Blog

Broken clavicle update and surgery decision

After breaking my clavicle on Saturday morning, I spent most of Sunday doing research on the injury. I read articles and blog posts online, spoke with friends and friends-of-friends who have either broken their clavicle or are orthopedic surgeons who treat the injury and tried to find surgeons in LA to see on Monday to discuss my options.

The main thing I found out is that in most cases, it is not necessary to have surgery to fix a broken clavicle. With time, most fractured clavicles will heal on their own and come back as strong (or nearly as strong) as before. Unlike a broken arm or foot that can be re-set and secured with a cast, a broken clavicle cannot be re-set because, with no way to secure it with a cast, it wouldn’t stay in place. But the body will grow fibrous tissue to reconnect the broken pieces of bone and eventually that fibrous tissue turns into bone. Even if it’s not perfectly lined up, most people end up with a strong and stable clavicle that allows return to full function.

For severe breaks, where doctors are worried that the bone won’t heal correctly and for professional athletes whose livelihood depends on a full recovery (like Lance Armstrong), surgery may be recommended. (But not always, for example, I don’t think either Tony Romo or Tyler Hamilton had surgery when they had the injury. Insert your own Tyler Hamilton joke here!) Surgery can ensure that the bone is re-aligned and often results in a considerably quicker recovery.

My orthopedic surgeon-friends in New York and Montana who looked at my emailed x-ray image on Sunday said that I fell in a middle area – it’s not an awful break or one that requires surgery, but it is somewhat displaced and there’s a bit of risk it won’t fully heal, or it could heal a little “shortened” because of how the broken ends will reconnect. Also, since I want to continue being semi-competitive in triathlons, I have less tolerance for the risk of a partial recovery. The consensus was that it should heal fine on it’s own, but surgery was an option that could result in a better and quicker recovery.

My first call Monday morning was to Dr. Ramin Modabber, a local orthopedic surgeon who operated on Dan Empfield (of Quintana Roo and Slowtwitch fame) to fix his broken clavicle after Dan crashed during the Tour of California Time Trial last May. I got in to see Dr. Modabber that morning and he suggested that I have the surgery. He was very clear that, if I wanted I could just let it heal. And most likely it would heal just fine. Either way, once it was fully healed, I probably wouldn’t know the difference. The thing I heard many times was that I was choosing between having a bump (from the bones resetting a little off) or a scar (from the surgery).

Dr. Modabber’s concern was that given the relative location of the bone pieces, they might reconnect a little “off” and I could end up with a slightly shortened left shoulder. Also the fibrous tissue and re-grown bone that fills in the empty spaces between the broken bone pieces might not be as strong as the original bone. Would either of those things have any functional difference? Maybe. Maybe not. But it’s hard to know.

The other advantage to having the surgery is that – assuming all goes as planned – it should accelerate my recovery time by up to four weeks. Without surgery, I’m looking at 6+ weeks before I can really start strengthening my shoulder. With the surgery, it could be as short as 10 days or two weeks.

Briefly, during surgery they re-set/re-allign the bones and put in a plate like this to hold it in place while it heals. Dr. Modabber told me that the plates come in a lot of different shapes and sizes.

This is what it looks like when it’s in place:

There’s a chance that they’ll have to go back in later and remove the plate, but that depends more on whether I can feel the plate and if it’s bothering me. That would be pretty beat, but I’ll deal with that when/if it becomes an issue.

Surgery always has some risks – anesthesia, infection, nerve damage – but the risks are pretty low and I believe Dr. Modabber and his staff will do a great job.

So… surgery is scheduled for next Tuesday (June 21). No doubt I’ll have more to say between now and then!

Thanks to everyone for your support and advice and suggestions!