Toolbox: Clavicle Fractures
Due to falls on the shoulder and relative high speed, a common injury in cycling is clavicle fractures. Although any part of the clavicle can be broken, they most commonly occur in the middle of the clavicle. What’s the typical diagnosis and prognosis for return to cycling?
By Victor Lun, MD
Diagnosing clavicle fractures is usually not too difficult given the usual deformity that results from the injury. X-rays of clavicle fractures can look alarming due to how angulated the fractures can appear and there can also be multiple fracture pieces.
In pro cyclists, there are often stories of riders getting their clavicles surgically repaired and returning rapidly to the pro peloton. In 2012, Pippo Pozzato broke his clavicle in the early season, but was back on his bike within days after clavicle surgery and went on to 2nd over the cobbles of Flanders weeks later. So should you gets yours fixed as well?
Fortunately, despite how bad clavicle fractures may appear on x-ray, most clavicle fractures usually heal on their own without surgery. Once the fracture heals, there is usually a cosmetic deformity of the clavicle, but there are typically no deficits in terms of any shoulder function, motion or strength. Therefore, the initial management of clavicle fractures is mainly symptomatic with analgesic medication and supporting the arm with a sling.
There are only a few absolute indications to have a clavicle fracture surgically treated, such as a break or severe tenting of the skin and secondary nerve or blood vessel injury. Relative indications for surgery are significant shortening of the clavicle and for cosmetic reasons.
Surgical treatment of clavicle fractures does probably allow for an earlier return to sport activity. However, one often requires a second surgery to remove the surgical hardware as the area of surgical fixation can become easily irritated since the skin is quite thin lying over the clavicle.
“Figure 8” slings have been recommended in the past but they are uncomfortable to wear and don’t really help the fracture reposition or heal faster, so they are probably not necessary and a simpler sling can be used. As one’s pain symptoms improve, gentle range of motion and isometric strengthening exercises can be gradually introduced. Stationary biking can probably be started at any time as long as the pain is tolerable. Obviously, rollers should be avoided!
It takes about 6-8 weeks for clavicle fractures to heal, but it may take up to 3 months for the strength of the fracture site to normalize. So avoiding sports activities in which falling may be a risk is recommended for about 3 months.
Although non-operative management of clavicle fractures is usually recommended, the circumstances of a clavicle fracture can vary between individuals. Therefore, it is important to have a frank discussion with a medical physician and/or orthopedic surgeon to determine how best to manage this injury.
WRITTEN BY: Dr. Victor Lun, MSc., MD, CCFP, Dip. Sport Med (CASEM) is a Sport Medicine doctor who practices at the University of Calgary Sport Medicine Centre. He is the team physician for several of the winter and summer sport Canadian national sport teams and a medical director at the Canadian Sport Centre Calgary.
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