broken clavicle...surgery or not?

Originally Posted by recoverydoc

Hear are a few tips for scars. I work with many professional boxers and this is what I use on them.

1. make sure the wound is well covered in triple antibiotic (bacteria create more scar tissure)
2.Once the stiches are out or staples you can use any of the scar creams that are sold.(mederma)
3. After a few weeks you can add the scar gel pads by curad or spenco second skin. They are silcone gel pads that continure to promete healing and changes in the scar.

It takes 6 months for the scar tissue to heal completely and go threw a remodel phase and if you do these few things early and often it will make a difference in appeance.

Originally Posted by cnielsen

Thank you for that very quick reply/advice! I really appreciate it.

I am off any type of anti-biotics, as I have no infections and I am just covering the scar with a sterile breatable bandage (and water proof one when showering). After the first surgery I put Bio Oil on the scar (over the counter stuff) after researching a few different scar healing products, including e-vitamin capsules and the gel pads. I never got to the gel pads, as the scar opened, but I might consider that now.

Right now I am concerned about the scar/wound healing up/not weeping than appearance, but I am sure I will focus more on that later (in fact today is over 48 hours since it last weeped, but I am reluctant to get my hopes up yet).

6 months for scar tissue to heal completely - that is great to know. I wonder if swimming in the sea/exposure to the sun and salt water/chloride is ok...beaches/pools here in Sydney are calling me. I try not to be too concerned about over-stretching it, but I sometimes find myself holding my arm in a funny position.

Thanks again!

C

Originally Posted by recoverydoc

The triple antibiotic is a cream/ointment not oral and prevents a locale infection and helps the wound heal. As long as the wound is closed your ok in the sea/sun just use the standard protection. Make sure you get proper rehab on that shoulder and its normal for it to feel funny. Best of luck

Originally Posted by matagi

Just so you know, you cannot buy triple antibiotic ointment in Australia. The closest you can get is Kenacomb ointment, but that requires a prescription.

This probably doesn't help with your immediate problem, but if you have a friend or relative travelling to the US, then get them to pick up some for you - that's what we do. It is also absolutely brilliant for road rash.

Also, if your swabs are coming up negative, then it is unlikely you have an infection - as your surgeon has suggested, it is probably due to your body reacting to the metalwork in your clavicle. This is unusual but it does happen on rare occasions.

Can I suggest you try taking Evening Primrose Oil (1000mg 2 or 3 times a day) - it might help and it shouldn't cause you any problems unless you are allergic to evening primrose.

Originally Posted by katiej

You were so right about not trying to look after myself. Thank god I had someone for a few days. My scar is a bit bigger than normal as it was quite tricky. My surgeon used the part of the bone that had tried to join as it's own graft so no extra surgery. 5 days since he op and the pain is alot less. Had a really sore throat till yesterday and sitting on my bum and pushing myself up with my left arm gave me pins and needles in my left hand. Whole area still bit swollen and numb but all improving now glad to say. Plate should come out in around 12 months time.

Originally Posted by Mediator

Congratulations on what seems to be a successful OP.
Do you happen to know what are the criteria for taking the plate out?

Originally Posted by katiej

No I don't. My surgeon believes it should. From what I've read I think it should too. Any further break could result in floating metalwork close to critical organs and nerves. Also I understand the screws can act locally as stress raisers. There's an earlier post on the subject.

My stitches have been removed day 12 and I'm sticking with the physio 3 x per day which started on day 1. Had to keep wound dry till now and for another 5 days. Physio does seem to be improving movement so worth sticking with to get back to full range of motion & avoid frozen shoulder. Back in 2 weeks for an xray.

Originally Posted by 2wheeljunky

So I just discovered this forum while doing a search about clavicle surgery.

I just couldn't resist the temptation to post since I probably have had more experience with clavicle surgery related to cycling injury than anyone here. I have had surgery for my clavicle THREE TIMES. If you are contemplating this procedure, you owe it to yourself to read this. Here’s my story…

On November 15, 2002, I ate shit over the bars while doing a series of jumps in the Santa Monica Mountains known as the Kenter Whoops, or Kenter Whoop De Doos. I was better than that mistake, but mistakes do happen and I hesitated off the lip of a fairly large jump. Came up short and went over the bars. I new something was wrong instantly. I drove myself home after some other guys helped me load my Enduro onto the top of my car. Once at home, I sat around the house in an extraordinary amount of pain for about an hour before I realized that I may actually have a significant injury that required medical attention.

X-rays at Cedars Sinai Hospital revealed a displaced fracture of the clavicle – I actually broke it in 2 places so it was in three pieces! Surgery was “necessary” - Vicodin was prescribed.

Two weeks later – the day before Thanksgiving, at UCLA Medical, I had the surgery which involved the implantation of a steel plate across the top of the bone to hold the primary fracture together. Secondarily, a rubber band was put in to hold the bone down and in place because the second break was on the bottom of the bone. This would ensure the bone would all fuse back together again.

I was told to wear a sling for 8 or more weeks, and follow up appointments were scheduled. About ten weeks later I started riding again – without the permission of my doctor.

On my fifth ride out, I was riding in Griffith Park, Los Angeles. I live near there and although it's illegal to ride a bike on the dirt there, I do it frequently.

