The clavicle, or the collarbone, is the most commonly fractured bone in the upper extremity and this most commonly occurs when people go off their mountain bike or road bicycle, falling onto the shoulder and fracturing this collarbone. The most famous, recent athlete was Tyler Hamilton, who, in the Tour de France last year, fell onto his shoulder, fracturing his clavicle and was able to continue riding through the rest of the race. Most people however find a fracture of this clavicle, this collarbone, to be extremely painful and quite cosmetically unacceptable. When they look in the mirror, they see a bump right on their clavicle, usually pointing up towards the ceiling. It is usually painful with a foreshortened shoulder and, when they take an x-ray, they see the misaligned bones and wonder if this fracture will ever heal and if they will ever be able to return to full sports.

Fortunately, while it is the most common bone fractured, it also has an excellent healing rate, when there is not too much overlap or too much angulation. Too much usually means more than 1 ½ centimeters of overlap of angulation. As long as it is less than 1 ½ centimeters, it will usually heal on its own. More than that, while it may heal sometimes, it often heals with a foreshortened shoulder, a cosmetic result that some people find unacceptable and can be best treated by early operative fixation. Fortunately, over the last few years, new methods of repairing the clavicle have been developed. Here, at The Stone Clinic, we designed an intramedullary fixation technique, where we are able to pass a screw down the bore of the clavicle in order to straighten it out, bring it out to full length, and permit it to heal. This technique has permitted our bicycle racers to get back on their bicycle within a couple of weeks of injury, even with relatively severe, displaced, clavicle fractures. The technique has also permitted people to heal with a shoulder that is completely out to normal length, in normal alignment, and with minimal scar and deformity. This fixation technique has been very successful in our hands and has been one of the methods that have permitted us to repair more clavicles now than we had in the past.

On a non-surgical side, clavicle fractures very often heal and can be treated by sling support and early, gentle range of motion and exercises. We have not found the figure of eight braces to be very comfortable and most patients give them up after a few days. The future of clavicle fracture treatment, may be percutaneous addition of growth factors to the fracture site in order to speed healing or it may be new designs of fracture fixation methods. But for now, we believe we can restore fracture length and stability to athletes who break their clavicle and return them to sports relatively rapidly with this safe procedure. Additionally, there is more information about clavicle fractures and their treatment at www.stoneclinic.com.

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The Stone Clinic in San Francisco concentrates on returning injured people to their active lives, fitter, faster, and stronger than they were before. The Stone Clinic includes Dr. Kevin Stone, physician and surgeon, a staff of physical therapists, and an x-ray and MRI facility. Our specialties include the treatment of joint injuries and arthritis with leading edge surgical and rehabilitation techniques. Elite athletes and everyday people alike come to The Stone Clinic from around the world for the best in orthopaedic care. The Stone Clinic is located at 3727 Buchanan St., San Francisco, CA 94123. For more information, please call us at (415) 563-3110