broken clavicle...surgery or not? - Page 35

I wasn't given a choice, either, but that was because the orthopod didn't want to make the paralysis permanent. Now, I've got about 95-98% ROM in the affected shoulder and a monster of a lump where the four clavicle pieces were. The majority of my lost ROM is from a nasty scapula remodeling that happened at the same time.

Your about to be 50 and you've only had three fractures? Man, you haven't had enough fun in your life. Newlyish 44, I've had four score more fractures than you. You need to get busy, man.

FWIW, though, sometimes fractures ain't all they've cracked up to be.

__________________
Sex is horrid
Pain is Fun
I cut my fingers off
One by one

Hi everyone,

Sorry to resurrect an old thread, but I have some questions. I am an active 22 year old male. I fractured my left clavicle in the middle less than two weeks ago and since then have seen one orthopedic specialist who suggested that I do not get surgery, but that it was my choice. The two GPs that I have seen consider it to be a "severe fracture" and think that surgery would be the best option. I am currently being referred to another specialist for yet another opinion.

I have been researching this fracture for the past week and it seems as though surgery is the best bet. I am okay with staying low key for a few months to let it heal, but my biggest concern is the major tenting of the skin due to the nature of my fracture that I have which will never subside. It is causing a teepee type of look with one bone overlapping the other, causing very jagged tenting. I am a fairly skinny person, so am also concerned that the plate and screws would be very visible and "frankensteinish" or also protrude my skin. I am not concerned with the scar by any means. I guess by biggest question to everyone is whether or not surgeons will still do the pin method of setting the bone back to it's unfractured state. I am willing to undergo two surgeries to have hardware installed and then later removed if it is the safest option.

Please, any insight would be wonderful. You can also e-mail me. I would appreciate it very much. Thanks for reading.

No need to apologise. This thread is a unique resource for anyone who's broken their collar bone anywhere in the world, and hopefully it gets bumped indefinately.

It sounds like you could be a candidate for the pin method. If you're worried about plates sticking out and such things pinning is the way to go. Because your break is in the middle also points to pinning. Pinning can be problematic however, and doctors who do the pin can be hard to find. Please read my belated update and thread summary below for further info.

The question of whether to get surgery or not comes down to what your priorites are. For me it was bone structure and strength recovery before anything else, and it sounds like that's what you're leaning towards too. Any scars will be hidden under clothing most of the time anyway. I will point out that if you have tenting then any protrusions from plates or pins are not going to be any worse.

Surgery has it's risks but most of the ones that were put to me before my surgery were unlikely, like dying from the anesthesia, accidentally cutting arteries, damage to the working of the arm/hand, or infection of the wound (engage devil's advocate: of course the problem here is, yes it's unlikely, but if it does happen it's big-time bad). What is guaranteed is nerve damage to the skin around the wound, so be sure to ask the surgeon where they're going to cut and how much nerve damage is expected if you go ahead. Of particular concern are the nerves on the top of the shoulder; if these get damaged you won't be able to feel your clothes hanging from that shoulder, which means it will be something you will notice all the time (my situation, and it's frustrating at times). Ask your surgeon to make great efforts to minimise the cut. Even a few millimeters of skin that you can still feel is worth it. Nerves do recover but you're not guaranteed full feeling back. If you get it pinned you may be able to avoid all this because the incision is so small (?) - for sure it's a lot easier to remove a pin that plates.

Something I wrote 2 weeks after surgery (6 months ago) and never posted as I was stalled on the massive task of organising the information in this thread. It's still not all fully referenced back to post numbers (I'm up to post #158).

++++++++++

Well, after going through with the plating surgery and all it entails, and after reading this entire thread over the past few days, I would now advocate caution with regard to making your decision. Re-reading my initial post I think I was a little too gung-ho and not yet informed, and if you want to make the right decision I think being informed is by far the most important thing, at least for your own peace of mind considering there are such varied opinions on clavical breaks. I think I'll summarize what I've learnt from this thread and elsewhere, maybe it'll help.