So I am up at the top of the hill and I see this Japanese tourist. Then I see this flight of stairs made out of rail road ties right next to the Japanese guy. I had launched these stairs, and cleanly stuck the landing, SEVERAL times. Right next to the stairs is a little path that allows me to just ride around them.

I looked at the stairs...

I looked at the path...

I looked at the unassuming Japanese tourist and just couldn't resist the temptation to have a little fun and show off.

I did a point and shoot off the top of the steps and came up just a little short – which had happened before and I’d recovered. This time I must have feathered the front brake a little because the rear wheel kicked up off the bottom step and over I went. Low speed over the bars crash.

Now, this was not a very severe crash. I stood right up and wasn't cut or scraped or anything. I started to brush myself off when I noticed a sharp pain coming from my right shoulder. F@ck! I thought. I think I just re-broke the damn collarbone!

SO I got on the bike and rode angrily home.

In an unbelievable twist of sick irony, when I got home I had a message on my machine from my surgeon. His office had called to remind me of my follow up visit -THE VERY NEXT DAY!!! What are the odds of that!?

That night I realized that when I pushed on the inside of my collarbone I could now feel something inside grind and pop and shift. I was convinced I had re-fractured the bone.

So I went in the following morning to see the doctor and was forced, naturally, to tell him what happened. He was fairly displeased to say the least. We did some x-rays and they showed no sign of fracture... that was odd, I thought, because I could FEEL the damn bone moving around in there.

But you can't argue with the x-rays, I thought.

I told him I had some pain and was granted a virtually unlimited supply of Vicodin - to which I became completely dependant on over the following months. The doctor decided that, since there was no visible fracture in the x-rays, it must be the implant itself that was moving around and causing me pain. A second surgery would be necessary in order to remove the hardware and end my suffering. But we had to wait a few more months because the bone needed a little more time to heal up – according to him. I now suspect that he just wanted to see if it would stop bothering me on its own.

Three months later - now DEEP into a steady pattern of Vicodin abuse - I went under the knife again.

When I woke up the doctor was called in to see me.
He explained that although we couldn't see the fracture in the x-rays, I had been walking around with a broken clavicle for three months. Apparently, the bone had broken in a different position. What this doctor had failed to tell me was the following:

Steel implants used to mend broken bone can actually CAUSE fractures. You see, the collarbone has some natural flexibility. When you screw a rigid piece of steel to it, it no longer does and the normal capability of the bone to absorb shock by flexion is eliminated. SO what happens? The bone actually snaps at the end of the steel plate! I was, needless to say, extremely pissed!

He had just done a second fairly extensive implantation of yet another piece of hardware. YIPPEEE!! That meant that not only had I been misdiagnosed and walked around with a fracture for 3 freaking' months! I also now had another implant on my collarbone which could cause another fracture in the future!!! PLUS, I was being told I still couldn't ride a damn mountain bike for at least another 3 months, and I should maybe even resign myself to giving up the only sport I have ever truly loved!!! I wanted to kill a couple of radiologists just to watch ‘em die!!!!

So, what have we learned from this?



First off, surgical implants for displaced clavicle fractures will mend the bone, but they also provide you with a permanent weak link because of the steel plate. The collarbone is ALREADY a weak link in the human body. A shank of metal bolted to it just makes it that much weaker. The steel, and I know I am repeating myself here, can actually CAUSE FRACTURES during falls that would normally not be significant enough to break bone.



Additionally, if and when you do break the bone again due to the implant, it will DEFINITELY require surgery. This is because the bone will be broken and in there with it will be all that metal junk moving around and preventing it from EVER healing. As I experienced first hand.



SO…



I told you earlier that I had had 3 surgeries on the collarbone.

Well, I just had all the steel crap taken out four days ago. This was a completely voluntary procedure. I did this because of what I know about those implants. My new doctor tells me that once healed – it will take about 6 weeks for the screw holes in the bone to fill back in – I will be as good as I was before I ever injured the collarbone in the first place.



Yes, I could still break the bone. But it would be just like any other collarbone fracture. 90% of which do NOT require surgery.



My best advice? If your doctor thinks you may heal without surgery… let it heal naturally.



Having that metal in there forced me to hold back in my riding, snowboarding, and dirt biking for the last 3 years out of fear of hitting the ground on my right side. I knew that on any ride, all it would take was a minor crash on my right arm, an outstretched hand, or my right shoulder and I would be in hell all over again. If I had it to do again, I probably would have lived with the displaced fracture. I have since met a few guys – mostly dirt bikers – who have had bad collarbone breaks and never bothered with the surgery. They definitely have some mild deformation of the shoulder, but they move around okay.



If you do have a surgery done, just realize that you will have a weak link until you have the hardware removed. This second surgery can also be an insurance obstacle. I basically claimed the implant was causing me a lot of pain in order to get the thing covered by my insurance. They wouldn’t do the procedure just because of my lifestyle and the risk associated with leaving the implant in.

I know this was a long post, but I have never before told this whole story anywhere and figured what the hell. If it helps just one of you guys in you decision making about shoulder surgery I will be pleased.

And remember the golden rule:
“If it ain’t broke, fix it till it is!”