CREBA lauds updated land-use, zoning ordinance

(Originally published in the March 25-31, 2012 issue of the Baguio Chronicle ---

a weekly newspaper based in Baguio City, Philippines ---

by Sly L. Quintos, Associate Editor.)

THE Baguio-Benguet Chamber of Real Estate and Builders Association or CREBA said that the proposed updating of the Baguio Zoning Regulations “is welcomed as an opportunity for us, the city government together with the citizenry, to be better attuned to the times and responsive to our city’s needs”.

“We, from the housing sector are also bona fide residents of the city and we have our duty to assist in our most humble way whatever we could share for the physical and economic development of the city towards a safer and healthier environment,” the local CREBA said in a collective statement issued by its Chairman of the Board (Engr.) Tom Panis, chapter president (Engr.) Edwin Zamora, executive vice president Lorenzo Aguilar, Director (Atty.) Alexander Bangsoy, and former presidents Jane Cosalan and Felicidad Ronquillo.

The City Council’s Committee on Urban Planning, Lands and Housing recently wrapped up the consultations with various sectors on the draft updated Comprehensive Land-Use (CLUP) and Zoning Ordinance and is now finalizing its recommendations for submission to the City Development Council or CDC.

Meanwhile, Baguio City Mayor Mauricio Domogan who heads the CDC which drafted the updated CLUP and Zoning Ordinance said the CDC is very receptive of the recommendations from the different sectors consulted on the proposed updated CLUP and Zoning Ordinance. He said there are provisions in the draft that needs changes for practical reasons such as limiting the number of storeys recommended for buildings in the city.

“Our challenge is to strike an appropriate balance in our controlling laws and regulations so that our response is properly placed in terms of guarded development that will not unduly deprive other sectors of the community but would truly mirror the desires and aspirations of all citizenry,” CREBA said.

“We have to be continually mindful that we do not blunder and cause stakeholders to relocate elsewhere (just) because they find our zoning laws too oppressive,” it added. “It will  be a huge disservice if investors collectively brand Baguio as a hostile and anti-development’ under our zoning laws . . . it is on the above premise that that position paper of CREBA is presented, lest we be accused of a misunderstanding of the most basic tenets of planning and urban development.”

According to the local CREBA, the forecasted balance of housing backlog by 2020 of 13,082 units “needs and buildable space of more or less 12 hectares based on a house floor area of 70 square meters and a 30 percent provision for open spaces”.

Where do we get this large chunk of area in Baguio where almost all its areas are now occupied?

The local CREBA is proposing the following to be classified as possible housing areas: Green Valley up to Sto. Tomas’ City Limits, Irisan up to Lamtang’s City Limits, Leonila Hill, Ambiong (Baguio side), Camp 7 area (left of the Satellite Market), Tam-awan Quezon Hill, SLU Bakakeng area, Kitma Village, Chapis Village, Pucay Village, Crystal Cave area. In addition, CREBA is also suggesting to classify all areas one lot deep where the circumferential road passes (Balacbac area, Bakakeng CICM, Kadaklan, Happy Hallow, etc.) “as these areas will be the next growth areas in the city”.

The local CREBA is also proposing that the height regulations for buildings (in R3 zones) shall be increased to 12 storeys subject to the soil bearing capacities of the area. Besides, real estate values in the city has gone beyond imaginable levels that developing an area are based on the earning potentials or return of investment (ROI) by their legitimate owners and speculators alike, CREBA added. The ratio of developable areas should be based on Section 803 (Percentage of Site Occupancy) of the IRR of the National Building Code / PD 1096 which mandates a maximum buildable area of 85 percent for inside lots and 95 percent for through and corner lots located in business-mercantile, industrial and high-occupancy areas.

The group also lauded the inclusion of landscape regulations, more particularly for new buildings to include in their design adequate provision for rainwater capture for purposes of flushing, watering of plants, and cleaning.

“Lest we be misunderstood as protecting our own self-interest” the CREBA said it would like “to come up with affordable low-cost housing technologies and materials and ‘holistic’ housing designs, exploring other products and programs to reach a broader segment of the poor in need of housing assistance”.

