Clavical Fractures

author : AMSSM

comments : 2

Crashed on your bike? You may have a clavical fracture. Clavicle fractures are the best, and the worst, fractures to have. Find our more in this article.

"I have been training for months for my first tri and I am ready...or I was until I crashed on my bike this past Saturday and fractured my collar bone. It is 2 weeks from my event and I want to compete. I am thinking about taping up my shoulder and collar area and going for it. I am not going for time...just to finish it. Any suggestions?"

Tracy L. Zaslow, MD, FAAP, CAQSM
Member AMSSM

Clavicle fractures are the best, and the worst, fractures to have. Classically they are "the best," because overall they heal easily with excellent functional outcomes and minimal or no intervention. However, more recent studies have shown symptomatic malunion (incomplete healing) rates to be higher than historically suspected.

They are "the worst," because there is no great immobilization or casting technique that makes them comfortable in the 1st two weeks before healing bone (bony callus) stabilizes the fracture and they take a long time to heal well enough to participate in activities that have a high risk of falling, like cycling.

Types of Clavicle Fractures

Clavicle fractures are classified by which third of the bone that the fracture involves: medial (closest to the sternum), middle, or lateral (closest to the shoulder).  Middle third fractures are the most common (70-80% of clavicle fractures). Clavicle injuries are common in cycling due to falls onto the outside of the shoulder.  With these types of falls, the clavicle will fail about 90% of the time. The clavicle can also be injured from falls onto the outstretched hand, but this only accounts for 2-6% of clavicle fractures.  X-rays are usually adequate to assess for clavicle fractures; CT scans are only required in rare cases with severe and complex injuries.

Clavicle fractures, even displaced ones, can usually be treated non-surgically. The two methods of bracing and immobilization are: 1) Arm sling - keeps the arm bent resting at your side; 2) Clavicle Brace - keeps the shoulders pulled back.

Healing a Clavicle Fracture

A clavicle fracture typically takes 12 weeks to heal. The fractures can heal faster in athletes who are skeletally immature (athletes who are still growing). Pain is the worst in the first 2-3 weeks as the initial bony callus (healing bone) is formed.  Pain should be the limiting factor for activity, but gentle range of motion exercises should begin early, in 1-3 weeks, to prevent the shoulder from getting stiff.

Returning to Sports

The timing of returning to sports activities depends on the sport.  Returning to non-contact sports that do not have an increased risk of falling can occur as early as 2-4 weeks; stationary biking is a great example. However significantly more time (~12 weeks) is needed for return to sports like cycling which has a high fall risk or contact sports, like football, because of the risk for re-injury before the fracture is adequately healed. Sometimes, high-level athletes who need an accelerated return to play may elect to have surgical fixation (a surgery where a plate is attached to the fracture site) to get back to full level participation more quickly.

In summary, cycling, especially competitive cycling, is not recommended in the first 12 weeks after a fracture, unless excellent early healing was shown on x-ray (this can occur in athletes who are still growing). Unfortunately, while taping may make the shoulder feel more comfortable, it does little to protect the bone from a repeat
fall.

Tracy L. Zaslow, MD, FAAP, CAQSM

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date: October 11, 2010