Broken Clavicle (collar bone)

[LugNut]

As I understand it, this is a fairly common cycling related injury, and so I have started this topic as a place to share information, pass on 'hot tips' and generally complain about broken collar bones. I hope it might also provide an outlet for the frustrations of those suffering from a disabling and painful injury. Also it should go without saying but please excuse all typing errors; only got one arm!

I broke mine yesterday morning while riding home from a party. I had a blood alcohol level of 1.09 and was riding fixed gear, so I really only have myself to blame. I had not ridden FG in a long time and had decided to take it that night because I was bored with my daily bike, and while riding downhill I was bucked off and landed heavily on my right side.
It was a quiet back street, and I lay on the road and tried not to move until any pain kicked in, as I knew that I had probably done something serious. Some bystanders arrived; paramedics, luckily, as I had crashed right outside of a hospital. I hobbled into Emergency with what I thought to be a dislocated shoulder. X-rays revealed a cleanly broken Clavicle.

I was told on the night in hospital that surgery was usually reserved for 'elite sportsman', or people who's work involves a lot of physical movement and lifting, however since talking to another doctor I understand that advancements have been made recently that have made surgery a good option for everybody. Instead of joining the two with a plate, a metal rod is inserted through the back of the shoulder that pins the bone together, and then removed once the bone has healed after 6 weeks. I was told that recovery time is sped up dramatically, the bone heals better without deformity and the risk of long term complication is lowered. This was a concern of mine, as bicycles are both my transport and recreation, and having long term pain or a seriously weakened clavicle would impact heavily on my ability to cycle. I have opted for the surgery and will probably be having it tomorrow.

The first day was very hard, it was a shock both physically and mentally, and I was still stressed at the prospect of such an interruption to life. I study full time and work two jobs, and so I'll be missing a week of uni and catching up during the holidays. I will continue to work one of my jobs for 2 days a week, but I'll be pretty useless at my job in a bike shop, and the timing for them is not good. I would say that at least 2 days rest would be necessary, the initial painkillers make you quite woozy and any movement is difficult. A weeks rest would be better to allow for surgery before the bone re knits.

I would be keen to hear other experiences with broken Clavicals, especially relating to surgery, recovery, a '2 years on' sort of thing, and any tips for completing everyday tasks.

Also: fixed gear for sale, going cheap! I'll stick to freewheelin'

[trailgumby]

So I take it the ends of the break are not in contact with each other?

I broke mine a year and a half ago and no surgery was required. Back on the trainer at 6 weeks, on the bike about 9 weeks later, no off-road until 12 weeks and nothing remotely technical off-road until 16. Sounds like you're well under half my age so your time frames will be shorter but be guided by your doctor.

I have titanium in my hand courtesy of a bike-hating driver three-and-a-bit years ago, seven pins and a plate. My experience has been that it doesn't impact daily life too much, but there is still an impact. Change in weather, people with strong handshakes both cause noticeable discomfort. Planning to get the metalwork out shortly.

Ask about how easy it is to remove if necessary before making the call.

[HappyHumber]

My experience was similar to yours... i.e. my own stupid fault. I had just ridden about an hour home from a friends and managed to stack it about 200m from my own front doorstep. Mine broke into 3 pieces. 2 major bits and a small splinter.

Wasn't really instructed correctly on how to brace it by the Emergency staff, and it was a few weeks before I got to see a Specialist. This I also partly blame on myself for not having a GP and the GP I did consult being absolutely useless in terms of referral (he first sent to me to an ankle specialist!). Anyway, by the time I did it had already began to heal enough and they said it would be pointless to re-break for surgery. It's basically healed a bit under 20mm shorter, and with a bit of a bump in it.... doesn't cause me any pain or affected me any other way. I was back on the bike in about 7 weeks, for gentle commuting.

The extra stupid thing was I had a new MTB on order from LBS at the time. I busted the collarbone 2 days before it arrived. The LBS guys had a great laugh when I went into collect it, arm in sling. The bike was a Carpet Queen in the lounge room for closer to 10 weeks, and then it wasn't anything to hard for some time.

Anyway... screws or bumps in your either or both of your clavicles are a badge of a true cyclist. Wear them with pride. Just have a more glamorous cover story than the one you shared in your OP

[LugNut]

So I take it the ends of the break are not in contact with each other?