The group said it also would like to undertake the ‘unbundling’ of the housing package or promote ‘semi-development’ to reduce the price of housing units “and make it more affordable to low-income earners”. It added it wants to develop better coordination with the different housing agencies “to adopt a more developmental and pro-poor framework to be able to reach more poor people”.

Meanwhile, Councilor Isabelo Cosalan, Jr. said the Committee on Urban Planning, Lands and Housing (which he chairs) wants to propose the inclusion of the following in the updated Comprehensive Land-Use (CLUP) and Zoning Ordinance:

·   The need to look deeper into the overall direction of the development plans. As in the ‘vision’ and repeatedly emphasized in the ‘mission, goals, strategy, and overall policies’, ecological balance through sustainable enhancement and preservation of the environment to stabilize biodiversity, takes center stage. The physical land-use plan, however, says otherwise. For the next 10 or more years, the plan would be taking away more than 119 from 566.21 hectares of vacant forested areas or more than 21 percent of the existing forest land supposed to be ‘for greening purposes’. Add this to the already occupied portions of forest / water reservations, roads and creek / river easements and the city will end up with barely a space to breathe.

·   The need to translate into clear, defined, and purposeful plan the proposed and adopted multi-nodal form of spatial development strategy where the particular field of specialization  for the particular cluster is expressly articulated to serve as investment and development guides.

·   The consideration of at last a 150year effectivity for the Baguio City Comprehensive Land-Use Plan to provide ample time for the realization of the vision-mission-goal statement.

The Committee on Urban Planning, Lands and Housing also want the adoption of the observations and recommendations forwarded by the various sectors consulted, e.g. the NEDA, the academe, the BLIST, the trade and industry, tourism, public safety and protection, social welfare services, health, infrastructure, and utilities, housing, and the indigenous people’s groups.*

Urban Planner gives piece of mind on city’s land-use plan: “We have to be continually mindful that we do not blunder and cause our city to die!”

(Originally published in the March 25-31, 2012 issue of the Baguio Chronicle ---

a weekly newspaper based in Baguio City, Philippines ---

by Sly L. Quintos, Associate Editor.)

TEMPERANCE on the matter of the Comprehensive Land Use Plan (CLUP) agenda is what we should (likewise) pursue. That we reconcile with Baguio’s ‘carrying capacity’ and the need for appropriate controls is a clearly-manifested direction in the proposal (to update it). However, the counter-direction we present is that we cannot afford to commit errors in judgement that will likely be disastrous for our city. Going way beyond the dictates of appropriateness is what we all must be wary of.

These are the futuristic words of Architect Raffy Chan as he speaks out his mind on the proposed Comprehensive Land Use Plan of Baguio City.

Chan holds a BS Architecture degree he earned from the Saint Louis University and a Degree in Urban and Regional Planning (DURP) from the University of the Philippines in Baguio and in Diliman. He also has a Master of Arts in Environmental and Habitat Planning (MAEHP) degree from SLU where he graduated magna cum laude.

He is the principal architect of R. G. Chan and Associates --- a consulting firm he established in Baguio in 1982 --- and a fellow if the United Architects of the Philippines or UAP for his contributions to the architectural profession in the field of design.

“If a simplification of our current CLUP agenda is to be made, it should centre on how we --- the public at-large --- can benefit from the proposed update (of the CLUP); on what will be the best for the city in the long run,” he said.

The City Council’s Committee on Urban Planning, Lands and Housing (chaired by Councilor Isabelo Cosalan, Jr.) recently wrapped up the consultations with various sectors on the draft updated Comprehensive Land-Use (CLUP) and Zoning Ordinance and is now finalizing its recommendations for submission to the City Development Council or CDC.

According to Chan, Baguio “has reached a saturation level in terms of development”.

“We have already gone way beyond its carrying capacity in terms of population and development is an easily-winnable proposition in any debate if you are lucky to be on the positive side of the discussion,” he said. “Our sewer systems are over-burdened, our garbage system is non-functional; all our city utility systems are badly in dire need of an upgrade; beyond a doubt, life in Baguio is becoming more challenged.”

