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broken clavicle...surgery or not? - Page 40

post #586 of 1857

Let us know if you got the surgery and how your healing up...for me I was out of work 1 week after surgery. 

post #587 of 1857

Yeah, Matt, like most bones once you break 'em they're never the same - even if you do get an operation. As you may have seen from earlier posts in this thread I have been considering having an operation to smooth off the edge of my broken clavicle that has healed without surgery. Before going through with this I need to accept the fact that it's not going to fully restore symmetry, but I mainly want to do it to make throwing things over that shoulder more comfortable. This is something I've discussed with my surgeon who is willing to do it but I am still working up the courage to actually go through with it (not to mention find a good time where I can find some downtime). I'm posting this because I know there are people out there that are in the same boat that I am. It's worth discussing with your surgeon.

post #588 of 1857

 
In 2004 at the age of 34 in good health and with a fairly high level of fitness, I sustained
a fracture about half way down the length of my right clavicle in a cycling
fall while travelling in the north of Thailand. I was fitted with a sling to support
my arm and a figure 8 brace, which is a padded strap that fits over the shoulders,
loop under arms and crosses over the back, it lifts back shoulders and pins down the
break. It was very uncomfortable and yet gave my shoulder a feeling of support, protection
and immobility in my torso that was welcome. When I returned to Australia after having

worn the brace for 10 days I removed it and discontinued wearing it under advisement from

my GP. His comment was, 'there is no conclusive evidence to suggest that the

figure 8 brace helps or hinders healing but they are no longer used in Australia'.

 

My fracture had a slight overlap with a gap of approx. 1 to 2 cm. and the injury was visible with
a lump in the skin where the top part of the overlapping bone was raised and
a slight shortening and dropping of my right shoulder. My right shoulder
rotated in slightly but I didn’t notice any scapular winging, chances are it was winging a bit.

Upon my return to Australia the x-ray revealed that the bone had begun to knit at a

bone tag (a piece of the bone torn at the site of the fracture and still attached to the bone)
and my GP suggested the bone could heal naturally. I continued to wear the arm sling
for 6 weeks during pre-accident-planned travel to the Europe and the UK over a 3 week
period, in which time I was very active. Wooops.

 

Subsequent x-rays the following year revealed that at the site of the fracture my clavicle was
joined by ball of fibrous bone material that had not calcified. A non-union or mal-union,
not sure? The bone hinged and pivoted at the fracture in the bone when I moved my arm and
was mildly painful. The fracture appeared to remain separate in the x-rays surrounded
by a faint line indicating the ball of callous. I was told this was due to the
absence of calcium and that calcium is what you see in an x-ray… I was also told
that the x-ray showed possible evidence of damage to the newly formed bone. Double
woops. My GP suggested I register on a public health waiting list for an operation
and that this would give me more time to see if the bone would heal naturally. So I crossed
my fingers and concentrated on food and exercise with a view towards helping calcium form
in the site of the mend. Note: I read that coffee inhibits the absorption of calcium.

 

During the following year I had a full range of movement but the injury was a little
painful most of the time, even though my shoulder as a whole was quite strong and
I had gotten use to the pain – to the point that I found it difficult to
confirm that I was feeling consistent pain in my injury. Under 2 years after
the accident I could sleep on my right side without any discomfort. My
physiotherapist of the time believed I had adapted well will a full range of
movement but believed the operation could still be beneficial in the long term
considering the manual requirements of my occupation.

 

In 2006 my number came up on the public health waiting list and after consultation at the public
hospital, in the opinion of the surgeon, my x-rays showed I had enough new bone growing

on the site of the fracture to allow me to skip the hip graft operation. After then being reassigned with a replacement
doctor and the conversation we had during the consultation I considered cancelling the operation.

The replacement doctor took a more conservative approach and was not confident the benefits of the operation
would outweigh the risks and was not willing to proceed. He suggested it was
possible I had been taking it easy on my injury and wasn’t making an informed decision
and that I should know the parameters of what I was dealing with so that I could make
an informed decision. He suggested I use my shoulder to its full potential to see if
it became more painful. I did this mostly by increasing the power and speed of
my laps in the swimming pool and as a result it did become more painful and was aching most of the time.

 

I then chose to see a specialist surgeon who had performed collarbone operations a number of times.

