The collarbone (clavicle) is a long bone running horizontally between the breastbone and the shoulder blade. Its primary function is to hold the shoulder joint away from the chest, allowing the arm a full range of motion. When fractured, the immediate goal is to reduce movement and minimize pain until professional medical care is received. Temporary stabilization, often called wrapping, is strictly a first-aid measure designed to immobilize the limb and prevent further injury during transport.
Recognizing a Potential Fracture
A broken collarbone often presents with immediate and severe pain over the injury site, which is made worse by any attempt to move the arm. Swelling and bruising will appear rapidly, and the injured shoulder may sag downward and forward. In some cases, a prominent bump or deformity is noticeable near the fracture, or the patient may feel a grinding sensation, known as crepitus, when the shoulder is moved.
If the skin is broken, if there is severe bleeding, or if bone is protruding, stabilization should not be attempted and emergency services must be called. Urgent medical attention is also needed if the person experiences numbness, tingling, or coldness in the arm or hand, as this may indicate damage to underlying nerves or blood vessels. Any sign of concurrent head, neck, or chest injury, such as difficulty breathing, takes precedence over temporary fracture stabilization.
Necessary Materials and Safety Precautions
Temporary stabilization is accomplished using a broad arm sling, which requires a single, strong, triangular piece of cloth or a commercial triangular bandage. The patient should be positioned comfortably, ideally sitting upright or semi-reclined. The arm is then gently brought across the chest with the elbow bent at a right angle, which is the position the sling will maintain.
Never attempt to “reset” or manipulate the bone fragments back into position. The sharp edges of a broken clavicle can easily tear surrounding soft tissues, including the subclavian artery or nerves. The purpose of the wrap is simply to support the arm’s weight and restrict movement, not to align the fracture. Removing rings, watches, or other jewelry from the hand and arm before applying the sling is necessary, as swelling can quickly make these items constricting.
Step-by-Step Stabilization Using a Broad Arm Sling
The patient should support their injured arm across the chest with their uninjured hand. The triangular bandage is then unfolded completely, with the longest edge, the base, placed parallel to the chest. One point of the triangle is positioned under the elbow of the injured arm, and the middle of the base is placed between the arm and the torso. The upper end of the bandage is brought up and over the shoulder on the uninjured side, hanging down the person’s back.
The lower end of the triangular bandage, which hangs down the forearm, is then brought up over the shoulder on the injured side, passing over the forearm. Both ends of the bandage should meet behind the neck and must be tied together using a secure knot. Ensure the knot is placed well away from the fracture site to prevent pressure on the injured area.
Once the knot is secure, the sling should be adjusted so the elbow is bent at a 90-degree angle, with the hand elevated slightly higher than the elbow to prevent swelling. The excess material at the elbow, the point of the triangle, can be folded forward and secured with a safety pin or tape. Finally, a second piece of cloth or bandage, known as a swathe, should be wrapped around the patient’s torso and the injured arm, securing the arm firmly against the chest. This swathe prevents the arm from swinging, ensuring maximum immobilization during transport.
What to Expect During Professional Medical Treatment
Following temporary stabilization, the patient requires immediate evaluation at a medical facility. A medical professional will order X-rays to confirm the location, type, and severity of the fracture. Most clavicle fractures are treated non-surgically with professional immobilization devices, such as a specialized arm sling or a shoulder immobilizer.
The medical team will manage pain. While the figure-eight brace is a type of immobilizer, it is rarely used today due to discomfort and lack of proven benefit over a simple sling. Surgery, often involving plates and screws to realign and stabilize the bone (Open Reduction and Internal Fixation), is generally reserved for severely displaced fractures or those that break through the skin. Physical therapy will be introduced to restore full range of motion and prevent stiffness in the shoulder and elbow joints.