The band is playing somewhere, and somewhere hearts are light,
And somewhere men are laughing, and little children shout;
But there is no joy in Mudville — mighty Casey has struck out.” Casey at the Bat
The clavicle is the first bone in the body to ossify and among the most commonly fractured, particularly in children. It can be fractured via several mechanisms including the classical fall on an outstretched as well as striking the point of the shoulder. It’s not uncommon to also suffer rib, scapula and/or cervical spine fractures and is seen repeatedly in cyclists. Frequently a patient will tell me they actually heard the bone crack when the fracture occurred. This injury can be confused with an AC separation, a rupture of the ligaments at the end of the clavicle. They’re treated differently.
Displaced fractures are pretty easy to diagnose as the whole shoulder seems to fall forward and the patient describes a crunchy sound/feel. Xrays will define the specifics of the break and help guide treatment options. One also checks carefully for any accompanying nerve or vascular damage.
For non-displaced fractures, immobilization without surgery has been the norm and usually gives good results in a short period of time. The athlete can ride the stationery bike indoor as pain permits (but not outdoors – there’s no value in copying Tyler Hamilton)and should be back astride the bike by 5-6 weeks post injury. When the fracture is displaced, consideration of surgery to achieve the best long term outcome is considered. If there’s notable shortening or displacement at the fracture site, then surgical stabilization actually shortens the healing time, reduces the potential for non-union/delayed union, and more reliably gets the patient back into life. That said, surgery is not with the potential for significant complication as nerves and vessels are close by.
So, if you think you may have broken your clavicle, the ER is the next stop for you with a careful evaluation of the entire shoulder and neck, xrays, and some of you’ll get to meet the Orthopedic Surgeon on call. Say Hi from me!
Arthritis of the Spine/Cinco de Mayo Humor