I broke mine a year and a half ago and no surgery was required. Back on the trainer at 6 weeks, on the bike about 9 weeks later, no off-road until 12 weeks and nothing remotely technical off-road until 16. Sounds like you're well under half my age so your time frames will be shorter but be guided by your doctor.

I have titanium in my hand courtesy of a bike-hating driver three-and-a-bit years ago, seven pins and a plate. My experience has been that it doesn't impact daily life too much, but there is still an impact. Change in weather, people with strong handshakes both cause noticeable discomfort. Planning to get the metalwork out shortly.

Ask about how easy it is to remove if necessary before making the call.

Yes, I was told by the second doctor that it may not heal neatly without a pin (he mentioned that it would be visibly lumpy but didn't say whether it would be weakened), and said that it was still my choice. I was just surprised to get two different opinions from two doctors at the same hospital. Your recovery sounds about what I was told, apparently this is shortened with surgery - another reason I opted for it. Good to hear it would heal okay without however, the human body seems to bounce back quite well, but I'd never forgive myself if I couldn't ride. My clavical rod will also be titanium, I'll have to come up with some jokes about being half man, half Lynskey.

[trailgumby]

The ends of mine were still together, only a millimetre gap, but I still have a lump you can see when I'm shirtless. Possibly it's a bit weaker but I've had offs since with no bone pain resulting, but I have been more careful.

[RonK]

About 6 -7 years ago at Killarney I went of OTB of my enduro at around 60kph when the gear lever caught on a loop of fencing wire. The local SES crew carted me and bike back to the start, and I waited around for an hour while they collected three more victims (an ambulance load), all with broken collarbones. The doctors at Warwick hospital just laughed and told us to visit our GP's, but basically advised that there was a general reluctance for surgical fixes.

I threw away my sling once the ends stopped grinding together (about two weeks) so I could type. Started cycling again around 4-5 weeks. Still have a bit of a lump but it has gradually smoothed over. It's been no trouble since.

[Wakatuki]

Broke mine 24 years ago at the age of 16.
Run over whilst cycling(or under) by a MG Midget!
It cost me a rear QR rod, rear hub to the bike and a chipped hip and a broken collar bone for me!
Clear break, left to knit on its own.

It still refuses to be as strong in the surrounding muscle in the right unbroken one. (It is my non dominant arm)

No real pain in it now, but sensitive to blows and knocks.
It has a nice deformed lump on it and generally keeps my left shoulder nice and tense, with knotted muscles, after heavy exercise.

My son in a freak accident fell down some stairs head first into the bottom exposed banister support with a nice whack and broke his too, he was 4.
He has no grief at all despite breaking it whilst it was healing in a trip/fall some 4 weeks later.

So the point of my post.......... None really.
It will heal and not really change your life, it will provide others with a source of entertainment for a few weeks and you a story to tell down the pub...

[LugNut]

Quick update for future sling brothers. As Wakatuki said, two months down the track and all is good. I'd rate my recovery at 95% after 8 weeks, 80-90% after 6 weeks. I had a few Physio appointments, and last visit he said that I was back to 100% movement. I have about 85% strength back, but that will be %100 after some weight training. I had the surgery to streamline recovery a few days after I broke it, I had a screw inserted, and it healed surprisingly quickly. I was back on the bike after 4-5 weeks, (well, 2, but super slow and careful. I'd recommend a flat bar with a left handed front brake/coaster brake combo But not everyone has an arsenal of community bike shelter bikes to borrow).

I have a fairly gnarly scar, but it's nothing more than pub story fodder. The first few days were the worst, as with most major injuries, and after that as bad as it got was the daily ritual of waking up and attempting a wake up stretch. Owch.

Just grab a few good books and take it easy for a few weeks. I'm a little bit more timid on my bike, but that's not really a bad thing.

[khuzai]

Thanks for this post LugNut et al.

I broke my right clavicle in what appeared to be a mechanical on my road bike. In short, I was powering on off the saddle in a sprint when all of a sudden, zero resistance from the drivetrain! Fell on my right shoulder and in addition to my clavicle, I also managed to break my scapula and a rib. Doctors were quite amazed at the scapula fracture as it take a major trauma to break it.

