By Djuro Petkovic, MD
The NFL had some unfortunate news this week when one of the best quarterbacks in the NFL, Aaron Rodgers, broke his collarbone and will undergo surgery. I know this news will not make the Bears’ faithful lose any sleep, but in the end no one wants to see any person, let alone a high caliber athlete, get injured and lose their ability to work.
Rodgers is just the latest in a series of high level athletes that have lost time due to a fractured clavicle. He broke his clavicle on the other side a few years ago, but was able to return later in the season without surgery and end the Bears’ season in their last game. Our own Patrick Kane lost the end of his regular season in 2013 and surgically repaired his clavicle before he heroically came back early and helped the Blackhawks win the Stanley Cup. Tony Romo had multiple fractures and surgeries on his non-throwing left clavicle over the years making him miss out on several seasons. But why is this small bone so important?
The clavicle is the only linkage between your axial and appendicular skeleton, basically linking your torso to your arm. It provides stability and keeps the scapula (or shoulder blade) in place so that you can position your arm in space. It also helps protect your main blood vessels and nerves traveling to your arms.
However, its position and thin shape puts it at risk for fracture. It is not covered by much soft tissue, leaving it vulnerable to injury without any good method of protecting it. Athletes that fall onto their shoulder are at very high risk for this injury. In Rodgers’ case, his shoulder was driven into the ground by a defensive player. It is also very common in cyclists who flip over the handlebars, as happened to Lance Armstrong in 2009. However, this injury does not only affects athletes, but has struck people from all walks of life, as this is the most commonly fractured bone in the body.
Fortunately, this is an injury that usually does not require surgery. Most of these fractures will heal without treatment, though they may heal with a small bump. There is much debate amongst surgeons regarding when to operate on clavicles. Surgery can make healing more reliable in those with certain patterns and displacements, and may also get certain people back to work and sport faster. Thus, many athletes end up getting surgery to get them back onto the field sooner if the injury has certain characteristics. The timeline for return to sport is still usually about 6-12 weeks depending on the situation. However, surgery carries more risk and will leave a scar. Some patients will also feel that the plate and screws used to fix the fracture are too prominent, and some want another surgery to take out the hardware once the fracture heals.
So how does one decide on surgery or non-operative treatment? Like many things in orthopedics, this is a decision based on a discussion between the surgeon and the patient. Only in certain cases, such as when the broken bone is threatening the skin, does surgery become necessary. Otherwise, the treatment plan should be tailored based on your goals and lifestyle, as well as the surgeon’s experiences with these injuries. If you end up suffering from this fracture, see your orthopedic surgeon for discussion of your treatment options.