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Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Understanding Tony Romo’s Collarbone Fracture

One week after losing wide receiver Dez Bryant to a broken foot, the Dallas Cowboys’ injury woes continued in Week 2 with quarterback Tony Romo suffering a fractured left clavicle (collarbone).

The injury occurred to his non-throwing shoulder when he was taken down by defensive end Fletcher Cox. The weight of linebacker Jordan Hicks compounded the fall, sending a high amount of force through Romo’s body and creating the perfect mechanism of injury for a collarbone injury.

The clavicle is one of the most frequently fractured bones in the body due to its poor protection. It plays a crucial role in two of the four articulations that make up the shoulder complex. The sternoclavicular (SC) joint is the only connection between the arm and the trunk of the body and is located where the clavicle joins the manubrium of the sternum (breastbone). The collarbone continues along the shoulder until it meets the acromion of the scapula (shoulder blade), forming the acromioclavicular (AC) joint. Here the collarbone serves as a strut for the shoulder, creating a pivot point that allows for a high degree of motion.

If Romo’s injury is an isolated fracture then the nature of the break comes into play. If the bone did not shift and remains non-displaced, the four-time Pro-Bowler could avoid surgery and would simply need to let the bone heal. If a significant displacement has occurred, surgical hardware would likely be inserted to stabilize the bone and insure proper healing. Location of the break is also key. Injuries to either the SC or AC joint can complicate a collarbone fracture and delay Romo’s return. However if the injury is to the middle third of the bone, it will set up Romo for a smoother recovery, regardless of surgical intervention.

Predicting a return to action is a bit difficult without knowing what treatment options the Cowboys will utilize but let’s look at what history and other data suggests about the injury.

To start, this marks the second time Romo has broken this collarbone. During Week 7 of the 2010 season, Romo broke his left collarbone in a similar fashion. He was struck by Giants linebacker Michael Boley and his left shoulder was forced into the turf in the process. Romo would miss the team’s final 10 games. However the team’s poor overall record likely influenced Dallas’ decision to place him on the IR. Green Bay Packers quarterback Aaron Rodgers missed seven games during the 2013 season after breaking his non-throwing shoulder just like Romo. He did not need surgery for the fracture. Last season former Philadelphia Eagles and current St. Louis Rams quarterback Nick Foles missed the team’s final eight games with a collarbone fracture of his own. The Cowboys can even look to an in-house comparison as Hall-of-Fame quarterback Troy Aikman missed five games of the 1998 season with a fractured left collarbone.

While the demands of the quarterback position are different, expanding the analysis to include players outside quarterbacks does, interestingly enough, offer some hope for Cowboys fan. Saints receiver Marques Colston missed just two weeks after breaking his collarbone and having it surgically repaired. Running back Ryan Mathews was back in action in just under seven weeks following his right clavicle injury and surgery in 2012.

Furthermore, a 2010 study of NFL players examined 19 mid-third collarbone fractures that were treated both nonoperatively and surgically. The average time of healing for non-surgical breaks was 7.3 weeks while those treated surgically needed an extra 1.5 weeks to heal.

Monday will be key for the Cowboys as they ultimately decide on what treatment option to utilize with their franchise quarterback. Considering the team proactively decided to utilize a bone graft in Bryant’s fractured foot, don’t be surprised if Romo goes under the knife as well. Surgery would improve stability and insure the pieces of bone properly fuse together. Either way it appears as if the 2-0 Cowboys will have to navigate the next few weeks without their starting quarterback and Pro Bowl receiver.

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