broken clavicle...surgery or not?

Grammarsow

Sorry katiej2, Thanks for that - I didn't really fully explain - I read all of the previous threads as best I could - I've seen NHS Ortho surgeon and my own private surgeon - they have both said they would have operated if I'd have seen them straight away (not possible cause in the states) now they are not keen to operate (time elapsed, calcification started but still movement, so may be a non union) but it's still up to me! lump discomfort - lots of reasons not to i.e. large cut, through nerves, pin and plate, artery to arm, all the warnings etc- The reason being is the bone 'tenting' and uncomfortable when wearing a seat belt or a rucksack - hence Marathon D'Sable reference - I was wondering without surgery did people get a full range of movement back - I NEED TO SWIM (and swim fast) and no pain, did the 'bump' get smaller?

At the mo still can't sleep on that side, 'bump' painful, aches and sometimes 'stings' - neck and between shoulder blades really stiff - is this normal recovery? and no strength! HELP!!!

katiej2

There's a few posts about surgery and how things have been complicated. I have no medical background only experience. It's not somethiing to take lightly you're quite right, I was scared but then I'm a girl .

As I said my NHS ortho said I was fine. My surgeon was private. He had no concerns (none that he mentioned to me any way) about operating at 20 weeks. He infact operated successfully on a friend of someone I know 2 years after. Call me a cynical but operating costs the taxpayer and if they think you can do without would they push for it?. I wanted to continue all my physical activites and leaving it as it was I could function but no where near what was acceptable for me. Had I been 60 then maybe it would be a different answer.

Range of motion takes time and 6 weeks isn't that long. My range of motion continued to improve. It was probably 12 + weeks before I could sleep on it and also wear a seatbelt. I put a scarf as padding under the seatbelt.
It's far worse now post surgery at the same stage as the shoulder has been more immobilised but I started exercises the day after the op. I've just started (5 weeks after) to increase range and its improving so long term I don't see a problem. Must must do the physio exercises religeously.

My sugeon kept putting me off surgery until after xrays at 12 weeks whilst it had joined, it wasn't doing it properly so I had relative movement.

All the risks are present and you need a good surgeon. The end of my scar got slightly infected and the area is slightly numb but speak to people who've had lumps removed and babies by the knife and they'll tell you the same and it's common. Neither bother me.

I'd virtually got full range of motion back before I went for the op.
The lump was the end of the bone sticking out as it was a malunion. I was told that it wouldn't get smaller, well not for a decade or so. I think if it heals more overlapping the calcified part will remodel itself over 12-18 months.

Again only my thoughts as an injured party but even if you have full range of motion, if you don't have a solid join you won't regain strength (actually surgeon said that) and it will give you pain swimming. My physio said explicity don't swim as it will aggravate the area. Infact I went swimming at about 17 weeks still with relative movement and I couldn't lower my body in (no strength/pain) and couldn't swim so I did a half doggy paddle. Even doing just that I knew about it the next day.

When is the race? Now that it's been left you could wait another 6 weeks and see if it improves. If you only did it 6 weeks ago it's still quite new. The other thing on my mind is both said they would have operated.

I used to go to the gym 4 times a weeks and do weights. Haven't been able to do upperbody since accident in June so it'll have taken about 12 months for me to fix start to finish.

Problem is we all heal differently. My surgeon gave me 12 weeks. I went to him after 8 and as it was trying to heal he adopted the wait and see. At 12 weeks he was fairly convinced but gave it another 4 to be 100% sure. It's a pain waiting but since most collar bones do heal naturally they don't want to be plating people needlessly.

I'd get another opinion but if you're paying for the consultation and xrays yourself be mindful they might want you to come back at 12 or 16 weeks.
Again I'm happy to refer you to mine who's a trauma specialist and knows his stuff.