Notwithstanding, “a reality that will not go away is that life has to go on for us who opt to stay in this city,” he said. “We have to be continually mindful that we do not blunder and cause our city to die.”

According to him, a very noticeable and distinct feature of the proposed (zoning) ordinance and its immediate predecessor is the inclusion of what can be termed as ‘strip development’.

Such ‘one lot deep’ district boundaries (e.g. along Bokawkan Road, Trancoville, Legarda Road, Lourdes Subdivision, San Roque, Camp 7, etc.), Chan said, “are oddments on the concept of segregating areas --- accepted as a norm in development planning”.

“Historically, this is known to have started with the areas along Naguilian and Legarda Roads which were the subject of the earliest applications for zoning exemptions or variances that have increased due to the predominance of the gaya-gaya impulse of the Filipino --- to imitate what his neighbour successfully started,” he said. Such areas eventually relegated as ‘commercial zones’ is “a crude response on the matter of development, with our government planners opting for the path of least resistance.”

“It seems that disallowing what was previously allowed is considered a path of trouble and does not ring true of a supposedly ‘planned’ course of action from our development framers,” he added. “What the government has given to Juan cannot be taken away from him --- afraid for it to be branded as an Indian giver.”

“As we struggle with the challenge of getting the stamp of approval from our local constituents during the public hearings for the approval of each new CLUP, the addition of these ‘commercial strips’ have become continually more pronounced and have consistently increased,” Chan lamented. “We speculate that these segments as the ‘give’ of our government planers in line with the ‘take’ in getting approval of their proposed CLUPs; to become more acceptable to those that occupy these locations; as their option to engage in their current activities is assured, their support for the CLUP update is in the bag.”

But why make an issue when many people accept such proposal?

“It is what does not immediately manifest but slowly and eventually wrecks havoc on us; as these strips eventually become more heavily-used, they metamorphose into problem strips,” Chan said. “Already, even as we talk about them, the problems are already evident in many locations.”

“Ill-equipped to respond to the demand of higher traffic volume (because the abutting road is of fixed width) and the increased demand for better utilities (water and electricity), these areas eventually exact a toll in terms of utility demand,” Chan warned. “The irony of it all is that most of the facilities thereat have rarely been sufficient to fill the initial demand that originally existed.”

Chan urged that “we put a stop to the addition of these areas into this ‘strip development’ locations”.

“The earlier we reconcile and put more appropriate controls over these potential ‘hazard strips’, the better will our planning response be in the long run,” he said. “We need to get more creative on how we can facilitate this.”

Going overboard on control?

“The imposition of a maximum height per zone as part of our CLUP is practically new; it is therefore important for all not to go overboard,” he said. “We need to strike an appropriate balance on what is practical, acceptable and realistic; on this matter alone, we are likely to chart the sustained commercial viability or doom of our city.”

Under the proposed Ordinance, 12 storeys (37.5 meters) will be allowed only if the following are met: (1) the proposed property is of sufficient size (at least 1,000 square meters); (2) buildable area will be limited to 50 percent of the total area available; and, (3) annotation in the lot-title relative to the buildable area.

“We reconcile with the initiative to put controls over our high-demand locations but we sincerely feel that there are other better and less-hostile options that can be considered,” he said.

He cited as an example a commercial property along Session Road which is or prime commercial value because of its location.

“The value of these commercial estates are at levels they currently are because of the earning potential for returns; the promise of a return of investment, particularly when measured against the maximum utilization of such properties, is what drives the value on these locations,” he said. “But against the untoward approval of the height regulation, such potential will be drastically divided by two because only half of the lot can now be built upon.”

According to him, if the desire is towards being responsive to the ‘carrying capacity’ agenda of the city and having ‘green’ buildings which are more responsive to the war against global warming, the public at-large “will be better served if technology is deployed as our means of response”.

