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	BMX TODAY September 2006 My first two columns for BMX Today focused on one of the most common injuries in the sport of BMX: fracture of the clavicle (collarbone). I talked about the way my approach to these types of injuries has changed over the years-as my personal involvement in sports and in treating athletes has evolved. And while I believe reconditioning and less invasive treatment options should always be considered first, surgery is sometimes necessary for an athlete. Conservative treatment sufficient for the non-athlete could leave the injured limb of an athlete returning to their sport insufficient for the demands. Last month I described the surgical repair of a fractured clavicle in detail. I received a number of questions regarding the "figure of eight" bandage. Whether treatment for a fractured clavicle is surgical or non-surgical, I do not advocate the use of a "figure of eight" bandage. It does not improve the position of the fractured bones, nor does it relieve pain. The biology of the clavicle is different from all of the other long bones and enables it to heal more rapidly and reliably. My goal is to assist the enormous healing potential that it has. If instability is a concern, a simple sling is all that is necessary. This month, top BMX rider and Sanders Clinic sponsored athlete, John "The Jackal" Purse talks about his recovery from many fractured clavicles. Tips from the Jackal Well, my clavicle has been fractured or broken with displacement seven times! So I have had many different injuries to both the left and right clavicle/collarbone. If you have a very difficult break of the clavicle in the same place multiple times, you develop what is called "nonunion of the clavicle." This is where the bone never heals-forming an artificial joint that actually moves! I developed a "nonunion of the clavicle" back in 2000. Basically, I broke my collarbone in the same place multiple times where as the bone never healed and required surgical repair. I spent the whole year trying to figure out why my shoulder hurt everyday and sidelined me from time to time with a "soft" crash. After nine months of not knowing what was wrong, I had a CT scan that revealed a diagonal break that wasn't visible on an x-ray. In the offseason, I had it repaired and have a plate and six screws attached to my left clavicle as we speak. I feel that if you break/displace your collarbone in the half or in pieces, surgery is the fastest, safest and most effective way for your bone to heal correctly. Also, if your clavicle is not aligned properly and the bone actually heals on top of each other, you will lose your proper shoulder width and range of motion and be plagued with back problems for the rest of your life! I've outlined a few tips that I found helpful in my recoveries. One of the most effective tools I've used is the "Figure of 8" brace and sling. Today's treatment employs a sling only if there's any instability. Fracture Only Keep it simple and don't exercise or do ANYTHING that may interrupt healing. The difference between fractured and displaced is the fact that you got lucky this time. Displacement is very difficult to manage and takes more time and effort to recover from. You should be good to go in 28 days, but keep your activity light until then. Also, read and follow the displacement procedures below to help you with your recovery. Displacement/Broken in Half My advice would be to basically stay in bed or stay inactive for the first 7-10 days. I know it is difficult to pull this off, but very important! The first 7-10 days are the most crucial in getting the broken clavicle aligned properly. During this time, soft calcium starts to form and surround the fractured or broken area of bone. Also it is normal to feel the clicking of the bone actually moving back and forth. Along the way, you are going to have to move around and will feel the bone pop and displace/move. You may even feel some type of pain and discomfort. Once you sit back down or lie down, move your shoulder around until you feel that the bone realigns itself, or you may have to push it back in place. Slowly, the soft calcium will start to harden as each day progresses. If the bone doesn't align in this time, it may never heal right and break under less pressure next time. Be patient! Working Towards Recovery Days 0-7 Acquire a sling that supports your shoulder. Also, use a sling to support the arm from moving. Use these slings for stability both before and following surgery if necessary. Be patient! Days 7-14 At about day 10-14, the soft calcium that forms around the broken area starts to harden at a faster pace. That is when it needs to be aligned and set. If it is not, you will not be able to align it anymore and may have a big "bump." Be patient! Days 14-21 At day 14-21, things are pretty solid, but very fragile. Don’t try to be active or you will run the risk of rebreaking the bone! Be patient! Days 21-28 At 21-28 days, the bone is pretty much healed but NOT 100%. Now, start to work on your range of motion very slowly. Start moving your shoulder (slowly) in a circular motion and raise your arms. This is the time to just get the shoulder moving again. It is not time to pursue your sport. Be patient! Days 29-35 At 29-35 days, you can return to your sport and don't take any risks, if healed properly, the broken area will heal stronger than before, but don't use that as an excuse to take more chances because it is "stronger." Be patient! JOHN "THE JACKAL" PURSE A Sanders Clinic sponsored BMX rider Send any questions to bmxtoday@nbl.org and get advice from the Jackal's personal orthopedic surgeon, one of the country's best.