PS I'm also katiej and katiej1, had some problems with login.

jp91

hey, thanks for your input! i think it deal heal properly the first time around bc i regained complete mobility and probably almost 100% strength. (no union problems) i played the last match of the season last june, then started this season normally. however, it is true that i still had little pains from time to time in the collarbone area, especially when i would fall on that shoulder, which probably was not normal. but as i mentioned, the fact that it's now displaced means that it doesn't handle shock absorption as well. last week i had xrays, echographs and scans done and the radiologist gave me a good prognostic--hypervascularization so the bone is healing well on its own. my orthopedist (who is from INSEP, a nat'l sports medicine institute in france) and i went over the results and i told her that i would not get the surgery. i would stop rugby completely this year and start up again next season and if EVER it broke a third time (knock on wood!!!), THEN i would get the surgery. she seemed disappointed about not doing able to do the surgery but i think she was ok with my decision.

i told her about my concerns and she said, in case of operation, i would be in a sling for 6 weeks but more to prevent making large movements and that i would be able to type soon afterwards. it's true that the shoulder doesn't move that much when typing. plus that the pain is less severe than broken pain. what's your opinion on that? bc the first week of my first fracture i just wanted to die from the pain. plus i live alone so that didn't help either. were you able to dress and undress without too much trouble, like being to put your arm in sleeves?

besides updating everyone on my case, i guess i am writing because i keep wondering if i should just get the operation; after all as someone pointed out, i'll be losing this rugby season, might as well use it recovering from surgery...; plus since there is good blood flow, the bone graft may not be necessary after all... help!!!

jp91

it depends on the severity of the fracture. mine was broken completely in two and the two parts were no longer in contact and i was told that it would just heal on its own. i did wear a sling for 3 weeks and a figure of eight for 3 weeks. it is incredibly uncomfortable bc you need to wear it all the time (i took it off to shower and dress, but i'm not sure that was allowed). but it does help to support your shoulders and keep them back so that the collarbone heals as straight as possible. best bet would be to see an orthopedic surgeon or even two!

jp91

btw, my surgeon said the incision would be 5-6 centimeters, half the size of yours.
did you use any of the scar diminishing creams? i've used mederma for other little rugby-related scars and it works really well. plus someone else mentioned some curad scar pads. i didn't take a look at where you're writing from, but i believe these are only available in the US.

Negina

Dear All,

I had surgery and a plate - some of you may remember my earlier posts.

My plate moved after a minor movement a few days after surgery.

It turned out afterwards, when I got a second opinion, that the screws were too short. Therefore, it's important to work with a surgeon of experience, who knows what he is doing.

I had a second operation to remove the plate since it was moving up and was going to break through my skin. Looked a bit scary - something out of a horror movie ;-))

The surgeon removed the offending plate and also inserted a calcium thingy into the bone which calcium thingy was filled with my own concentrated blood drawn during the operation. This helps the healing process.

Since that second operation, it was all uphill - return to full range of movement, no more pain, etc. Scar is a bit sensitive but it doesn't matter and it almost doesn't show in my wedding pictures even though a wore a strapless dress...

So, good ending - I am sure all of you will have it!

I would like to thank you all for the great info and support throughout this miserable experience - this forum has meant more than I can say!

I wish you a very Merry Christmas, quick and painless recovery and a happy life in 2007 and way beyond!

Kind regards,
Negina

katiej2

My op was 6 weeks yesterday. Been leaving sling off at home for last week but wearing it outside the house. If nothing else it makes people more aware you have something wrong. Unfortunately I tripped and fell onto my hands and knees yesterday so now it's all sore. Hopefully not done any damage.

For typing I tend to hold the bad hand in the same place and move the other hand around. Your just working the muscles if you move it more so might get aches and pains, best thing is listen to your body. Like you say you're not moving the joint.

Problem is if you don't move the joint at all. I was doing pendulums and stretches and scapula setting from day 1. Got back all neck movement after 4 weeks. Arm is no where near as mobile as without op. At 4 1/2 weeks my physio said if I left it another 2-4 weeks it would be solid. My surgeon said I couldn't raise my elbow. Physio advised lie on back and assisted raise the bad arm as if taking behind head. Can just get just past vertical at moment but it's improving. Main thing is need to allow 6 weeks for screw to consolidate in bone so moving the joint stresses the screws so you risk causing it to come loose.

