Symmetry Blog

Injury of the Week - Fractured Clavicle

Symmetry Physio - Thursday, July 19, 2018

We look at the heartbreaking injury suffered by Richie Porte during The Tour de France.

Riche Porte's heartbreaking exit from the Tour de France this past Sunday became even more devastating when he found out he fractured his right clavicle. At only the 10km mark of his 156km Tour de France race, Richie fell off his bike and immediately grasped his right shoulder. Porte's fractured collarbone is the most recent instalment of 'Injury of the week'.

Fractured Collarbone

Fracture of the clavicle is one of the more common fractures seen in sporting activities. It is usually caused by direct impact in sports such as AFL or by falling onto the bone in sports such as horse racing or cycling. A very painful injury, fracturing the clavicle usually involves an injury to the middle third of the bone. The outer-fragment often moves downwards and the inner-fragment moves upwards. Upon examination, there will be localised tenderness, swelling and the deformity in the bone may be felt. In the case of Richie, after he fell off his bike a medical professional is seen examining and feeling his collarbone and decided that he needed an X-ray to confirm the diagnosis.

With a diagnosis of a "straightforward non-displaced right clavicular fracture", Richie sits on the sooner end of the recovery time frame. Fractures in the middle third of the clavicle are often classified by their percentage of movement:

  • Non-displaced = Less than 100% displacement
  • Displaced = Greater than 100% displacement

As a general rule, non-displaced clavicular fractures will undergo conservative management whereas displaced fractures will usually receive surgery. The main indicator for surgery is bony fragments piercing the skin or shortening of the bone greater than 1-2cm

The main aim of Physiotherapy treatment is to provide pain relief, as clavicular fractures almost always heal in four to six weeks. However, a point of concern is while healing, the ends of the clavicle can overlap leading to a shortening of the bone. This can lead to quite significant functional deficits with a range of motion in the shoulder and strength. Clinicians will sometimes use a "figure-of-eight" bandage as opposed to a traditional sling to try and prevent shortening of the clavicle. During this period of immobilisation, it is important for the patient to perform assisted shoulder movements to reduce stiffness of the shoulder joint.

As Cycling places relatively low loads on the shoulder complex, Richie won't necessarily have to undergo a vigorous shoulder strengthening program. This is provided he has the appropriate range and strength required for cycling. If Richie was returning to football he would need a comprehensive shoulder strengthening program to ensure he has the appropriate strength to meet the strenuous demands of footy. 

At Symmetry Physiotherapy expect to receive guidance through the early stages following injury and an individualised strengthening protocol to help you get back to doing what you love.

Ryan Himing

Symmetry Physiotherapy

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