The editors of InsideSurgery.com are noting the news reports stating that bike champion Lance Armstrong will have surgery first thing Wednesday morning in Austin, Texas for his fractured right clavicle. He is quoted as stating that there are “more broken pieces than we thought.”
Although none of the editors are treating Armstrong, he undoubtedly had an magnetic resonance imaging (MRI) or computed tomography of his clavice that showed the more serious nature of the fracture.
As Armstrong seems somewhat surprised by this harsher diagnosis, one must surmise that he did not have these higher level tests done in the hospital in which he was treated in Spain.
The surgery itself is not complicated for an experienced orthopedic surgeon and will typically utilize a plate and screws. An incision will be made long-wise close to the clavicle to place the hardware. The orthopedic surgeon will place the bone ends together, wash out the bone fragments, and place a plate to keep the fractured ends aligned and in contact.
Care must be taken to avoid injuring the subclavian artery and vein which run immediately below the clavicle and can lead to impressive bleeding if torn.
Radiographs will be taken immediately after the plate is placed to insure good reduction of the fracture and positioning of the plate. The hardware will remain in his clavicle and is not removed at later date.
Armstrong will likely receive one dose of antibiotics such as cefazolin (Ancef) before the surgery and likely three doses eight hours apart post-opertively.
He almost certainly will be placed under general anesthesia and should be extubated (breathing tube removed) immediately after the operation. He will experience some discomfort and most probably will need narcotics intravenously for a short time to control the pain.