I live alone and someone else on here advised me get someone to stop or get a motel. I agree. I got a relative to stop with me for a week. You just can't do things. You have a scar to protect so don't want it to be wet so practicality is I got soemone to wash my hair. You're so stiff it's difficult to wash and move properly. Still can't get behind my left shoulder. After a week you can cope. But it's easier if you don't have to. I also filled the freezer with microwave meals and shopped up for a couple of months on the basics as again you can't carry alot.

My fracture pain was really bad for about 3 weeks first time round. One week after the op and it was ok. Couple of weeks after almost feels like you're fine. I wore XL shirts for first couple of weeks then into my normal shirts. Less painful than last time. Only just started wearing stretchy t-shirts as still not meant to lift shoulder. Problem is getting them off without use of extra hand but can be done.

I couldn't lie flat without pain for first 4 weeks. Now it's no problem and I can lie on opposite shoulder ok. Had to prop myself up in bed with about 8 pillows and gradually used less and less till I could lie normally. Awkward sitting up from lying initially. If you had something to pull yourself up from like in hospital be easier. Still alot easier than when it's not plated.

Biggest pain is not driving. Been 6 weeks and at least two more. I have someone who irons and cleans for me to help me out, that's a godsend. it is tough being on your own.

Other peoples experiences differ. Someone on here was in the gym after a week. Having started this in June and now being Dec I don't want to do anything to set it back.

If it doesn't heal properly this time you'll be out next season.

Regards pain after it's healed couple of people I know have had twinges for ages after and it took someone about 8 months to get mobility and strength back though he didn't see a physio.

katiej2

ps I also have posts as katiej and katiej1

jlo29

This is pretty much exactly what happened to me! Im a 19year Australian Rules player and iv broken my collarbone 3 times. Once in 2003 and twice this year. About April this year I broke my left collarbone and it was pretty angulated, like you could see/feel the massive bump. I went and saw a surgeon/doctors and they pretty much said I would be right to play. So i took 10 weeks off, and in my second game back I broke the same collarbone from probably the weakest hit you will ever see.

So I got the surgery you were talking about, the plate/screws and the bone graft from the hip. I would definately reccomend the surgery. Playing a pretty high contact sport and havin broken your collarbone a couple of times I found it mentally good to try something different than just wearing a sling. I kind of didnt trust that option any more.

The surgery will make the bone hurt a lot less than when its in the sling, because the bone wont be moving around so much as its in a fixed state. The hip actually hurts a lot more than the collarbone. I found sleeping it would just kind of give a sharp pain for about the first 2 weeks but nothing to bad. The only problem i have found is that the shoulder feels really odd for a long time. Becuase to get to the collarbone they have to cut through nerves and they take time to heal. Its numb for the first few weeks and then kind of feels odd to touch after that but I havnt found that to be a major problem.

So basically my advice is surgery is the go, but thats just my un-proffesional opinion. If you have any more questions ask away

wolfman113

HEY JAMES I BROKE MY CLAVICLE BACK ON MAY 25 AND WENT 6MONTHS IN CONSTANT PAIN BEFORE I HAD TO HAVE SURGERY ON IT... I REALLY DIDNT HAVE ANY OPTIONS OF SURGERY OR NOT . I BROKE IT PRETTY BAD. BUT IF YOU HAVE A CHOICE I WOULD NOT HAVE THE SURGERY DONE????I HAD A TITANIUM PLATE AND 6 SCREWS PUT IN MY SHOULDER AND HAVE A LOT OF PROBLEMS WITH IT I AM NO STRANGER TO BROKEN BONES BROKE MY TIBIA BACK IN 1988 HAD A FIXATER AND ROD IN MY LEG FOR 2PLUS YEARS/ I AM NOT A FAN OF ANY SURGERY THERE ARE TOO MANY RISKS INVOLVED. IF YOUR BREAK IS NOT TOO BAD LET IT HESL ON ITS OWN MY FRIEND. YOU REALLY DONT WANT TO BE WHERE I AM AT...........

oste

Jan 2007

Ok, below is my story posted on page 8, and even though none of u cripples replied to me i went ahead with the surgery and i feel fantastic.



i chose not to go through public health even though my number came up (after two years) and instead I paid a specialist with numerous collar bone ops under his belt to perform the op. Had the plate with six screws and the hip bone graft. Recovery was fine, much less painful than i expected and took a little longer than expected before i was completely healed - back to work in 8 weeks back to 'normal' in 16. I have a full range of movement and most of my strength back - it is way way better than the two years with a non union. My shoulder appeared slightly tucked in before and after the op my shoulders a symmetrical again - vain I know but my research leads to believe body alignment aids good health. All the pain is gone even when i swim and play hard, and the scars are minor. The only obstacle now is a minor muscle strain from shoulder down to my upper arm, but then maybe I shouldnt do so many pushups.

i still gained more info from this site that any other research or avenue, including my specialist!