He suggested the plate and screws was his preferred procedure rather than the pin running
the length of the bone and that I would require a bone graft from my hip after
all - in contradiction to the first surgeon i spoke with. I was warned of all the shock horror complications

as per his duty of care. After much thought, indecision and worry I decided to proceed with the specialist surgeon
in the private hospital in 2006 at a cost of $6000 AUS. Fortunately I had a accrued 2 months sick leave at my work

and my supervisor approved the time off.

 

During the op the surgeon removed all the excess fibrous bone material, attached the plate to my collarbone
with 6 screws and completed the hip bone graft to fill the gap. I am pleased to say
the operation was a great success. I returned to work in 7 weeks but keeping in mind my experience after

first having the accident I took it easy for about 16 weeks before I felt my full strength had returned.

I’ll try to post an x-ray but be warned these x-rays you see with the plate and screws look deceptively angry and I was a bit 

shocked when I first saw it.

 

To this day my collarbone and shoulder strength is great but of course it is not what it was before the break.

However it is significantly stronger than it was during the two years after the break when the bone had
not mended properly. I have a full range of movement equal to the range I had
before the break; my Osteopath tells me my shoulder and my whole body has realigned
and is now symmetrical once more (the op combined with swimming pool laps and yoga i think?);

any shoulder/neck strains from the injury and compensations I made for my right shoulder have subsided and I’ve
had only minor problems with the skin irritation from the rubbing of backpack
straps, car seatbelts etc. My right shoulder still rotates forward ever so slightly but to a much lesser degree.
The minor numbness of the skin post op. on my chest directly below the incision slowly
reduced in size and completely disappeared after roughly 18 months; the scar is
very thin and faint and the metal plate is not obvious under the skin and an observer can only see it once i have

pointed it out and they've had a feel of it (no it doesn’t set off the metal detector at the airport); plus I have a small

scar on my hip from the graft. As expected, I can’t sustain the same amount of weight or pressure directly on
the plated collarbone as I could before the break. It can still feel quite
fragile in terms of direct concentrated weight but it is hard to know if this
is more of a mental restriction or a physical one as I am still protective of
the injury and don’t want to risk any further injury. So no hard-core wrestling.

 

For the most part the plate has made my broken collarbone strong, comfortable and erased any regular pain
that I was experiencing with usage and I am very pleased I made the decision to
have the operation. I believe it was well worth the experse and I think I would be in a lot of pain in the future if I hadn't.

In recent times my only complaint regarding the injury is a sharp pinch/pain around the plated collarbone when using

a power drill above my head – not such a good practice anyway. I do a lot of manual labour that requires continuous

lifting so this is a relatively minor complaint and all other ativities that require me to use my arms above my head

pose no problem or discomfort.

 

I plan to go for an x-ray in the coming months because I am considering removing the plate. My only fear is that the

bone has not completely mended and the plate represents a portion of what is holding my collarbone

ridged. I’ll keep updating my progress if anyone is interested to know.

 

Phew. If you've got this far my best advice to anyone who has recently sustained a broken clavicle is to:

 

    
- Seek advice from a number of clavicle/bone fracture specialists. The
many variables in my story alone demonstrate that you will need a course of
action tailored to your personal situation.

   
- Take the time to rest your broken collarbone properly. My fracture gave me

minimal pain and I did not make the healing process a priority. An arm is not an

easy thing to stop using, especially when there is not a lot of pain.

      
- Provided you are not in too much pain and the bones are not too far apart, I would

do my research, plan for a calcium rich diet and light excercise and I would still wait

a period of time to see if it heals naturally. Then make a decision regarding an operation.

But this is just my personal preference.


 

I value the input from users on this site and I remember what a relief it was to find it, so I
thought I’d do my bit. As a reference, my break looks almost
identical to the photos and x-ray of the subject and I had the procedure that is shown

in this video that I saw in an earlier post in this thread:  

 

http://www.youtube.com/watch?v=ZIX9bGvA1OQ

 

It would have been helpful if this video had been posted when I was trying to make the decision.

 

I think it can be comforting and sometimes traumatic to hear of other peoples experiences but I
try to remember we are sharing our personal 'stories' and as many have said before me, the
internet should not be used as a substitute for sound advice from a medical
practitioner with experience in this area.

