Duke orthopedic surgeon bucks conventional wisdom; develops surgical approach for broken collarbones

April 16, 2001

DURHAM, N.C. -- 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.

"For patients who have malunions, we simply remove the additional bone material that has grown over the years until we get to the original bone, and then it is handled like a regular break," he said.

Basamania's interest in repairing broken clavicles began in 1991 while at Fort Bragg near Fayetteville, N.C., when he took care of paratroopers and other soldiers who had broken their clavicles during training. By 1994, he performed the first of the new procedures.

"The first case was a paratrooper who shattered his clavicle when he landed on it during an exercise," Basamania said. "Within two weeks of surgery, he was out surfing, and eight weeks later, he placed second in an international judo competition."

Basamania joined the Duke orthopedic faculty in 1998 and as the word spreads about the procedure, more patients are traveling to the Duke Sports Medicine Clinic for treatment. While at first he primarily took care of injured military personnel, his new patients now tend to be athletes and motor cross racers.

For Lemire, more than 24 years of discomfort and inability to participate in his favorite activities has ended.

"I can now sleep on my side. Before, I couldn't sleep on my left side without waking up with a sore shoulder," he said. "Since the surgery, I have been able to lift weights without pain and actually gain muscle."
Note to editors: Dr. Carl Basamania can be reached at (919) 684-3591 or cbasam@usa.net. Two drawings of how the Basamania system works are available at http://photo1.dukenews.duke.edu/pages/ in the Medical News folder as "Clavicle1.jpg" and "Clavicle2.jpg." The first illustration shows the pin being inserted through broken clavicle; the second shows how the bones are aligned after the screw is tightened.

Duke University Medical Center

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