and apex of the lung. Fractures in this area may be accompanied by serious complications such as brachial plexus injury.

Clavicle fractures are divided into three types: type I is a middle 1/3 fracture, type II is an outer 1/3 fracture, and type III is an inner 1/3 fracture.

1 Proximal clavicle fractures Fractures of the proximal 1/3 of the clavicle are usually treated conservatively. This type of fracture is not common clinically. Usually, the fracture ends are less displaced and the sternoclavicular joint is rarely involved. However, when the fracture fragments are significantly displaced posteriorly, protrude into the base of the neck or the mediastinum, and there is a risk of compression of the blood vessels and nerves at the base of the neck by the fracture fragments, and when multiple injuries or floating shoulder occur, open or closed reduction is required.

2. Most mid-clavicle fractures can be treated with a forearm sling or an "8" bandage. Conservative treatment remains the main treatment for non-displaced mid-clavicular fractures. Indications for surgical treatment of mid-clavicular fractures include: open fractures; fractures associated with subclavian neurovascular injury; significant displacement and obvious skin bulge that may develop into an open fracture; ipsilateral clavicle and scapula fractures (floating shoulder); displacement exceeding the clavicle diameter or shortening exceeding 2 cm. There is great controversy in China about the choice of treatment method for middle clavicle fractures. For non-displaced middle clavicle fractures, conservative treatment can be tried, which rarely affects the patient's postoperative function and appearance. However, for displaced mid-clavicular fractures, surgical treatment is recommended. Because displaced mid-clavicular fractures are prone to cause complications such as shoulder deformity, shoulder dysfunction and nonunion after conservative treatment.

3 Distal clavicle fractures Conservative treatment can be chosen for non-displaced distal clavicle fractures. Most distal 1/3 clavicle fractures are non-displaced or slightly displaced and are located outside the joint. Therefore, non-surgical treatment is usually chosen for distal 1/3 clavicle fractures. Whether surgery is necessary depends mainly on the degree of displacement of the fracture ends, stability and the age of the patient. There are many internal fixation techniques used to treat distal clavicle fractures, such as Kirschner wire fixation, coracoclavicular screw fixation, clavicle plate and clavicle plate hook. However, each technique has corresponding defects, which limits its clinical application. Most Kirschner wires cannot resist the gravity of the drooping upper limbs and are prone to bending, slipping, or even breaking. If the Kirschner wire does not pass through the cortex of the medial segment of the fracture, the fixation is not secure and it is easy to slip, with a slippage rate as high as 50%. The needle tail left under the skin is likely to irritate the adjacent tissues and cause pain, affecting functional exercise.

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