“Options, such as ‘green roofs’ the collection and re-use of rainwater within buildings, and similar concepts can all be considered as the conditional mandates when a larger project scope is desired,” he said. “Such will also result in a mutually-beneficial exchange for a building owner, plus the chance to provide better value for the project.”

In this area, he is proposing an additional 5 percent buildable area if a ‘green roof’ is included in the building design, plus another 5 percent if rainwater is collected and re-used.

“Such prescriptive incentives will pave the way towards being more responsive to the ‘green agenda’,” he said. “The government should manifest partnering incentives through its laws where a concession is given in return for a ‘partnering initiative’ from property/development owners.”

With all other options available, Chan said he is against Section 14 (Height Regulation) of the proposed CLUP ordinance.

“If it should ever pass as proposed, it would introduce a ‘functional obsolescence’ of such magnitude on all of the prime properties in the city in one over-bearing sweep,” he prophesized. “Real estate in Baguio would never be the same again; describing the same as an overboard response, likely to cause this city to slip into the doldrums of curtailed development would not be appropriate.”*

More on safe riding

(Originally published in the March 25-31, 2012 issue of the Baguio Chronicle ---

a weekly newspaper based in Baguio City, Philippines ---

by Sly L. Quintos, Associate Editor.)

NOTHING can be more exciting and health beneficial that riding a bicycle. But it can be dangerous if certain safety precautions are disregarded. The risk of a serious brain injury or death as a result of an accident is very real, especially at the time of the accident.

Lacerations, bruises, skull fractures and traumatic brain injuries can occur if there is a blow to the head.

Head injury is perhaps the most common and the most dangerous results of a bicycle crash. Because bicyclists are usually in motion at the time of an accident or fall, significant force may be involved in these injuries. The American Association of Neurological Surgeons reports that without proper protection, a fall of as little as two feet can result in a skull fracture or other traumatic brain injury. The extent of the head injury may depend on the force of the blow. In mild cases, hitting your head during a bicycling accident might involve a brief period of unconsciousness, while serious accidents can cause permanent neurological damage or death.

Traumatic brain injuries are caused by a blow to the head that disrupts the brain's function. It can lead to temporary or permanent disabilities. It is a non-degenertative, non-congenitive injury to the brain because of an external force.

The US National Highway Traffic Safety Administration reported in 2008 that nearly 70 percent of all fatal bicycle crashes involve head injuries, but only 20 to 25 percent of bicyclists wear helmets. While it is impossible to prevent all head injuries, regular use of bicycle helmets, combined with an understanding of bicycle safety rules, can greatly reduce these injuries.

Traumatic brain injuries can cause long-term disabilities after a bicycle accident. Common disabilities include communication problems, changes in behavior or personality, depression, aggression and problems with vision, hearing or reasoning. The most common cognitive impairment among severely injured patients is memory loss, characterized by some loss of specific memories and the partial ability to form or store new ones. Problems with thinking, reasoning and memory after a head injury can make it hard for injured people to adequately perform at school or work.

The greatest deterrent to traumatic brain injury due to bicycle accidents is wearing a helmet. The use of helmets has been shown to reduce risk of head injury by as much as 85 percent and the risk of brain injury by 88 percent, reports the U.S. Consumer Product Safety Commission. Out of 99 cyclists in the emergency room with serious brain injury, only four percent were wearing helmets during the incident. 

Helmets contain a layer of crushable polystyrene that helps absorb the force of a blow to the head, reducing damage to the skin, skull and brain. The outer plastic shell allows the helmet to slide on rough road surfaces, preventing your neck from jerking or bending when you hit the ground. The safest type of helmet has a round shape with no sharp projections or pointed tails at the back. Tails on helmets can snag during a crash and knock the helmet aside, reducing its ability to protect the head. Replacing helmets that have been in an accident, even if the accident wasn't serious, is an important safety consideration. Once crushed, the polystyrene foam may no longer provide sufficient protection in future accidents.

