Cyclist Lance Armstrong wrote that he will choose to undergo surgery shortly after a crash in a race Monday left him with a broken collarbone and uncertain stakes in the 2009 Tour de France.
Armstrong fell off his bike in a pile-up in the final 12 miles of the 109-mile first stage in the Vuelta a Castilla y Leon race in Spain. The injury took the seven-time Tour de France champion out of the Spanish race and landed him back home in the United States to await treatment, according to Phillippe Maertens, a spokesman for Armstrong's Team Astana.
"I'm alive! Broken clavicle (right). Hurts like hell for now," Armstrong, who was competing in just his third stage race and fourth competition overall since coming out of retirement this year, tweeted on the social networking site, Twitter. "Surgery in a couple of days. Thanks for all the well wishes."
Sports medicine experts say that although collarbone fractures are extremely painful, they often heal on their own. In fact, it's sometimes possible for cyclists to train indoors during healing and in some cases undergo surgery to speed up their recovery.
"Sometimes athletes -- and this happens in Europe among soccer players -- they're actually treated surgically to get them back on the field more quickly," said Dr. Frank A. Cordasco, an orthopedic surgeon at the Hospital for Special Surgery in New York City.
If the break is simple, Cordasco said it's possible for doctors to insert a titanium rod to stabilize the bone and speed up the healing process.
"You put a small flexible rod through the middle of the bone and it fixes the fracture and enables the fracture to heal," he said.
But if the collarbone broke in multiple places, Cordasco said Armstrong might have to undergo a more complicated procedure with a series of metal plates and screws.
Cordasco said a person's pain tolerance can also sometimes determine time off from competition.
Cyclist Tyler Hamilton sustained a clavicle fracture during the 2003 Tour de France, and was actually able to finish in fourth place.
Although Armstrong's personal Web site said he is "officially retired," the 37-year-old cancer survivor and seven-time Tour de France champion had returned to racing with the Astana team and was said to be preparing for a run at an eighth Tour de France title.
Despite the injury Monday, Maertens said Armstrong could be back on the road in a month, in time for a race in Italy in May and the Tour de France in July.
"The collarbone is broken, and I have a little bit of road-rash abrasions," Armstrong said as he left Valladolid University Hospital. "I've never had this happen before; it's pretty painful. I feel really miserable."
Armstrong had already covered 97 miles of the stage and was at the front of the pack when he fell, Maertens said, adding that Armstrong knew immediately what had happened, although he had never before broken his collarbone in his 17 years as a cycling professional.
When he fell, Armstrong's first reaction to the crash was reportedly to utter the single word "sh**."
From the time he returned to racing in 1998 after his battle with testicular cancer to his retirement after the 2005 Tour de France, Armstrong was not sidelined for any significant time periods from crash-related injuries in training or competition, although he did take an occasional spill.