Q&A: Dr. Drew Stein, orthopedic surgeon, discusses the case of Lance Armstrong's broken collarbone (aka clavicle)

Tuesday March 24, 2009 10:57 AM By Max J. Dickstein

Lance Armstrong on Monday, with his right arm in a sling under a pullover. (Jaime Reina/AFP/Getty Images)

By Max J. Dickstein

Lance Armstrong’s cycling team manager Johan Bruyneel pronounced yesterday that the seven-time Tour de France winner will be able race in the Giro d’Italia and the Tour this summer despite a broken collarbone he sustained on Monday in a pileup during a race in Spain.

Armstrong flew from Madrid to the United States yesterday for possible surgery.

We asked noted Manhattan orthopedic surgeon Drew Stein to estimate Armstrong’s prognosis based on reports about his injury.

Do you think it’s realistic for him to recover in time to be racing in June or July?

Yeah, definitely. Most of these bones will heal within two months. But he’s having surgery, so that should realign his bone and allow it to heal quicker.

Are there risks involved?

There are possible complications associated with surgery on clavicle fractures, which are non-union (non-healing) and infection. If he got one of those, obviously that would put him out for the rest of the summer.

So you wouldn’t recommend surgery to a typical patient with a broken collarbone?

Most people don’t have surgery on their clavicles. There’s only two reasons that you would do it if you’re not an elite athlete: if the bone is sticking out of your skin (an open fracture) or it’s tenting the skin (an impending open fracture); or if you have some kind of neurovascular damage with it, so the nerve or artery gets injured with the clavicle. I’m sure he doesn’t have any of those and I’m sure he’s trying to do this just to try and quicken his recovery because he’s got these two races coming up.

What does the surgery entail?

They open the skin and they put a plate and screws on it to realign it. Sometimes they’ll even put bone graft in it to allow it to heal quicker. I don’t know what his surgeon’s going to do, obviously, but that’s the most typical way to fix it.

How soon do you think he could put pressure on it and start to train again?

You’d have to wait until the incision heals — at least two weeks. Then he could probably rig something, because he has unlimited resources, where he could probably start training again within two weeks I would say. As far as putting weight on the arm, that might take a little longer. He might have to rig something so that his arm is a position of less wright-bearing. And that would probably be on a stationary bike because obviously they wouldn’t want him to risk falling while he’s recovering.Is a broken clavicle particularly likely to break again?

The biggest risk of the clavicle is non-union, so non-healing. And then once you have a plate on a bone, if you fall, the risk of it breaking at the end of the plate increases because that’s where the stress riser is. So it’s not more likely to break again, but if he falls on it, the place that it would break would be in a different spot, most likely — which would be at the end of the plate.

Have you seen many patients with clavicle fractures from cycling situations?

No, I don’t think so. Most of the clavicle fractures that I see are from a fall diving on the arm, whatever sport it is. Or skiiing, you know, landing on the shoulder. But not cycling. Although it’s pretty common in cycling — you go over the handlebars. In a pileup, you can’t really control where you’re falling or how you’re falling. I’m sure if he was by himself and his tire whipped out from under him, it wouldn’t have happened.

So if he were your patient, and not an elite cyclist, you’d probably just say, "Let it heal normally"?

Yeah, you put him in a sling. Then he can start motion as soon as he’s comfortable — usually that’s in about two or three weeks. Then you have to wait for it to completely heal for any activity. You’d probably start him on some therapy just to so that it wouldn’t get too stiff while it heals.

You wouldn’t even set the bone?

You can’t really reset or realign the clavicle once it’s fractured. There’s too many muscle forces on it that’ll just pull it right back to where it was.

Lance is 37. How is healing tracking versus someone younger?

It shouldn’t be a problem. As long as he’s not a smoker, and there aren’t any risks — obesity, diabetes, osteoporosis — and obviously he doesn’t have any of these things. And, of course, the dreaded steroid use. Obviously, that’d fail you, too, if someone’s on it.