Update (10/26/2010 at 4:00 PM): ESPN.com is reporting that Tony Romo underwent a CT scan today and that team doctors do not feel he needs surgery. They estimate he will be out 6-8 weeks.
ESPN Dallas.com’s Calvin Watkins is reporting that Dallas Cowboys quarterback Tony Romo suffered a left clavicle fracture in last night’s loss at home to the New York Giants. Romo was injured in the second quarter of last night’s game when he was tackled by Giants linebacker Michael Boley. On the hit, Romo’s left shoulder was driven into the turf.
“I tried lifting my shoulder and it hurt like heck, but I was like, OK, it will just keep getting better,” said Romo after the game, who suffered the same injury to his right shoulder when he was a teenager. “The adrenaline of the game will allow me to [play], it’s my left shoulder, I don’t need to use it too much.” He tried to reenter the game but was having pain and difficulty breathing, so Cowboys’ doctors and trainers took him to the locker room. Further examination and x-rays determined that he had a fractured clavicle. Cowboys owner Jerry Jones told reporters that Romo could miss 6 to 8 weeks, saying “We’ll see if surgery is required,” Jones said. “If not, he’s going to have some time out.”
I don’t have details of the extent of Romo’s injury, as I am not one of the Cowboys physicians. That said, it would not surprise me if the doctors for the Cowboys decide that Romo needs surgery to fix his clavicle fracture. Traditionally, clavicle fractures have been treated without surgery by simply putting the patient in a sling for 3 to 6 weeks. That is still the accepted treatment for nondisplaced fractures. However, injuries in which the ends of the bones are widely separated are being increasingly treated with surgery.
A study in the October 2010 edition of The American Journal of Sports Medicine shows how surgical fixation is being increasingly used to treat clavicle fractures among NFL players. Robert J. Morgan et al. looked at all of the midshaft clavicle fractures suffered in the NFL over a five-year period. Of the 19 fractures suffered, six were nondisplaced, meaning that the ends of the bones lined up well. These fractures were treated without surgery and healed in just over seven weeks. The other 13 were displaced at least 100%. 6 of these 13 were fixed with surgery, either with a plate and screws or a pin down the center of the bone. All of the ones fixed surgically healed at an average of 8.8 weeks. Of the 7 displaced fractures treated without surgery, 3 of the 7 healed without a problem at approximately 13 weeks after the injury, but 4 of the 7 refractured it within the first year of the injury.
The authors conclude, “… The results of this study demonstrate it may be reasonable to consider acute surgical management of completely displaced or comminuted middle-third clavicle fractures in the NFL player. Acute surgical fixation provides a predictable clinical course, might avoid missed playing time in the subsequent season, and may allow safe return to play in the same season if the injury occurs in the preseason or early part of the regular season.”
This trend towards fixing clavicle fractures surgically is being used more in the normal population as well. Fractures that line up well are still being treated simply with a sling and physical therapy to restore strength and range of motion. But increasingly fractures with separation of the ends are being fixed with surgery. In these situations, surgical fixation often provides a more predictable course of healing with a more cosmetic appearance to the clavicle after it heals. Also patients seem to have better strength and use of the arm with less discomfort in the months and years after the injury.
Now I don’t know how displaced Romo’s clavicle fracture is. It’ll be interesting to see how the Cowboys’ doctors treat his injury, but do not be surprised if he undergoes surgery in the coming days.