But first, an update on my progress: I am 2 weeks post op, 4 weeks since the accident. Certainly my shoulder feels solid again, everything feels 'tight' though in that area. I can't really tell if I am symmetrical again, too much swelling and muscle reduction. I'm out of the sling at home only and using the arm a bit so it doesn't seize up - physio next week. My scar is long (maybe 6.5 inches) running vertically and a bit over the back of my shoulder. It's still raised and looks horrendous although my local GP says it's healing well. Unfortunately I've sustained some nerve damage that my surgeon told me before the op was likely. Although I never got to see my surgeon post op and ask, it does feel like a nerve has been cut and it is the worst of my pain - it feels like a red hot stabbing impliment is being pushed into a spot lower on my chest that looks on the surface to be perfectly fine. I have lost sensation or reduced sensation to all of the front shoulder and a little of the front of the upper arm. I've received no instruction on whether I'll get any feeling back.

I am satisfied surgery was the right choice for me. My thinking was body structure before body facade. I believe I really had no choice, and the advice and attitude of the doctor I saw before the op seemed to suggest the same. I did not manage to get a hold of a local shoulder spacialist. I rang 6 but they were all unavailable over the christmas period - bad timing I guess. I had to make a decision and did.


(PLEASE NOTE: I AM NOT A DOCTOR, THE FOLLOWING IS SIMPLY A SUMMARY OF POINTS RAISED IN THIS THREAD SO FAR, #NUMBERS ARE THREAD POST NUMBERS)
Broken clavical - surgery or not?
Consider:
+ No two clavical breaks are the same. One might require a radically different solution than the next. For example, single break in the middle with small displacement may require nothing more than immobilisation followed by some physiotherapy. A double break, with one break close to the arm end, and it could mean multiple surgeries spreading over years, big scars and metal hardware inserted.

+ "The biology of the clavicle is different from all of the other long bones and enables it to heal more rapidly and reliably" (http://www.sandersclinic.net/news_ar..._tdy_sept.html)
[#260]

+ Most clavical breaks are left to heal naturally. Only 2% of clavical breaks operated on.
[#500]

+ There is a growing school of thought that plating is preferable in certain circumstances that previously would have been left to heal naturally due to the likelyhood of ongoing overall body problems (eg back pain) caused by altered or loss of structure in the shoulder.
[#502]

+ Broken bones start to knit together and solidify after 14 days. 6 weeks for recovery with sling

+ Non-union or mal-union is likely in breaks in the distal 3rd (arm end of clavical) so those are usually surgery candidates

+ There is some evidence indicating some anti-inflammatories inhibit bone growth and healing (eg. Iboprofen). I was only prescribed a few days supply of Iboprofen when I left the hospital which I wondered about. Maybe this is why.

+ Smoking hinders the healing process

+ Older people heal slower than young people so maybe natural heal not as effective for them.

+ Females with big boobs may want to consider the weight this puts on the shoulder structure and go for the sturdy plate & screws option.
[#154 #180]


Your choices for repairing clavical breaks:
Natural Heal
Most common repair method. Main advantage is no need for surgery and all its risks. Expect a bump to form around the break that can be annoying, which may reduce after 10 years.
- figure 8 brace
- sling
- physio recovery longer than surgery
- risk of waiting may cause seizure atrophiy of muscles - hence pendulum exercises [#142#148#161#173]
- waiting for natural heal that doesn't occur means bone graft (#37) which is painful, or maybe they could use a needle and get some bone marrow - less painful, or there maybe enough to work with in the clavical. (waited: 6mths #29, 4mths #67, 4yrs #70, 12wks #89, 2yrs #110#236, 3mths #142#148#161#171#173, 5mths #154#180#191)
[#27 #29 #30 #32 #34 #46 #59 #60 #83 #85 #114 #115 #116 #140 #500]

Surgery - plate & screws
- Plate & screws entails a titanium plate joining the broken clavical and fixed via screws through the bone. It is the sturdiest option and the most prevalent. However it results in the biggest scar
- bones are designed to flex under stress, so adding a titanium plate or screw weakens the bone by reducing the flex. It means it will take less of a tumble than normal to rebreak the bone. My surgeon did not recommend I get the plates removed but here's an argument for removing after healing. 6 weeks for the screw holes to heal after removal. [#133] (I've been told by my doctor it's possible the holes won't completely heal).
[#33 #45 #75 #77 #96(problems) #98(problems) #97(problems) #99 #110#236 #133 #142#148#161#171#173 #145 #146#164 #447 #485 #486 #490 #494]

