The clavicular fractures are among the most common causes of bony lesions. The fracture is localised more frequently in the passage between third medial and lateral (80%) that is the weakest point. When the fracture is complete, the medial fragment shifts upwards due to the action of the sternocleidomastoid muscle, while the lateral fragment moves downwards due to the action of the deltoid muscle joined by the arm weight.
The traumatic mechanism occurs especially because of a fall on the arm in extension (fall from a horse, motorbike or bicycle).
Pain in the fracture seat might be so intense that moving the limb could be impossible. The area is swelling and deformed at the level of the fracture edges, altering the normal profile of the shoulder. The injury is generally evaluated thanks to a standard radiography, but sometimes a musculotendinous ecography is sufficient. It is important, instead, to undergo a CT scan in more difficult fractures to diagnose, while a MRI will be suggested when the lesion of the rotators cuff is suspected.
The fracture recovery depends on the condition of alignment of fragments that which requires that the shoulder is kept backwards through the functional “8” bandage, necessary even if annoying.
The clavicle heals in three weeks on average, but if stubs are complexly compound, the immobilisation will be prolonged. When bandage will be removed, a bony callus will be easily perceivable and visible, as if it was a step. It is usually avoided the surgical treatment of the injury. Rehabilitation is extremely important: when the bandage is removed, it is necessary to start a set of rehabilitation therapies in the pool and in the gym to recover in the shortest time possible the range of motion of the shoulder, the strength of its muscles and the neuromotor control on the shoulder.
The fracture of the clavicle is a common injury is in contact sports and in those with potential sudden falls, such as skiing, cycling and motorcycling.
In the acute phase of trauma, while waiting for the doctor is important to immobilize the injured part to avoid as much as possible movements that exacerbate the fracture and pain. The clavicle fracture heals spontaneously after 4/6 weeks with a guardian or functional bandage, even if the two stumps are not repositioned so as to mate perfectly: can remain aesthetic damage due to bone callus and the partial overlapping of the stumps of the fracture.
Rarely the treatment is surgical because of the scarcity of subcutaneous tissue that exposes the bone to infection and the risk of nonunion. For this reason most of the clavicle fracture is treated with a specific rehabilitation protocol; after the final removal of the bandage treatment you start an initial phase in the pool, of recovery of full range of motion in all planes of the shoulder, through fluency exercises and active and passive mobility.
Subsequently, the protocol consists in the recovery of the strength of the stabilizers of the scapula, shoulder girdle, through exercises in the gym with rubber bands with increasing resistance, as well as in the full recovery of neuromotor control, and having consciousness of the position of the limb through continuous correction of the posture with verbal warnings (during the exercises) and performing the exercises in front of the mirror.
The re-educational path ends with proprioceptive and sports specific exercises (especially external rotation) in the field.
Usually the clavicle fractures are resolved positively in 8-12 weeks after injury.