When I was at the emergency ward, the doctors said my broken bones were all non-displaced therefore no surgery required. They were concerned however that my trauma was major as I managed to break my scapula, which apparently is really hard to break. 10 days on, the follow up x-ray showed some movement in the two fractured ends but it was still intact. The doctor said it was up to me if I wanted to opt for surgery or not without getting into details on the pros and cons of each option. And he said he can't guarantee that operating on it would make it heal better. Needless to say, I went for a second opinion. And this doctor in summary said that if I wanted it to heal quicker go for the surgery, otherwise it would heal by itself. I opted to let the bones do what they do and at the last fracture clinic on day 18, it was healing and feeling better. But the doctor said my clavicle healing (usually 6 weeks) will be slowed down by my scapula and rib (8 weeks).
It's day 22 today and I'm off my sling but I still can't quite lift my arm up much. All the muscles on the shoulder and upper arm are a bit stiff and tender but they are moving more and more each day.

I am hoping to be on a wind trainer on the 5 week mark and take my time after that to get back on the road.

[kx315]

Broke my left one 13 years ago (2 day before my first child was born.....boy was I popular ) going over the bars at 100km on my motor bike. Hurts like hell at the time (up there with breaking ribs) as its hard to get comfortable especially sleeping at night.

I was back on the bike in 4 weeks, generally the newly fused part of the bone is actually stronger than the original.

[winstonw]

hey lugnut, what hospital did you attend? To my knowledge, no publics and most privates in Qld would not offer surgery. I only spoke to Royal Brisbane Hospital ED a few months ago about this. Did you get it done as a public or privately insured patient?

Does a titanium elastic nail sound familiar, or was it definitely a screw?

[LugNut]

Winstonw,
I came off my bike outside the Epworth Private Hospital in Richmond. I just limped right on in. Having said that, I have private health insurance. The doctor on duty said that it would heal fine on its own, and she 'would recommend surgery if you were a sportsman'. Talking to a friend's dad a day later, who happens to work at the Epworth Emergency, he asked 'why wouldn't you get the surgery? It's very easy nowadays they just pop a screw in and send you away' etc. That, plus my (probably false) concern that my injury might inhibit my cycling, convinced me to go for the surgery, and I went back to the Emergency dep for a referral.
Looks like a screw to me, but I wasn't told specifically. Here's the post surgery x-ray. Realise my Name and Dob are on there, not concerned. It's scanned backwards and incorrectly spelt anyway


Speedy recovery khuzai, that sounds nasty.

[winstonw]

Winstonw,
I came off my bike outside the Epworth Private Hospital in Richmond.

Thanks Lug, appreciate the effort of putting up the xr. Will ring around the private hospitals in Brisbane and see what they say...and I appreciate not all collar bone fractures are the same, and get the same consideration.

[khuzai]

Will ring around the private hospitals in Brisbane and see what they say...and I appreciate not all collar bone fractures are the same, and get the same consideration.

winstonw, I was treated at Mater Public and at the first fracture clinic, the orthopaedic doctor did not give me a straight "yes, you should go for surgery" or "no, leave it to heal". He said it was up to me but they did offer surgery as an option. Then I went to Wesley (private) for a second opinion, and this doctor said clavicle heal but it would heal quicker if you went for surgery. He reassured me that if I didn't do surgery, it would heal so I went with that, but they too offered surgery.

I guess if you want to recover quick, most hospitals would offer surgery. It also depends how displaced your clavicle fracture is.

[iaintas]

Public will likely not offer surgery if it doesnt need it as it will cost the hospital money.

Private will likely offer surgery as it makes them alot of money.

now for the technical part from a orthopaedic friend. If it is undisplaces surgery will not reduce healing times, its still going to be about 6 weeks, putting in a pin does not increase bone growth, all surgery will do in this case is open it up to infection, possible nerve damage etc. all small possibilites but they exist.

displaced fracture will need to be pinned to improve healing times, but still going to be 6 weeks, all this does is reduce the distance and hold things in place whilst healing.

Surgery is not a quick fix and always comes with added potential complication, each fracture is different and each specialist is going to have a different opinion on whats going to be best, personally as a health care worker i would avoid surgery if i could, 6 weeks is still 6 weeks weather i have a pin in place or not.

[trailgumby]

Just be aware that 6 weeks just provides you with a "sticky" join, and your surgeon is likely to recommend staying off the road until at least week 8 has passed,, and no off roading or racing until end of 11 or 12. Especially so for older riders such as us, and that was for a best case undisplaced break like mine.

