New Approach to Healing Collarbones

Simple technique even helps patients with old injuries

Friday, April 20, 2001

When Dan Lemire broke his collarbone 24 years ago during a sandlot football game, doctors told him they could only offer a sling and hope for the best. Surprisingly, that was the long-standing medical treatment -- do nothing, let the bone heal on its own, and hope that the results aren't too disabling.

"Since the injury, I continued to experience soreness which limited my physical activity," said Lemire, now a 44-year-old lawyer in Brookfield, Conn. "The bone never really fused together properly. One of my arms became shorter than the other, and I experienced upper back problems because the mechanics of my shoulder and back were thrown off."

The collarbone, also known as the clavicle, is shaped like an italic letter "f," and runs above and parallel to the ribs. It is one of the major bones making up the shoulder, the most unique joint in the body, gaining its strength and flexibility from a complex interplay of muscles, tendons and ligaments. Only primates, humans and birds have clavicles. Because of its position and its relative thinness, the clavicle is also one of the most frequently broken bones in the body. It is estimated that about 15 percent of all fractures involve the clavicle.

Unwilling to accept prevailing medical doctrine, Duke University Medical Center orthopedic surgeon Dr. Carl Basamania spent much of the last decade developing and testing a new approach to this injury that is now drawing patients from across the country to Duke's operating rooms.

The new procedure and device developed by Basamania not only offers immediate treatment for patients with newly broken collarbones, but is finally providing relief for patients who, like Lemire, have lived for years with the consequences of improperly healed bones, known as malunions.

"When I decided that I wanted to fix broken collarbones, everyone thought I was crazy and that I would certainly ruin my career," Basamania recalled. "As medical students, and even as surgical residents, it is pounded into your head that there is no suitable surgical treatment for these breaks. I wanted to see if we could do better than that."

His approach is deceptively simple, minimally invasive and, based on the more than 150 procedures he has performed on new injuries and more than 30 on malunions, is proving to be a great success. Those surgeons who in the past questioned Basamania's medical sense now either send their patients to him or learn how to do it themselves.

"Previously, the only surgical treatment for fractured clavicles involved attaching the broken bones together with a large metal plate and screws," Basamania explained. "Since this very rarely provided satisfactory results, very few surgeons performed them, believing that a malunion was better in the long-run than complications from the surgery."

Basamania's approach involves sliding a long thin screw through a tiny slit in the shoulder. He guides the screw through the center of the bones' pieces, like beads on a string. As the screw is slowly tightened, the pieces are squeezed together and held secure. After the bone has healed and is strong -- usually after eight weeks -- the screw is removed. Patients are left with a properly healed clavicle and a inch-long scar.