Luckily, cyclists seem to be listening, as helmet use continues to rise. The older a cyclist is, the more likely he is to wear a helmet. When purchasing a helmet, look for a sticker that says it meets standards required by the Consumer Product Safety Commission. Choose a helmet that fits properly, and be sure to snap the buckle together under your chin.*

Local downhillers stage impressive podium finishes in Bulacan

(Originally published in the March 18 to 24, 2012 issue of the Baguio Chronicle --- a weekly newspaper based in Baguio City, Philippines --- by Sly L. Quintos, Associate Editor.)

YOUR Self-Propelled would like to extend his sincerest congratulations to the Baguio-Benguet downhill artists for their incredible podium finishes at the recently-held Bulacan Mountain Bike Downhill Race in San Jose Del Monte.

Considered the longest (literally and figuratively) and the toughest downhill race in the Philippines, it features overwhelming hairpin turns and dizzying jumps that only the iron-hearted riders can dare to fly over.

Literally, it is the longest because it extends to nearly three kilometres. Figuratively, it is also the longest because it spans two provinces --- starting from the Bulacan side, cross the border, and finishes at the Rizal Province side.

Our local downhill daredevils who showed incredible podium finishes are: under the 19 to 29 years old category (of 30 riders): JOB BAYAO (2nd Place), MARVIN BUENO (3rd Place), SEAN BANAGAO (4th Place), and VINCE DANGIAPO (14th Place).

Under the 30 to 38 years old category (of 40 riders), the following showed unbelievable downhill courage: JEFF ABALOS (8th Place), ERWIN FLORES (9TH Place), JORDAN IBIS (15th Place) and DENNIS LEE (16th Place).

-------------------------------------------------

DOWNHILL biking is a gravity-assisted time trial mountain biking competition where the riders race against the clock, usually starting at intervals of 30 seconds (seeded from slowest to fastest), on courses which typically take two to five minutes to complete. Riders are timed with equipment similar to that used in downhill skiing. The placing is determined by the fastest times to complete the course; races are often won by margins of under a second. As the name of this discipline implies, downhill races are held on steep, downhill terrain, resulting in high speed descents, and with extended air time off jumps and other obstacles. 

The 2011 Downhill World Champion is Danny Hart from the United Kingdom.

The very first downhill time-trial race took place in Fairfax, California on October 22, 1976 on a fireroad now referred to as Repack Road, due to the need to repack the single rear hub brake after a descent.

The bikes used were based on beach cruisers that had a single rear brake that worked by pedalling backwards. A mechanism came into operation causing a conical metal brake shoe to be wound on a thread into a conical metal hub. To prevent a metal to metal brake from snatching it was always filled with grease. Heavy use of the brake during the descent would cause the brake to over heat, melting the grease till it drained from the hub and required repacking. Ten riders descended 1,300 feet of Repack in about 5 minutes. 

The first bikes used for descending were known as "klunkers" or "paperboy bikes": coaster brake cruisers using balloon tires first imported to America by Ignatz Schwinn. 

By 1979, two organizers and competitors of the Repack downhill, Charlie Kelly and Gary Fisher founded the company which named the sport, MountainBikes. 

As mountain biking grew enormously during the ‘80s, downhill riders continued to use either rigid or limited suspension travel (under 2 inches) bicycles, and purpose made downhill bikes were not made until the ‘90s. Some of these innovations included dual crown suspension forks and disc brakes, as well as very elaborate frame suspension designs.

Later, riders from all disciplines of cycling began focusing on downhill. Particularly, many BMX racers made the crossover, including champions such as John Tomac (Team Tomac Bikes), and Brian Lopes. Their influence is seen in the increased difficulty of many courses, especially the big jumps and drops aspect of downhill. The coming of age for downhill biking was its inclusion at the first UCI Mountain Bike Championship held in 1990 in Durango, Colorado.

Modern downhill bikes weigh between 14 to 19 kg. and usually feature full-suspension and frame geometries that lean back farther (slacker geometry) than other mountain bikes.

