So you’ve fractured a clavicle…

***Before I dive into this, a clavicle fracture can be very serious. You should go see a doctor, probably an Emergency Room. Clavicle fractures can result in terrible complications like lung punctures and can be life-threatening in rare circumstances. Go get it checked***

Cyclists and skiers frequently fracture their clavicles due to the risk of falling on the shoulder. I’m six weeks out from a cycling fall that fractured my clavicle and displaced the end closer to my shoulder. It was a bad fall, I went to the Emergency Room, and was checked out. I was shocked by how little information is available for amateur cyclists regarding how to come back from this injury. I wanted to write this to help anyone who has suffered a clavicle fracture better understand recovery.

A few notes about the classification of clavicle fractures you should know to understand the diagnosis:

Fracture: broken bone, but a fracture doesn’t mean a complete break.

Simple vs. Compound fracture: If it’s through your skin, it’s compound. Otherwise, it’s simple. One common indication for surgery is if the fracture is at risk of becoming compound; the bone appears to be tenting the skin.

Displaced vs. Nondisplaced: Displaced fractures mean the bone has moved from its anatomical position. The broken bone ends are not lined up. A displaced clavicle fracture can heal without surgery, and without being set back in anatomical position

Comminuted: Medical term for shattered.

My doctor in the ER provided little information. They took an X-ray, confirmed the fracture (in the case of a displaced fracture, you’ll know. You can’t keep your shoulder back), and provided me a sling. I was told to wear the sling and follow up in two weeks with an orthopedist. I was also informed that most clavicle fractures heal without surgery.

First up, note on the sling. Wear it tight enough that it takes the weight of your arm off the shoulder, but not so tight that it brings up your shoulder. It’s difficult not to move the fractured bone because the sling only prevents arm movement. You’ll be surprised how much your shoulder moves even when not moving the arm. Sitting up, lying down, basically, any sudden movement of the torso hurts.

I wore the sling for two weeks before going to the orthopedist. That’s a mistake. Go as soon as you can. If you need surgery, the doctor in the ER may have been conservative and discharged you after determining the injury is not life-threatening. That does not mean surgery isn’t the best bet for you, it just means that the ER doctor thinks you’ll live. Go to an orthopedic surgeon who’s familiar with sports injuries as soon as possible. Surgery will get you back on a bike faster, albeit with greater risks of things like infection. Without surgery, you may recover slower, specifically in the case of a displaced fracture.

In my experience from that two week period, less movement leads to faster swelling reduction. I read a lot on the internet about the way fractures heal during this period. I thought my bone would have a bump on it as it formed what’s called a soft callus. I never noticed a soft callus despite constantly palpating the break hoping to feel one. The lack of soft callus does not mean the bone is not healing. Particularly in the case of displaced fractures, the bone may not develop a soft callus on the top of the bone (the area you can feel).

The orthopedic surgeon took further x-rays at two weeks. The x-rays were horrifying, but I was assured that healing took time. I was further discouraged because I could feel the bone ends rubbing constantly while going about the tasks of everyday life. I presumed that if the bone ends were moving against one another, no healing was taking place. The bone ends take time to remodel, repair damage and then work towards re-form.

I went through several days of near depression feeling that the bone simply would not heal. At five weeks, it still seemed like things hadn’t made much progress. Suddenly though, somewhere between 5 and 6 weeks, my collarbone knitted back together and stopped perceptively moving. Seemingly all at once, the injury seemed to resolve. I was shocked at first, and tentatively returned to most of my normal activities, and I’m thrilled to say that the bone is only improving with more time.

If you have a clavicle fracture, and you don’t want it to end your season, have surgery. From what I’m told the recovery from a surgical intervention is along the lines of 2 weeks (with an aggressive surgeon). The risks of surgery are real, so it’s not unreasonable to take a conservative approach.

Expect the break to take you off your bike for 6 weeks. Realistically, my clavicle fracture is healed, but I won’t be riding outside aggressively for probably another month. I’m at the point where I can run, ride the trainer for an hour, and that’s enough for now. Taking 6 weeks off made me antsy and I’m dying to get back to any sort of training. The fracture gave me time to unwind training stress and gave me a chance to refocus my goals for the coming season. Recovery from injury requires recognition of where you’re at, and then conscious effort to move forward from there.

Best of luck!