[winstonw]

thanks khuzai, I appreciate not all fractures are the same. I'm a physio and see a lot of clavicle fractures - over 20 this year, 7 of them by members of my CC. for the last 10-15 years, it was common not to offer surgery for the majority of fractures. maybe there's been a subtle shift in thinking, which I'll report on after talking with a few EDs and orthopods. I've seen many fractures not operated on that should have been imho. They can compromise the nerves that run into the upper limb, and change the dynamic of shoulder movement setting one up for rotator cuff issues, and accelerate thoracic and cerical spine issues. Though long term functional considerations as subtle as this are not well appreciated by the majority of doctors and orthopods ime.

on another note, it used to be common to put unoperated clavicles in a figure of 8 binder to help with a more anatomically normal fusion, but this was stopped about 15 years ago.

[trailgumby]

Ah, Ive been teaching you to suck eggs! Sorry

[matagi]

thanks khuzai, I appreciate not all fractures are the same. I'm a physio and see a lot of clavicle fractures - over 20 this year, 7 of them by members of my CC. for the last 10-15 years, it was common not to offer surgery for the majority of fractures. maybe there's been a subtle shift in thinking, which I'll report on after talking with a few EDs and orthopods. I've seen many fractures not operated on that should have been imho. They can compromise the nerves that run into the upper limb, and change the dynamic of shoulder movement setting one up for rotator cuff issues, and accelerate thoracic and cerical spine issues. Though long term functional considerations as subtle as this are not well appreciated by the majority of doctors and orthopods ime.

on another note, it used to be common to put unoperated clavicles in a figure of 8 binder to help with a more anatomically normal fusion, but this was stopped about 15 years ago.

Who knows? The figure 8 bandage may yet make a recovery. Clavicle surgery used to be fairly hit and miss 15 or so years ago in terms of successful outcome, but with improved techniques the results have similarly improved.

It's true most docs don't appreciate the long term consequences of subtle functional defects, that's why the smart ones refer their patients to physios.

[durianrider]

I did mine when I was 8. Never been the same since.

Lucky you didnt smash your teeth out as well.

Fixies are bad enough sober. Combine booze and its a fatality waiting to happen.
I say no to both.

Get to bed as early as you can for the next few months to aid recovery.

[winstonw]

I only rode a fixie once and won't do it again....seems some of the guys racing here will also think twice.

[LugNut]

Oh yeah. Parted it up and got rid of it with my arm still in a sling. The kicker is I built it for a laugh, we had a frame donated to my community workshop that had had it's dropouts ground off and replaced with home made track dropouts, it was such a ridiculous thing that I offered to throw some spare parts at it. I had front and rear brakes. I was only riding because it was so close to my house (but I didn't feel safe walking that time of night), and the fixed gear was the only bike I felt comfortable leaving outside late at night. Recipe for disaster indeed. I've had my faith in the helmet validated, hitting my head felt just like landing on a soft pillow. Later inspection revealed that I had hit my head hard enough to crack the helmet and make an obvious impression.
All in all could have been worse.

[khuzai]

One word of advice for all who break collar bones, don't wait till after week 3 to see a physio. You may get a frozen shoulder. Even more so if you fractured other bones like the shoulder blade or rib. My physio is currently treating a cyclist with a broken collar bone who didn't see him until week 6. Frozen shoulders are not fun, will cost you more time and money.

[kx315]

Broke my left one 13 years ago (2 day before my first child was born.....boy was I popular ) going over the bars at 100km on my motor bike. Hurts like hell at the time (up there with breaking ribs) as its hard to get comfortable especially sleeping at night.

I was back on the bike in 4 weeks, generally the newly fused part of the bone is actually stronger than the original.

Well I put the kiss of death on myself posting in this thread ....... courtesy of a piece of unseen debris on a cycle path near home I am now nursing my second broken collar bone in 13 years

[LugNut]

Broke my left one 13 years ago (2 day before my first child was born.....boy was I popular ) going over the bars at 100km on my motor bike. Hurts like hell at the time (up there with breaking ribs) as its hard to get comfortable especially sleeping at night.

I was back on the bike in 4 weeks, generally the newly fused part of the bone is actually stronger than the original.

Well I put the kiss of death on myself posting in this thread ....... courtesy of a piece of unseen debris on a cycle path near home I am now nursing my second broken collar bone in 13 years

Argh, sorry to hear mate. At least you might get a bit of special attention this time around.