08.07.2007

Transworldmotocross.com
Tuesday Tip: Clavicle Fractures

By Mark Sanders, MD

Dr. Mark Sanders is back, and this time he addresses one of the most common motocross injuries: clavicle fractures. Take it away, Dr. Mark...

Among one of the most common MX injuries I see 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 riders "mark of honor" - today we address it more aggressively. For an action sport athlete, equal distribution on the bike is as essential as the balanced strength of his key muscle groups. 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 is different from all of the other long bones and enables it to heal more rapidly and reliably. We assist in this healing of less severe fractures by putting the athlete in a sling for the first five to seven days. They can then begin moving their shoulder - working towards trying to lift it over their head and improve range of motion. The disturbing clicking sounds, some very pronounced, generally persist for about a month. They are normal and will not affect the exercises or recovery.

At four weeks or when the clicking, or popping, sounds subside; they can begin lifting lightweight objects -- such as an unopened soda can -- to build strength. Heavier weight can be added as comfort allows. Younger patients are back at their sport by six weeks, while older patients require more time -- usually three months.

It is important to understand that the clinical healing will generally occur in advance of the x-ray healing and surgery is not always necessary. The x-ray will eventually match clinical results, though a bump will always remain - surgery or not. Surgical treatment exchanges a bump for a scar, provided no complications occur.

When there is a severe displacement of the fracture - threatening to poke through the skin, or multiple fractures in the extremity, nerve injury, multiple rib fractures or a fracture close to the end of the clavicle - surgical treatment is performed with a pre-contoured and locked plate and screws.