Surgery - pin (xray image of a pin post #294)
Pinning entails inserting a pin inside the bone along its axis. Classed as internal fixation. The scar created from this procedure is smaller than plate & screw. The pin can be removed after a few months without too much difficulty. Some doctors do not like to pin because they have less control over the break site. Pinning can be problematic, for example screwing the pin in and not realising it's poking out of the bone at the end opposite the incision. Pin is load assistive whereas plate & screw is load bearing - in other words a pin is less sturdy than plate & screw, and maybe not recommended for very active people. Distal 3rd breaks unlikely pinning candidates as you can't get a solid fix with a pin. Multiple breaks also may be difficult to pin, especially if trying for small incision.
[#35 #36 #112 #284 #294 #299 #305 #309 #316 #317 #320 #329 #367 #419]

Surgery - k-wire
The bone is fixed with wires that stick out of the skin. Classed as external fixation. Explained in post #346. Wires easily extracted. Very uncomfortable. Don't know too much about this method.
[#307 #346]

Experimental
- stem cell bone regeneration
[#322]

Complications/Surgery Risks
- nerve damage and loss of feeling around incision (likely, but nerves regrow, takes 2yrs)
- infection of the incision
- dying from the anesthesia
- accidentally cutting major arteries
- damage to the working of the arm/hand
[#24 #113]

Nerve damage
[#64 #66 #71 #393, #394, #395, #396, #466, #478]

Scars
[#63(5"scar) #64(5"scar) #75(5"scar) #173(6" scar + pic) #197]

Recovery aids
- Bone stimulator
[#331 #380 #405]

Types of breaks:
- Sawdust/shattered
[#64]
- 2 breaks
[#77 #83]
- collar bone plus other bones broken
[#65 #87]
- broke collar bone multiple times
[#133]

Diet and supplements to aid bone regeneration
Basically you need calcium, and vitamin D to help absorb the calcium, plus whatever's good for healing scars. I went with the following and got some strange looks from doctors looking at my xray after 9 weeks commenting they were amazed they couldn't see the breaks anymore:
- Low fat yoghurt (Calcium)
- Cod Liver Oil (vitamin D)
- apples (boron)
- Vitamin E Oil applied to the scar to aid healing
Healing Broken Bones
Vitamin D - Wikipedia, the free encyclopedia
[#79 #108 #117]

Thanks for the replies.

Below I have attached a copy of my x-ray that was taken the morning after the accident. Any surgical opinions would be wonderful. I am very uncomfortable with letting the fracture mend in the state that it is in mostly because I have lost all bone structure and the fracture is causing uncomfortable skin tenting.

Also, if anyone knows of any surgeons in the Greater Toronto Area (Ontario, Canada) that have experience with and practice the pin method of fixation I would really appreciate it if you could get in contact with me so I can ask my GP for a referral.

Can this be pinned?


Thanks!

Brad

I think you hit the nail on the head as far as my priorities go. As far as I'm concerned a scar is just another one to add to the collection. My deformed bone is just plain painful, uncomfortable and cause for other orthopaedic problems in the future. I'm seeing 2 more surgeons this week and am taking my time on making my decision. According to the studies I have read the surgery can be performed successfully no matter how long after the accident. The only downfall is the extra loss of muscle due to extended downtime on the arm. Thanks again for your insight, b1. Your write up is very thorough and contains a lot of useful information.

Hey guys, does anyone still read this thread? I'm having a really hard time finding a surgeon in Ontario, Canada who is willing to operate on me. I just got my second opinion today and the doctor told me that surgery is not even an option. It's been 3 weeks since I fractured my collar bone and I'm seeing little improvement. I hate to sound vain but I am concerned with the bump that will be left over if I do not get an operation. Are there cosmetic surgeons who will operate on a broken clavicle to properly align it and be less invasive with implants?

Thank you very much!

Sorry, I can't help with recommendations for a surgeon ..... but I am curious why is surgery "not even an option"? This sounds a little odd to me.

BTW, even with surgery, you will end up with a noticeable bump.

EDIT: Just saw the x-ray - if that's the current alignment of your clavicle, I'd be surprised if it unites ..... that needs surgery. (disclaimer - I'm not an orthopaedic surgeon)

That is the x-ray that was taken the day after the accident. I just got a new one taken today and it does not look very different from the original. I understand that my clavicle will never looking like it used to, but I feel like the surgery would definitely help somewhat restore it's look. You can probably guess what it looks like judging by the x-ray I posted.

