[Medical Q&A] What should you be alert to if you always use one hand to drag the other forearm after an injury?

Planner: Chinese Medical Association

Reviewer: Shao Zengwu, Chief Physician and Professor of Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology

If this happens, you should be alert to clavicle fracture. The typical manifestation of clavicle fracture is that the head is tilted to the affected side, the affected limb is adducted, and the healthy hand supports the forearm of the affected limb. It is necessary to check whether the patient has shortness of breath and weakened breath sounds, the blood circulation of the affected limb, and whether the sensory and motor functions of the affected limb are impaired.

Anteroposterior clavicle X-rays can confirm the diagnosis and understand the degree of fracture displacement and comminution. CT examination can identify sternoclavicular joint dislocation, epiphyseal injury, and whether the distal clavicle fracture involves the articular surface. For patients with a clear history of trauma, as well as local tenderness, bone friction, skin and soft tissue injury, bruises and swelling, abnormal activities and other special signs, clavicle fractures should be highly suspected, and combined with imaging manifestations, a clear diagnosis can be made.

Non-displaced fractures or minimally displaced fractures can be treated non-surgically, using a forearm sling and an 8-shaped bandage. The purpose of surgical treatment is to restore the stability of structures such as the sternoclavicular joint, acromioclavicular joint, and coracoclavicular ligament, restore the normal shape of the clavicle and its sling function, and restore the mobility of the shoulder joint as soon as possible. For proximal clavicle fractures, if compression symptoms persist, the medial part of the clavicle can be removed and the sternoclavicular joint can be reconstructed. For mid-clavicular fractures, plates and screws should be used for internal fixation, and some simple fractures can also be fixed with intramedullary nails. For distal clavicle fractures, the distal clavicle plate or distal clavicle hook plate should be used for fixation, and the coracoclavicular ligament should be reconstructed if necessary.