Broken Clavicle (ER)

“So
I understand you were trying out for the Dallas Cowboys today and
you took a pretty good hit. Is that right,” kids Dr. Mike
Ziegler, emergency pediatrics, Children’s Healthcare of Atlanta
. “No, what really happened?”

Fifteen-year-old Evan Tipton was playing a pick-up game of tackle
football when his clavicle met the other kid’s head. “I
guess I got the worse end of the tackle,” Evan jokes back. “Okay,
so his head hit your collarbone, and then his body fell on you
as well?” asks Dr. Ziegler.

“Clavicle fractures are very common. The type of injury
that Evan sustained is one of the exact, classic ways that you
get a clavicle fracture,” the doctor explains. Very common
and very painful; the slightest movement of Evan’s arm, and
he cringes in pain.

The x-ray makes it clear, “Yeah, that’s supposed
to be nice and straight like this, see how it kind of goes up like
this and is broken in the middle,” Dr. Ziegler points out. “Will
it ever straighten out again?” asks Evan’s mom. “No,
not really. It’ll be remodeled to some extent,” the
doctor reassures, ”functionally he’ll be fine. It’s
not gonna have any effect on his ability to function.”

The treatment is simple- a sling, because a cast or splint just
isn’t practical, pain medicine, and time; time to let the
bone heal all by itself.

“So you’re gonna be okay. The only thing that’s
gonna be different is that in the future you’re gonna have
a little bump there,” explains Dr. Ziegler, “because
when the bone heals with a form of callous there, kind of a scar
of bone, and so you’ll have a little bump.”

According to the Centers for Disease Control and Prevention, falls are
the leading cause of non-fatal, unintentional injuries and emergency department
visits for children up to age 14. Most of these falls occur at home – particularly
among younger children – and often involve a fracture of the clavicle
(collarbone).

Children’s Medical Center of Dallas says a fracture of the
clavicle – the bone that connects the breastplate (sternum)
to the shoulder – occurs when more force is applied to the
bone than the bone can absorb. This type of fracture is common among
children and is often the result of a fall, sports-related injury
or traffic accident injury. A child who plays football or soccer,
goes mountain biking, skis, sleeps in a bunk bed, or frequently climbs
trees is at a greater risk for sustaining a broken clavicle. And
if a child has a bone disease, especially osteoporosis and calcium
deficiencies, the risk of breaking a bone also dramatically increases.

How can you tell if your child has a broken clavicle? The American
Academy of Orthopaedic Surgeons (AAOS) suggests looking for the following
signs of a break or fracture in your child:

• Sagging shoulder (down and forward)
• Inability to lift the arm because of pain
• A grinding sensation if an attempt is made to raise the arm
• A deformity or “bump” over the fracture site
• In some cases, a fragment of bone that pushes the skin into
  a “tent” formation

If you notice any of these signs, contact your pediatrician, who
can then make a diagnosis with physical examination and diagnostic
tests.

The AAOS says treatment for a broken clavicle may include
the following methods:

• A simple arm sling can usually be used to immobilize the arm.
  Your child may have to wear the sling for three to four weeks.
• Depending on the location of the break, your doctor may apply
  a figure-eight strap to help maintain shoulder position.
• Analgesics, such as acetaminophen, or nonsteroidal anti-inflammatory
  medications, such as ibuprofen, will help reduce pain.
• In rare cases, depending on the location of the break and the
  involvement of shoulder ligaments, surgery may be needed. Surgery
  usually gives good results

According to Johns Hopkins Department of Orthopaedic Surgery, healing
time for a broken clavicle depends on the child’s age, the
location of the fracture and the number of breaks in the bone. Most
clavicle fractures involve a single break in the middle of the long
bone. In children (younger than 8 years old), the clavicle may heal
in four or five weeks. Children’s Hospitals and Clinics in
Minneapolis gives the following advice to help your child during
the healing process:

• Give pain medicine as prescribed.
• Avoid any activity – especially sports – that puts
  stress on the collarbone for six to 12 weeks. However, your child
  may begin range of motion and strengthening exercises as soon as
  the pain subsides.
• While dressing, put the sleeve on your child’s affected
  arm first.
• Do not lift your child by the arms.
• Do not lay your child on his or her affected side.

While any child who plays and participates in sports is at risk
of sustaining a fracture, you can take several steps to minimize
your child’s chances of injury. Consider these tips from the
American Institute for Preventative Medicine and the Durham Safe
Kids Coalition:

• Give your child enough calcium to build strong bones. One thousand
  to 1,500 mg of calcium is recommended per day.
• Make sure your child gets plenty of exercise. Moderate, weight-bearing
  exercise, such as walking and dancing, increases bone mass.
• Always supervise your child, especially at playgrounds or in
  the backyard.
• Never allow your child to wear scarves, necklaces, purses or
  clothing with drawstrings while on the playground. Your child could
  become entangled in these items and sustain a fall.
• Your child should play on age-appropriate equipment.
• Make sure you and your child wear the right protective gear
  for any activity. Items to wear include a helmet, a mouth guard,
  and shoulder, knee and wrist pads.
• Check that everyone in the car
  is wearing a seatbelt. Don’t start
  the engine until everyone has buckled up.