Does anyone else have any input based on my xray? I feel like I would be a good candidate for surgery. It's been over 4 weeks since I broke it and it's still giving me constant pain and discomfort. Also, when I turn my head to the right I get a piercing pain at the fracture sight which shoots down to my elbow. Have I done some nerve damage? I can actually see the tendant travelling down my neck and over the fracture site, maybe it is interfering with that?

Thanks again, you've all been so helpful.

First, there shouldn't be a tendon running over the fracture. Tendons don't insert mid-shaft like that. They do very near the bone ends. You're asking a lot of questions that should be directed toward a doctor. Nerve damage? Of course it's a possibility.

What you need to do is get a second opinion. Also, anytime you don't feel a doctor is being responsive to your questions you should seek another doctor. Definitely find another orthopod. Now's not the time to be searching for a someone that will do the exact procedure you want. If you find another orthopod, and he/she says they'll fix it with plate and screws, take it. It's likely you need that fixed sooner than later. Surgeries tend to get more complicated and more painful the longer they take place after the initial injury (especially surgeries on deformities/non-unions such as yours).

As for finding the next orthopod, you can ask friends and family for recommendations. You can call an emergency room and ask who the orthopod on call is. Another is to pick an orthopedic group that covers a lot of specialties. It can be a challenge sometimes, but keep at it. When I broke virtually everything around a shoulder girdle, the alleged best shoulder guy in the city refused to see me. He said my shoulder was too high risk for him.

Good luck with your search and collarbone.

__________________
Sex is horrid
Pain is Fun
I cut my fingers off
One by one

From when I broke mine, I was told it will not really start to knit till almost 6 weeks and mine hurt for a while longer than that, 2-3 months I think, full strength not till Jan and I broke mine in August. Calcium starts building at 5-6 weeks in a soft mass than slowly hardens to bone over a few months, pins are just a "cast" placed inside to allow a quicker return to normal life, the bone will still need to time to heal.......patience.....patience.....patience.
Mine was broke it 2 places, z type pattern, I still feel a twinge once in a while still, broke last year.

If that's what you were told, you must have had a very unusual case. My clavicle was in 4 pieces and in need of surgery; however, the surgery couldn't be performed for fear of making permanent some right shoulder/arm paralysis that I had after the accident. Still, within 3-4 weeks, I was in aggressive physical therapy, and at 6 weeks the fractures had healed enough to be released from the orthopod.

Pins, plates, and screws aren't just forms of a "cast." They're intended to hold bone ends in good approximation for good, quick healing. They're used to hold grafts in place. They're used to hold bone ends in position to prevent shortening of the bone as it heals, and they're used to hold bone ends immobile in cases of slow healing or non-unions. Full strength is not only a function of how well the bone heals but also how quickly a person resumes normal activities.

__________________
Sex is horrid
Pain is Fun
I cut my fingers off
One by one

Hello guys! I found a lot if interesting facts about broken clavicles here, thanks! I broke my right one yesterday riding my bike in a crazy way, in the middle of the bone and the gap was big between the 2 ends and after the second x-ray, it had shortened but still the doctor was leaning towards surgery, an I really want to avoid surgery. It was not painful, I only felt pain when moving my arm, and even then not much. The doctor "propped" me up an said to come back on Tuesday for some further decisions. I really want to avoid surgery because I'm not keen on their technology here, I'm afraid of infection because it's summer... and I have enough time to take care if the natural healing process. Now, a day after it still does not hurt unless I move the arm to much. I'll try to post some news on Tuesday about how the visit to the doctor went. Take care! And please give me feedback on what you think of my situation if you can. Thanks!
P.S. it's my first bone fracture ever, I'm 22 and I'm a keen cyclist since...well since I was very little and I'm not going to give up cycling after this accident, just gonna enjoy it without jumping or doing crazy stuff.

Sounds like me, first bone break @ 34. My break was near the shoulder joint. First Dr said let heal, second specialist said let heal if your not too active or surgery if you want to play tennis properly again for instance, but also cleary outlined risks of surgery. I went for surgery and for me, best decission I made. My more detailed thread is somewhere within this forum, but in short I was good 6-8 weeks after surgery. Won a golf event 10 weeks after surgery, had the screws & plates removed 8 months after surgery (optional but I wanted out) collar bone a little tender for 2 weeks after screws removed but coplete recovery with full movement and scar that isn't so bad. Now over 12 months since plates removed and all good. Very gald I did not wait and see as per 1st Dr's recomendations. Good luck