As of 2006, 203 mm (8-inch) is the 'norm' for suspension travel however some commercially available big mountain freeride bikes can have over 300 mm (12-inch). Large-diameter 203–5 mm (8-inch) hydraulic disc brakes moderate speed. Downhill bikes and freeride bikes are similar but there are some slight differences. Downhill race bikes typically are much lower and have slacker head angles than freeride bikes, so that the bike is more stable at speed and in corners. Freeride bikes have a steeper geometry and a higher bottom bracket height, so that they are better for balance and maneuverability, however freeride bikes sometimes use single crown forks, which are shorter in travel length and lighter than the dual crown forks often used by downhill riders, dual crown forks usually have around 200 mm (8-inch) of travel, and single crown forks are usually around 180 mm (7 inches) maximum.

Downhill gear features body armour and full-face helmets; helmets are often rated by CE, CPSC, and ASTM standards, however rarely by DOT or Snell. Other protective gears such as a neck brace can be added to reduce the risk (by bringing the head to a controlled stop) of neck and spinal injury.

Aaron Gwin is currently the U.S' top-ranked racer on the World Cup Circuit.

In 2010, he finished his World Cup Campaign with a 4th place world ranking and a 4th place at the UCI mountain bike world championships. He races for the Yeti/Fox Racing Shox World Cup Team along with teammate Jared Graves.

The Diablo Freeride Park located in Vernon, New Jersey is a downhill facility on the East Coast of the United States. Historically they have hosted the US Open of Mountain Biking, which is the premier US gravity race. The 2010 U.S. Open had $50,000 in cash and prizes and a $7,500 purse for men's pro champion. Diablo also hosts their own series of competitions called the Gravity Series.*  

Session Road Animal Cruelty Stirs Uproar

(Originally published in the March 18-24, 2012 issue of the Baguio Chronicle ---

a weekly newspaper based in Baguio City, Philippines ---

by Sly L. Quintos, Associate Editor.)

ANIMAL rights advocates are up in arms following a broad daylight display of cruelty to animals right in the middle of Session Road last weekend.

The incident involves an unidentified person who stuffed a live dog into a sack and hanged the sack into the spare tire of his green Nissan Patrol. The snout of the dog was also tied shut with a nylon cord.

A concerned private citizen identified as Dezzy Belle was able to take a photograph of the motor vehicle as it cruised along Session Road to an unknown destination and immediately reported the incident it to the police station along Governor Pack Road.

Quickly acting on the report, police personnel Jaime Fonacier flagged down the motor vehicle to confront the driver who reasoned that he was forced to hang the dog at the tail gate of the motor vehicle because the motor vehicle is fully occupied with six passengers. He also reasoned that the dog is emitting foul odor.

Another witness who claimed to have peeked inside the motor vehicle said there are no other passengers in the motor vehicle but instead saw pots and other cooking implements which suggests that the dog in bound to be slaughtered for human consumption.

“We have to raise awareness among the people. We have to correct the wrong notion that it is only a dog. It’s not just about dogs. It’s about a living creature,” Baguio-based Ivy Buenaobra said. She is currently the Education Officer of the Animal Kingdom Foundation.

Animal Kingdom Foundation or AKF is a non-stock, non-profit animal welfare organization whose mission is to support, protect and promote welfare and the rights of animals and to eliminate the practice of illegal slaughter of dogs for human consumption and to introduce legislations or amendments in the existing animal-welfare laws of the Philippines. It is registered with the Securities and Exchange Commission and duly enlisted with the Bureau of Animal Industry’s Animal Welfare Division of the Department of Agriculture. AKF has been in the forefront of animal-welfare advocacy in the country since 2002 enforcing the Republic Act 8485-Animal Welfare Act of 1998. AKF is the local affiliate of the International Wildlife Coalition Trust (IWCT) based in the United Kingdom.

Buenaobra said AKF is set t file charges against the owner of the motor vehicle for violation of the Animal Welfare Act (RA 8485) and Administrative Order 10 of the Department of Agriculture (on transporting of animals).

The motor vehicle has been traced to be registered to a lawyer from Quezon City.

The incident also triggered outrage in the popular social network Facebook where the photograph was posted and circulated.

