Sunday, 1 April 2012

Finally - an end to broken collar bones?

Hardly a week seems to go by without news that a professional cyclist has broken his or her collar bone in an accident. According to studies, the majority of professional riders will suffer an injury of this type at least once during their career, with amateurs who cycle twice a week also standing a 41% chance of being injured in the same way during their lifetime. In fact, it's not uncommon to hear cyclists saying that they wish nature had come up with a better design.

Dr. Adolf von Elkalebeite
Until last year, Dr. Adolf von Elkalebeite was the head of the Sports Science Laboratory at the University of Geneva. He is a recognised expert on athletic injury and he's worked with some of the most famous teams, organisations and governing bodies in sport, including FIFA, the Olympic Council and Fédération Internationale de l'Automobile. As a keen amateur rider himself - he says he dreamed of turning pro in his youth after being inspired by his hero Ferdinand Kübler, the oldest living Tour de France winner and who has assisted the doctor in a study into the changes a retired athlete's skeleton undergoes as part of the aging process - his first love has always been cycling.

A new approach
"Cycling - along with medicine, of course, has been my life," Dr. von Elkalebeite says. "For many years, it was difficult for us to secure any funding for my academic program and I ran it primarily as a labour of love." That's no longer a problem. In fact, the 71-year-old doctor no longer has to go cap-in-hand to the University authorities begging for money at all. The reason? He's discovered a way to prevent all those broken bones.

Although a broken clavicle, as doctors term the bone, begins to knit relatively quickly with limited athletic training frequently becoming possible within a week of the injury's occurrence, full recovery - and return to previous performance - may take some months; meaning that a broken collar bone can negatively affect a rider's entire season. Millions of pounds have been spent by professional cycling teams in an attempt to develop new, more effective methods of hastening recovery but thus far have met with little success.

"I realised one day that the problem is an intrinsically simple one," the doctor told us. "While we've designed the bike to fit us, the human body evolved to walk upright and run, not to ride a bicycle - which is so different to anything our ancestors on the plains of Africa did that we're simply not physically suited to the task."

"The clavicle acts as a strut permitting the arm to remain attached to the body yet still achieve free movement. However, due to its position it often absorbs the impact created when a cyclist's body hits the road; a task for which it is unsuited and which causes it to snap. That's all there is to it: we cannot prevent it snapping, nor can we hurry repair. It does what it is supposed to do very well indeed, but we ask of it something else."

Dr. Sally-Patrice Röthy
Finding a solution
From that point, it didn't take a huge leap of the imagination to realise that if the collar bones with which we all come supplied can't cope with the strains placed upon them in a cycling accident then rather than attempting to increase that capability it might be better to come up with something that can. Dr. von Elkalebeite got in touch with his colleague Dr. Sally-Patrice Röthy, formerly head of the University's Orthopaedics Laboratory where her team investigated new materials for use in artificial joints.

"Replacement hips have developed vastly since the first examples in the late 19th Century, when surgeons attempted to use carved ivory," she explains. "Modern types are made of titanium, and they offer certain advantages over natural hips. For example, the material's strength-to-weight ratio is greater than any other metal - in fact, it's stronger than any metal with the exception of some heat-treated steel alloys.

"When Dr. von Elkalebeite first came to me, I suggested titanium immediately and once we'd looked closely at what he wanted to do he agreed it seemed ideal. Then we started to wonder if we might be able to make it still lighter, and that's when we came up with the concept of using titanium only for the tips of the bone where it interacts with other parts of the skeleton, while using carbon fibre for the main length of the bone."

The concept is simple, but actually making it happen was not. "Titanium is highly biocompatible, so that part was no problem," Dr. von Elkalebeite says. "Same is true of carbon - as any school kid knows, our bodies are full of it. The issue was finding a biocompatible bonding agent that could make the fibres rigid - in the case of existing carbon fibre objects, such as bike frames, epoxy is used. However, epoxy relies on epichlorohydrin as a hardening agent and since epichlorohydrin, as an organochloride, is a toxic, carconogenic irritant it's unsuited to this application."

The source of the resin - a species of gum arabic tree
(image credit: Marco Schmidt CC BY-SA 2.5)
The solution came from an unexpected source. One of Dr. Röthy's students had grown up in rural India before winning a scholarship to study for her medical degree in Delhi before moving to Geneva to take his doctorate. He remembered that when he'd broken his leg as an infant, his grandmother had told him a story about breaking a finger when she was a child. The snapped bone was exposed by the injury and she had been taken to see an untrained "physician," what we in the West might term a medicine man, who had used a resin collected from a locally-found species of tree to literally glue the bone back together.

