Here, this is from an article in the Journal of the American Academy of Orthopedic surgeons:

In a prospective, randomized study, 26% of patients treated with a figure-of-8 bandage were dissatisfied compared with 7% of those treated with a sling. The patients treated with a sling reported less discomfort. There was no difference in overall healing and alignment of the fractures, indicating that a figure-of-8 bandage does little to obtain or maintain reduction.

OK, I have been searching a little and it looks like you're right about this. Especially the comfort issues.

But one thing that I think can be benficial with the figure eight is that you are still able to move your arm and work on range of motion without risking to dislocate the shoulder. For me it had great value to be able to do some easy workouts just a few days after the break, but I was still very careful not to do anything that hurt significantly more than it would if I was just sitting still.

I think calling them worthless is an overstatement....we use slings in our ER almost exclusively (based on the literature that you referenced) but you'll find a lot of orthopedists will strongly recommend figure-8's. Then the ER doc looks like an idiot....as they're told that the figure-8 will help position their broken clavicle back in alignment. The evidence does not support that notion but the figure-8 hurts and seems like it should help so the pt buys into it....

I've talked to quite a few pts' with clavicle fractures and you do see mixed opinions. Some started in a sling and then moved to a figure 8 and were happier. There does seem to be a subset of pts that the figure of 8 immobilizes the fracture better and they can be more functional with their arm without all the popping and pain. They seem to be a minority. Most pts feel that the figure-8 is a medieval torture device....esp. if you try and put it on the first day....and then really tighten it up....

Also how about surgery? Plate vs. IM rod/pin (not sure if thats techinically the name)? Thats a better discussion. I think if I broke mine I'd strongly consider an IM pin....if it was sig. shortened or displaced. I think our ortho guys use roughly 2cm short and 2 cm displaced = surgery as a general rule....

Dave

Thanks for the input. i seriously would rather have surgery and have a screw/ pin installed than to gamble that it will heal on it's own only to find out 4 weeks down the line it was not. the guides you gave for how the dr. determines if surgery is needed is helpful. i can not wait till my ortho visit tomorrow. i just need an expert opinion based on my circumstances. at this point over 48 hours out i feel like i could go for a walk, but the thought of getting on my bike/ on a trainer is at least another 3 days out, my guess. i may try to use a recumbent bike at my ymca on monday.
s

I'm a 38 year old male and broke the distal 3rd of my clavicle on Feb 29, bike slipped right out from under me on a downhill turn on a cold (but dry) morning. Aside from trying to not kick myself for being responsible for the accident (I'd much rather have someone else to blame), the healing has been OK so far.

The ER x-rays showed large separation of the bone (and it was poking out a bit, tenting my skin) and since it was near the shoulder, a plate and screws was recommended without any sort of hesitation from the orthopedic doctor. My family doctor (who recently broke his clavicle) seconded the opinion.

I've only been given a splint (no figure 8 was suggested for me) and the discomfort and pain weren't too bad before the surgery, a bit worse after. But a week after the surgery I started some pendulum exercises, and got on a bike trainer at about 10 days. I might try running this upcoming weekend. Although I wasn't fond of going under the knife, I would have been less able to move and/or needed more immobilization of my shoulder for my clavicle to have healed at all without it. Now the incision is mostly healed too, so I might get in the water in two weeks.

Good luck with your healing.

Yea I just got my 2nd opinion and my clavicle is started to mend and join. YEAH!! I ahve been able to bike/ run and just started back to Yoga after 3.5 weeks. Dr says sswimming at teh 6 week, but I feel I can do breast stroke now, so we will see. I am to blame for my fall, but would be more upset had someone else did it to me. At least I was having fun when it happened, skiing. Heal up.
S

According to my doc (Team Doc TdC) the figure 8 does not really make a difference, unless you keep it really tight for the next few weeks, which most people can't do.
Most docs don't recommend them anylonger. Sling works just fine. The bones will almost always find each other.

I would offer caution on surgery. Any time a foreign object is place within the body there is a danger of infection. Minimal, especially with current techniques, etc, but still present. If it will heal without cutting it is worth the wait. Bone sepsis is not a pretty thing, why risk it?

