Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Clavicle Fracture

SYMPTOMS

There is acute onset of localised swelling and pain over the anterior part of the shoulder, with typical deformation, after direct or indirect trauma, often in a young athlete.

AETIOLOGY

It is common in rugby, ice hockey, riding and cycling.

CLINICAL FINDINGS

A clavicle fracture is usually easy to diagnose since the patient refers to a ‘crack’ and can point to the fracture site where there is bruising, deformation and tenderness on palpation. Vascular complications (wrist pulse) and neurological complications (reflexes and sensation and power of the hand).

INVESTIGATIONS

This is a clinical diagnosis. X-rays should be taken in different planes to demonstrate the fracture and the presence of intermediary
fragments. MRI or CT are usually not required in the acute phase for the diagnosis but may be performed in cases involving great trauma to investigate associated injuries to underlying blood vessels or ribs or to the acromioclavicular joint.

TREATMENT

An 8-bandage, applied properly, will reduce the pain as well as holding the fracture in the best position for healing, which takes six to
eight weeks. Only complicated cases will require surgery.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the grade of injury and for consideration of surgery. Refer to physiotherapist to start an eight to twelve week rehabilitation programme back to full sport.

EXERCISE PRESCRIPTION

Many sports and activities, such as water exercises and cross-training, can be maintained but avoid further direct or indirect trauma to the shoulder. Running should initially be avoided since the shoulder will be sensitive to this type of impact and holding the arm still while running will cause secondary upper back and neck pain. Swimming should also wait for around six weeks. The specific rehabilitation should aim at a full range of controlled motion, good posture and thoracoscapular control after two months, followed by functional training for up to three months before resuming full sport.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Vascular or neurological injuries, sternoclavicular or acromioclavicular joint dislocation and rib fractures should be ruled out.

PROGNOSIS

Excellent-Good in most cases.

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