"I was dubious about this," says Dr. Röthy. "I mean, it does seem rather hocus-pocus, don't you think? However, the student came back to me with a copy of a document obtained for him by a family member at the University of Delhi. It confirmed that the tree, a species of gum arabic, does in fact exist. Its use in primitive medicine is known, but has not been extensively studied - though one thing that was known it that not only does it appear to be biocompatible, it also seemed to have pain- and infection-fighting qualities. We got some samples flown over as soon as we possibly could."

It soon turned out that they'd hit the jackpot. Not only did the resin from the tree have exactly the right mechanical qualities, rapidly hardening and setting the carbon fibre, molecular analysis revealed that it contained the same salicylic acid as found in willow - natural aspirin, accounting for its reported pain relieving qualities. "We never did find anything likely to help fight infection," says Dr. von Elkalebeite, "which leads us to believe there may be a fungus with similar properties to Penicillium that occurs on the tree in the wild. More importantly, though, tests could find no evidence that the resin was not 100% biocompatible."

Top: human clavicle. Bottom: Dr. von Elkalebeite's improved version.
With the technicalities out of the way, actually making the thing was a very straight-forward process. Titanium joints were fabricated to mimic the interface points of a natural clavicle; then a carbon fibre central shaft copying the shape of the clavicle was produced with the new resin. A recently retired Professional Continental cyclist who wishes to remain anonymous for fear of being banned from amateur competition was then recruited to be the first person to receive the false clavicle. "He told us that he had suffered five clavicle fractures in the past and each had given him a large amount of pain," Dr. von Elkalebeite informed us. "Because of that, he was eager to help others avoid the same injury. Also, by this time, we'd attracted a lot of attention from professional teams - making the experiment worth his while was not an issue.

Next, they had to wait for their guinea pig to have an accident - which happened just a month later when he was involved in a collision with a car during a training ride. "We had created a special cycling jersey fitted with miniaturised acceleration logger devices in the sleeves," Dr. von Elkalebeite explains. "By downloading data from these, we could establish the impact that had been transmitted through the replacement clavicle during the accident, and we found then that it had successfully absorbed and withstood an impact some six times greater than would have been necessary to causing extensive mechanical failure in a natural clavicle. Removal and microscopic study confirmed that it had suffered no damage."

The Present
Asked if any currently-active cyclists have been fitted with the artificial clavicles, Dr. von Elkalebeite explains that the procedure is at present experimental and would require approval by both governmental bodies and the Union Cycliste International. "It could be seen as offering an unfair advantage," he says, sounding as though he is reciting a speech he's been over again and again, "because a rider fitted with them would feel willing to take greater risks, confident that he or she is less likely to face missing races if an accident occurs."

He is unmistakably cagey, and steers the conversation around the issue. However, some people have wondered if he's gone further - among them, a well-known ex-rider turned team manager who says he wishes to remain anonymous until such time as he has proof to back up his allegations, giving the pseudonym Johan van Nott rather than his real name. "Anyone who knows anything about this sport knows that no team would simply hand over as much cash as we're talking about here," he claimed on his blog. "In the current economic climate and with the guys at the top of the sport demanding the sort of salaries they do, the teams just couldn't afford it. The only thing that would persuade then would be if they got something back right now - after all, many teams can't even be certain they'll still be around in a year or two, as we saw with the rapid demise of Highroad."

One thing's for certain, though - the two doctors have secured a large amount of capital from somewhere. On the same day in Autumn of 2011, they resigned from their posts at the University and, within days, registered a new company under the name La Clinique du Sport à Genève. "A couple of the guys on the team reported back to me that they heard a couple of Belgian riders talking about the Clinique a few days before Paris-Nice this year," says van Nott. "Apparently, the word around the peloton is that it's soon going to be offering the procedure to anyone with the money to pay for it. There's also a rumour that at least one rider - I'd better not say who - has already got two of the false collar bones fitted after suffering a third break in four seasons. We got hold of a load of video of his races, and it did appear that he's now taking bigger risks in the technical sections."

The future
The invention seems nothing short of miraculous and may yet prove to dramatically extend the amount of time professional cyclists can spend racing - but, as is the case with all scientific developments, it must first be approved for competition use by the UCI. As of yet, there has not been an official announcement regarding Dr. von Elkalebeite's work nor confirmation that it is even gathering evidence with a view to making one; however, spokesman Fabian Lottractio told reporters: "We are aware of the matter and will continue to monitor it. At present, we see no need to consider new regulations, but should it prove to be a precedent - perhaps ushering in a new age in which athletes can gain a competitive advantage over others through synthetic body parts, which could be construed as a form of doping - we will decide if we need to act."

They need to make that decision soon. At present, it's only rumoured that riders have undergone surgery to have the artificial device fitted, but as soon as the Clinique opens its doors riders will show an interest. "Cycling is a dangerous sport already," van Nott claims. "The last thing it needs is a peloton seeded with bionic kamkaze cyborgs throwing caution to the wind on the descents and corners with little regard for their own safety or that of riders around them."

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