Last week, British racer Bradley Wiggins was caught in a crash that took out several riders in Stage 7 of the Tour de France. He landed hard on his shoulder and as he was examined by team doctors, it became clear his race was over. The diagnosis: a broken collarbone.

This is the same diagnosis a young patient of mine had recently after a fall from her bicycle. She just finished the seventh grade, and a week into summer vacation found herself with her arm in a sling. Whether it ends a pro bike race or interrupts a summer of swimming, a broken collarbone can be troublesome.

The collarbone, or clavicle, is one of the most vulnerable bones in the body. If the shoulder joint is like a tripod, the clavicle is one of the tripod’s legs. Any trauma to the shoulder, and especially falls that place a large force on it, put the clavicle at risk for fracturing.

Cyclists are especially vulnerable to clavicle injuries, but so are skiers or football players, who are often tackled onto their shoulders with great force. Dallas quarterback Tony Romo suffered a clavicle fracture last year from that kind of tackle.

Once injured, the clavicle usually heals dependably. Doctors often say the clavicle will heal if both ends are in the same room. The two fragments of bone can be far apart, or even overlapping, and they will almost inevitably find each other. First, the bone ends remodel. Next, a large knot of new bone, called a callus, forms. Gradually, over several years, the callus remodels and the clavicle returns to a more normal shape.

This process takes time, and many athletes reinjure their clavicles by returning too quickly. Think about trying to glue a pencil together and it becomes easy to see why a healing clavicle is so vulnerable to snapping again. The best approach is to allow the bone time to regain its strength before putting it at risk on the field.

Surgery is an option for some kinds of clavicle fractures. In some elite athletes, I recommend surgical fixation of a fracture injury because it may allow them to return to sports earlier. In other cases, because of the site of the fracture or the way the bone ends come together, surgery may be the safest and best route to recovery.

Surgeons generally either affix a flat metal plate on top of the collarbone to hold it in place or they use a screw. The screw is the newest approach. It can be threaded into each end of the fractured bone and then tightened, pulling the fragments together. From there it holds the bone ends in place without requiring a lot of hardware and a big skin incision.

One important thing to remember about any situation in which hardware is used on bone has to do with mechanical stress. It turns out that our bones are very elastic, so they flex and move whenever we apply load to them. In this respect, they’re a lot like the suspensions on our cars.

Metal is much less elastic, and it moves a lot less than bone when we apply a load to it. This means that if there is a metal plate or a metal screw attached to a bone, that section of bone will not be able to flex normally. The bone around it has to flex more than normal to make up for the stiff metal. This stress riser effect sometimes causes bones to weaken and even fail around metal hardware.

In general, it’s best to let the clavicle heal naturally if it can. Pro athletes or others who can’t afford losing six weeks to healing may opt for surgery, but they face increased risks of complications down the road.

As for Bradley Wiggins, he was put on a plane back to England and had surgery immediately. Now about a week from his injury he is already looking forward to racing at the end of the season. And my young cyclist in Maine? She let her bone heal the more natural way and was back in the lake enjoying summer swimming last week. 

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the U.S. ski team.

 

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