Good luck and good health

Steve





March 2006

I would be interested to hear if any one else has sustained a non-union type of bone knit?
Sorry bout the long email but it is a 2 year story...
I broke my right collarbone at 33yo in a cycling fall in 2004 while in the north of Thailand. The fractured bone knitted at a bone tag in the break and I continued to wear the sling for 6 weeks. The Doctors tell me the fracture in my clavicle is joined by callous/fibrous bone material that has not calcified. Once the bone knitted my right collarbone has hinged and pivoted, the fractured bone is still separate in the x-rays (1 cm) and slightly over lapping at the join, maybe .5 -1cm. I also managed to break/crack the new forming bone in the first month without realizing until a subsequent x-ray in 2004.
While registered on a public health waiting list I would cross my fingers and work with food and exercise towards helping calcium form in the callous. It didn’t well not enough, which I am told is unusual and my doctor cant offer any examples of this type of union or how it will age. If I pause and think about it, it is a little painful most of the time even though my shoulder as a whole is quite strong. I earn a living working manually and have a full range of movement. I do feel pain in the fracture when lifting weight directly in front of me with arms out stretched. Fortunately, after 2 years I can now sleep on my right side.
My physiotherapist believes I have adapted well will a full range of movement and believes the operation may be beneficial in the long term.
My number has come up! After two consultations viewing my recent x-rays I have enough excess bone around that will allow me to skip the hip graft operation. Good news I believe.
Now, after seeing a replacement doctor I am considering giving the operation a miss. The doctor assigned to me is not confident the benefits will out weigh the risks. I am taking a month to think about it, get a second opinion and do a bit of research - the reason I am here…
Would appreciate hearing about any similar cases?

Good luck and good health

Steve

clavicolarotta

I joined this club on Dec 29, 2006 when I had a really nasty crash at a pretty high rate of speed landing on my shoulder and head. BTW, my helmet probably saved my life.

I was taken to a nearby hospital and x-rayed. The ER doctor confirmed what I know instantly upon hitting the ground, broken clavicle.

He told me that the usual treatment is six weeks in a sling. They sent me on my way with some percoset and told me to make an appt with an orthopaedist. Being the holidays, I couldn't get an appt for a week.

When I did finally get in to see my orthopaedist, who is a great surgeon BTW, he took one look at my x-ray and he said "Argh! You need surgery immediately." I had not seen my x-ray in the hospital and, quite frankly, what do I know abour reading x-rays. But even my 2 y.o. daughter would be able to read these x-rays. There was a huge gap between the bones. The doctor said they would never rejoin. The break was just too bad. After the surgery, he told my wife it was one of the worst collarbone breaks he'd ever scene.

I had the surgery two days later and I am glad I did. I could feel the bone moving around before the surgery and it was freaking me out.

The surgery went very well according to the doctor, but I have to say the post-op pain has been pretty bad, much worse than the surgery I had in my other shoulder to repair torn ligaments. but in the long run, it was the right thing to do. I wouldn't have had full use of my arm with the bones broken as they were. I lead an active lifestyle and it would have been an endless source of frustration for me.

I can't wait until I get my arm out of this sling and can start riding again.

SpyroMike

Do you think this needs surgery?

clavicolarotta

I think the best judge of whether or not you need surgery is an orthopedic surgeon.

But your x-ray looks almost as bad as mine did. I wouldn't be surprisedif you require the surgery.

Best of luck to you. I am now nearly two weeks past surgery. I am glad I did it, but it feels rather weird right now. I feel a sort of of pulling or tearing near the site of the incision.

Still haven't had a proper night's sleep since this happened.