April 2007

Ask the Sports Doctor
Mark S. Sanders, MD
Sanders Clinic for Orthopaedic Surgery and Sports Medicine

Question: I injured my shoulder after a bad fall off my bike recently. My doctor said I fractured my clavicle. I've read about different ways of addressing a fractured clavicle-just wear a sling until it heals, or surgical repair. How do you determine which treatment is right?

Dr. Mark Sanders: One of the most common injuries I see among cyclists is a fractured clavicle. And while I once felt that the vast majority of fractured clavicles should be treated nonsurgically, with any residual bump serving as a rider's "mark of honor," today we address it more aggressively for the athlete. If a serious clavicular fracture is not repaired with the right procedure, the athlete risks losing optimal shoulder and arm function on one side, compromising the entire upper body and overall performance.

The biology of the clavicle enables it to heal more rapidly and reliably. Generally, we can assist in this healing of less severe fractures by putting the athlete in a sling for the first week, allowing them to begin moving the shoulder and working towards trying to lift the arm over their head and improve range of motion. Immediate mobility is key in regaining strength and preserving range of motion in an injured limb. Following an X-ray at approximately four weeks, or when the clicking or popping sounds subside, they can begin lifting lightweight objects to build strength-adding heavier weight as comfort allows.

In an elite or professional athlete, or where there is a severe displacement, overriding of the fragments, fracture fragments threatening to pierce the skin, or multiple fractures in the extremity, associated nerve injury, multiple rib fractures or fractures close to the shoulder end of the clavicle, surgical treatment is indicated. What I have found very effective is surgical repair with internal fixation-affixing a pre-contoured and locked plate and screws to the top of the bone. Commonly, bone graft is added to maximize the chances of early healing, and new titanium plates allow screws to lock into the plate rather than compress it-which makes stress shielding of the bone less likely and hardware removal unnecessary.

Send enquiries to: sportsdoctor@sandersclinic.net
Read more on this topic and others at: www.sandersclinic.net