Is That Your Collarbone That Just Snapped?

Over the bars, and "crack." 

I treated a couple of patients recently with clavicle (collarbone) fractures, and while they weren't bike related, this IS one of the more common bony injuries seen in mountain bikers and cyclists in general.

Happened to me once, when I was just a wee lad and I was trying imitate some of my BMX idols. I was jumping, had done an x-up, but didn't un-x my handlebars in time. I landed with my bars turned and was launched over the bars. I say "launched," but in reality, I was probably 10 or 11yrs old and also probably got 1ft of "air," and probably just flipped over without much drama or fanfare, but I digress.

Falling onto outstretched hands (called FOOSH injuries) sometimes results in a broken collarbone, but most happen from falling and landing on the side of the shoulder. 

The collarbone, or clavicle, is sort of "s" shaped and believe it or not, is the only bony connection from your arm to your chest. Your arm is connected to the scapula (shoulder blade) with ligaments and a joint capsule, and the scapula is connected to the rest of your chest via the clavicle through ligaments at the "AC joint" (acromioclavicular joint) and ligaments connecting the sternum to the clavicle. AC joint separations (different from shoulder dislocations) are another common shoulder injury, but will be a topic for another day. 

Anyway, that "s" shaped bone is thinnest in the middle and thus the middle portion is the part that usually breaks, called a "mid-shaft fracture."

"The middle third of the clavicle is fractured in 69% of cases, the distal third is fractured in 28% of cases, and the proximal third is fractured in 3% of cases.

From UpToDate

Broken collarbones are fairly easy to diagnose as there is usually pain right over the break and the injured person can often feel some crunching or cracking with movement. 

On the trails, you'd be looking for that fall pattern (typically landing on the shoulder), pain right over the collarbone, and maybe some crunchiness. The injured person sometimes holds the broken side down lower (due to the pull of the torso muscles), so uneven shoulders can be a clue.

Beyond that, most fractures are readily seen on plain film x-rays.  

Extreme pain or trouble breathing would have you thinking about other injuries to the torso, and we're assuming here that the person didn't hit his/her head or have other trauma.

Numbness or tingling in the injured arm would be concerning for associated nerve injuries, and vascular injuries are also possible, but in practice, both of these are rarely seen.

And finally, two other possible complications that could happen with a broken collarbone would be an open fracture--the bone is sticking out or there is a cut over the fracture site--or if the fracture fragments are angulated in a way that's putting significant tension on the overlying skin. Either of those would warrant urgency in being evaluated and would likely involve surgery.

Making a modified sling would be the first step towards treatment, and in many cases--assuming the bones are not sticking out--a sling is the only treatment if it's a simple break. Surgery is done if the bone fragments are significantly displaced, but there are some other reasons that surgery is considered. An orthopedic surgeon would be the one to go over all of the pros and cons of an operation. 

Most broken collarbones heal without much fuss, and you can be back in action in 4-6 weeks. Other than trying not to fall, you can work to maintain good bone health as a way of preventing this, or other fractures from happening.

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