Justin

I broke mine the end of 1996. I had a friend who had broken his and not rehabbed aggressively, causing a lot of trouble for him, so I was serious about rehabbing it. Mine was broken in 2 places and probably had a mild shoulder separation. The middle piece was a small triangle between the two main pieces. Two days after the break, I started stretching all soft tissue even though I could feel the bones moving around. I did this until about day 8, when I figured the bone ends would be getting "sticky." I firmly believed this helped a whole lot! On day 10 the bone knitted together. On day 11 I rolled over in bed and heard them "pop" apart. On day 12 they were back together. About 2 and a half weeks after the break, I started swimming very easily, with a slow, careful freestyle. It hurt, but I am convinced this helped quite a lot. I was back on the bike after about 4 weeks, which probably wasn't smart, because if I had gone down it would not have been pleasant. A buddy of mine kept bumping me the entire ride. He knew I was scared and wanted me to get over it. He recovered fine from the gunshot wound. I was even scared to reach for my water bottle. The fear eventually left, although I have not hit 50 mph since that time- the accident happened at 20 mph.

In the end my right shoulder is now shorter than my right- I lost about 3/4 of an inch. I had some knot issues for a few years until the muscles accepted the new geometry. I can still wear a suit right off the rack, although one tailor wanted to put a bigger shoulder pad in. I recently watched a an x-ray tech almost go nuts trying to get me even for a recent x-ray during a physical. I finally had to point out that she would never get me "square." A massage therapist worked out a bunch of knots and said my shoulder was a little lose and might always be that way. My biggest fear is that I will be having sex with the woman on top, she will reach down and feel the bump and get grossed out. Hasn't happened yet. 11 years later I really do not notice much of a difference between shoulders.

Regarding surgery, the only reason I would have it is if it was the only way to keep the original length. I am pro-shoulder harness. I have nothing to back that up, but I think anything that helps you with good posture while it is healing is probably a good idea.

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"Remember: a bicycle is an elegant and efficient tool designed for seeking out and defeating people who aren't as good as you."

--BikeSnobNYC

Thanks for the info. I am now in Florida at the beginning of week 4. I want to swim badly. The bones are connecting ( 2nd opinion early this week) but not 100% yet. When you said it hurt while swimming. How exactly did it feel? I tried to do a breaststroke and it was not painful, but I could feel pressure in the broken area. Mind you my shulder was very tired after a 17 hr drive. So that could be at play too. I am paranoid I will hurt the healing process, which is good, I guess.
S

It hurt, but it was not a "bad" hurt. But yes, I could feel pressure in the clavicle area. If your bone does not heal exactly like it was before being broken, you are going to feel some different feelings in there. I did very slow, careful freestyle concentrating on form. I would swim a lap and rest. Then another. I was concerned with range of motion, not serious training. I would seek out a warm pool, one that frequently has old ladies doing aquarobics in it.

Make sure the bones have knitted together. I knew instantly when mine had joined, when they popped, and when they rejoined. Make sure you heal!

Let me point out, that this would be a perfect time to kickboard like crazy. An efficient kick is great even for triathletes who use a soft kick when they race. You can work on getting an efficient kick with good ankle flexibility.

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"Remember: a bicycle is an elegant and efficient tool designed for seeking out and defeating people who aren't as good as you."

--BikeSnobNYC

Thanks for the info. I did a 200 yd swim in the ocean yesterday to feel the collarbone out. It felt solid and no pain at all. Just went easy and was limited a little by range of motion. So I will start back w/ very shorts sessions, like you mentioned. Yeah- finally getting back at it.!!
S

I am doing a college research project on clavicles and am surveying those who have fractured their clavicles. It would be very helpful if you could fill this survey out:

http://www.surveymonkey.com/s/P7NRZV6

Thank you!

x2 on the recliner......I ended up using a heavy duty lawn chair...it became a part of our bedroom furniture for a month. Depending on how uncomfortable it is try to stay somewhat active...I had a pin in mine - but started kicking in the pool and riding the trainer...the Doc said getting
me heart rate up helped get the blood circulating around the area......someone told me to knock off sodas because the phosphoric acid impeded healing - not sure about that one.