Surgical Repair of Broken Collarbone Gets Cyclists Back on the Road Faster

For Immediate Release

Surgical Repair of Broken Collarbone Gets Cyclists Back on the Road Faster
Leading sports orthopaedist discusses benefits of surgical reduction in clavicle fractures

NY, NY and Greenwich, CT, July 2007  A broken clavicle, popularly known as the collarbone, is one of the most common fractures of the upper body and a frequent injury among cyclists. Until recently, the prevailing treatment recommendation for the vast majority of clavicle fractures has been a nonsurgical regimen of immobilization followed by extensive physical therapy, which sidelined most patients for up to four months. However, recent findings confirm that many clavicle fractures actually heal faster and better with surgical reduction, allowing cyclists to get back on the road more quickly after this injury.

Researchers have confirmed numerous problems associated with nonoperative healing of clavicle fractures, explains Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams. The primary problem that can occur is called a nonunion at the fracture site, which means the bones do not heal together in a straight line. This can cause long-term discomfort, as well as difficulties with strength and range of motion, Dr. Plancher adds, noting, For these reasons alone in high energy multiple piece collarbone fractures, surgery is often a better alternative for adults with active lifestyles.

Study shows far better outcomes with surgery
There are, in fact, many reasons for athletes who sustain a clavicle fracture to consider surgical reduction. A study published in the January 2007 issue of the Journal of Bone and Joint Surgery compared the results of nonoperative treatment versus surgical treatment of midshaft clavicle fractures the most commonly injured region of the clavicle, and the one most likely to be treated without surgery. The researchers found that the surgical group outperformed the nonsurgical group in all standard tests of strength and range of motion throughout the study. In addition, the surgical group had far fewer non-unions (where the bones do not heal) and malunions (where the bones heal poorly or overlap) than did the nonsurgical group. More importantly, the average time it took the surgical group to achieve full healing was about 16 weeks; for the nonsurgical group, it was 28 weeks. Finally, after one year of follow-up, the surgical patients were more likely to be satisfied with their shoulder function and appearance than the nonsurgical group.

Risks and Signs of Clavicle Fracture for Cyclists
Cyclists are at a high risk for clavicle fractures, Dr. Plancher notes, adding, “Witness the countless professional racers and mountain bikers who have amassed multiple broken collarbone diagnoses throughout their careers! He confirms that the main cause of a clavicle fracture is a fall on the shoulder, which most often occurs for cyclists when they are thrown over the handlebars. However, even a sideways fall off of a bicycle can result in a broken collarbone.

According to Dr. Plancher, riders who sustain a fall should check for the following symptoms in order to determine if the clavicle may have been fractured:

  1. Pain at the shoulder site is the most obvious symptom, and this will likely be a more intense discomfort than an average bruise or sore muscle.
  2. Visible dislocation of the AC joint is often obvious as well, because the clavicle is subcutaneous located right below the skin, with little fat or muscle protecting it or masking its appearance.  The bone may actually look elevated with a large bump on the top of the shoulder or disjointed, Dr. Plancher explains.
  3. Tenting of the skin around the collarbone suggests that a fracture is forcing the skin on top of the bone to rise.
  4. An open fracture is the most serious symptom, and one that requires immediate medical attention. Dr. Plancher points out that an open fracture is easily identified when a portion of the bone remains protruding through the skin. However, a bone fragment can pierce the skin and then descend back into the body, leaving only a small cut as evidence. For this reason, cyclists who sustain a shoulder fall should always check the skin for cuts or gashes, and seek emergency medical care if one is found.

Fortunately, cyclists who sustain a clavicle fracture are likely to be able to rehabilitate and return to their sport more quickly and with greater strength and flexibility than ever before, thanks to these new surgical treatment protocols, Dr. Plancher concludes. These approaches are so important, because they restore a faster, better quality of life to our most active patients. 

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