“Obviously not enough was done by the police; it is painfully obvious that this dog was bound for the dinner plate,” said Utah-based Filipina Maria Parsons said on Facebook. “Sadly the ignorance of the police to RA 8485 in a district that is a well known hot-bed for the dog-meat trade does not bode well for the welfare of that dog. Administrative charges should be looked at also. The police should be held accountable for not acting to enforce the law.”

“This is intolerable,” Nena Hernandez added.*

Collar Bone Fracture

(Originally published in the March 4-10, 2012 issue of the Baguio Chronicle ---

a weekly newspaper based in Baguio City, Philippines ---

by Sly L. Quintos, Associate Editor.)

THE clavicle is the most commonly broken bone in cycling crashes or accidents. It is often caused by a fall onto an outstretched upper extremity, a fall onto a shoulder, or a direct blow to the clavicle.

The immediate signs or symptoms of a collar bone fracture are: pain (particularly with upper extremity movement), swelling (often, after the swelling has subsided, the fracture can be felt through the skin), sharp pain (when any movement is made), referred pain (dull to extreme ache in and around clavicle area, including surrounding muscles) nausea, dizziness, and/or spotty vision due to extreme pain.

X-Rays are the standard method of diagnosis; however, ultrasound imaging performed in the emergency room may be equally accurate.

The standard treatment for a collar bone fracture includes: (non-operative) resting the affected extremity and supporting the arm with the use of a sling.

In older practice, a Figure-8 brace is used to immobilize and retract the shoulder, maintaining symmetric positioning to facilitate healing. More recent clinical studies have shown that the outcomes of this method were not measurably different from simple sling support, and due to the movement difficulties caused to the patient, this method has mostly lapsed.

Current practice is generally to provide a sling, and pain relief, and to allow the bone to heal itself, monitoring progress with X-rays every week or few weeks. Surgery is employed in 5 to 10 percent of cases. However, a recent study supports primary plate fixation of completely displaced mid-shaft clavicular fractures in active adult patients.

More than 90 percent of clavicle fractures are successfully healed by non-operative treatment. If the fracture is at the lateral end, the risk of non-union is greater than if the fracture was of the shaft.

Surgical treatment is also resorted to when some of the following conditions are present: comminution with separation (multiple-piece), significant foreshortening of the clavicle (indicated by shoulder forward), skin penetration (open fracture), clearly associated nervous and vascular trauma (Brachial Plexus or Supra Clavicular Nerves), non-union after several months (3 to 6 months, typically), Distal Third Fractures which interfere with normal function of the ACJ (Acriomio Clavicular Joint).

A discontinuity in the bone shape often results from a clavicular fracture, visible through the skin, if not treated with surgery. Surgical procedure will often call for an Open Reduction Internal Fixation or ORIF where an anatomically-shaped titanium or steel plate is affixed along the superior aspect of the bone via several screws.

In some cases, the plate may be removed after healing, but this is very rarely required (based on nerve interaction or tissue aggravation) and typically considered an elective procedure. Alternatively, intramedullary fixation devices (within the medullary canal) can be implanted to support the fracture during healing. These devices are implanted within the clavicle's canal to support the bone from the inside. Typical surgical complications are infection, neurological symptoms distal the incision (sometimes to the extremity), and non-union.

Healing time varies based on age, health, complexity and location of the break as well as the bone displacement. For adults, a minimum of 3 to 4 weeks of sling immobilization is normally employed to allow initial bone and soft tissue healing, teenagers require slightly less, children can often achieve the same level in two weeks.

During this period, patients may remove the sling to practice passive pendulum Range of Motion (ROM) exercises to reduce atrophy in the elbow and shoulder, but they are minimized to 15 to 20 degrees off. The immobilization is followed by a therapeutic regimen of passive exercises and later of active exercises. Full radiological union is typically achieved in 16 weeks for adult surgical patients, and shorter times are achieved by teenagers and young children. In patients who participated in prescribed physical therapy, 85 to 100 percent mobility returned in 6 to 9 months, with full strength returning in 9 to 12 months.*