CLAVICLE

	Clavicles are easily fractured amongst children, and these heal rapidly, but in adults it may be a mre trouble some injury.
	A fall on the shoulder or an outstretched hands in the most most common source of the injury. The fracture usually occurs in the middle third of the clavicle, but can also occur in the outer third( the shoulder joint area). In the middle third fractures the outer fragment is pulled down by the weight of the arm and the inner fragment pulled upwards by the muscles attached to it.

Clinical Features

• Pain. The arm is held to the side as to prevent any movement which may increase the pain.
• Swelling. There is usually an obvious deformity at the site of the fracture. This may be associated with a wide degree of bruising around the area.

Management

The common Middle-Third Fractures :

Reduce. These fractures usually do not require any accurate reduction of the fracture. This is both difficult to obtain and not essential.
Hold. The arm is placed in a sling until the pain subsides 2-4 weeks.
Move. As soon as the pain starts to ease, the shoulder and the arm should be excercised.

Outer-Third Fractures. These fractures if left untreated can cause a gross deformity, and occaisionally may lead to discomfort and weakness of the shoulder:

• Reduce. For severley displaced douter-third fratures closed reduction is often difficult to obtain. Some advocate open operative procedures to obtain the reduction.
• Hold. The reduced fragements are held together with an internally inserted metal works, ie. Pins. But the patient will have a sling for analgesia and further support of the reduction. This is worn for 6 weeks.
• Move. The arm is encouraged to move thereafter to return the function as full as possible to its normal state.
  
  

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