 

Best,

Steve



 

 



 

 



 


Edited by oste - 11/13/10 at 1:57am
post #589 of 1857

had my plate in now about 8 months had it in the day after i broke it but i really want it out!the local hospital wont do it i have been in touch with the hospital on the isle of mann who did it and he will remove it no problem just wonder if its worth all the hassle??cheers steve.....

post #590 of 1857

Hi.  Not a cyclist but a stock car racer, same mentality though!  Midshaft clavicle fracture six months (yup, six) ago, displaced by 18 mm.  Did this crashing a dirt bike (used to be a motocross racer too).  I am 48, so now race only stuff with a cage, hence the stock cars:)  Ortho recommended surgery, but I pased to try and let it heal, and to get back in the car again.

 

I was back racing in six weeks, won first race back, and have been monitoring with x-rays.   GP keeps saying a couple more months.  I now have a non-union, with not too much pain, full ROM.  I went back to the ortho at 5-1/2 months, and he took me off all lifting, and told me to keep my arm at hip height and not use for two months to see if it will join.  I have lots of fibrous tissue, but, none has calcified.

 

I have gone one month of the two, and can still feel the new "joint" moving, so I am not too hopeful it will join now, so I am seriously considering surgery.  If I do so now, I can heal in time for next race season (five months).

 

Couple of questions:

 

- does anyone hold out hope that a non-union can heal after six months?

- at what point does delayed union become non-union?

- if I get a plate and screw ORIF, I am concerned about the five point belts we use in the racecar causing pain on the plate.  They are strapped up pretty tight.

 

Great forum.  I have two daughters who jump horses competitively, so the chances that one of us may be back here again is higher than most:)

post #591 of 1857

Hello all,

 

This thread has been very helpful to me so I thought I would tell my story like so many others have.  I broke my clavicle 2.5 weeks ago on a trail close to my house.  I was as far into the trail as I could have been, and Search and Rescue had a hell of a time finding me.  My clavicle ended up being a distal third break displaced by rough 2.5 cm. 

 

My Dr. told me that I could wait 4 months, have the bone heal on it's(with certain deformity), or have surgery that week.  He said he would guess it had a 50% chance of healing by itself, but with breaks like mine, surgery is really the online option for active individuals like myself.  Being in medical sales, I was already familiar with the risks associated with internal fixation, and had already committed to being ok with surgery before I stepped into the Dr's office. 

 

I fell on Sunday, had surgery on friday at 1:00pm, and was home stuffing my face from starving myself for 18 hours by 5pm.  After having a bone displaced and sticking into soft tissue for a week, the pain from the surgery was relatively non-existent the first few days.  I went off pain medication after 2 days, and was doing my pendulum exercises 3 times daily.

 

At day 5, the pain took a turn for the worse.  I have broken more bones than anyone I have ever met, and nothing can be compared to the increasingly chronic nerve pain I felt starting on day 5.  It felt as though someone was holding a flame to my skin, right above the incision, and there was nothing I could do about it. Pain medications, ice, heat, ....nothing worked.  I stopped all exercises and the pain finally subsided after about 3 days.   I have not ready about anyone else experiencing nerve pain like this after surgery, but I thought I should mention it in case anyone else experiences it.  My Dr. said it was normal and that I should stop physical activity until it subsided.

 

I am now on day 13 of my recovery, and I can lift my arm parallel to the ground with no pain.  Any higher, and I feel the stress of the weight of my arm right where my clavicle break occurred. My pain free ROM has increased roughly 10 degrees a day.  My entire shoulder, from my upper chest to my trap, has no feeling.  I'm not too worried about this, as it is expected to grow back in a year or to. If not, cant win em all.

 

My doctor has cleared my to go back to light duty physical work  at my job starting next monday, so I feel as though the recovery is going very swiftly.  After only 17 days post surgery, I will be able to return to work at full capacity(only lightduty stuff anyways).

 

Thats my story, and thanks again to everyone who has contributed to this thread.

-TJ

post #592 of 1857
Quote:
Originally Posted by tdonne2 View Post

Hello all,

 

This thread has been very helpful to me so I thought I would tell my story like so many others have.  I broke my clavicle 2.5 weeks ago on a trail close to my house.  I was as far into the trail as I could have been, and Search and Rescue had a hell of a time finding me.  My clavicle ended up being a distal third break displaced by rough 2.5 cm. 

 

My Dr. told me that I could wait 4 months, have the bone heal on it's(with certain deformity), or have surgery that week.  He said he would guess it had a 50% chance of healing by itself, but with breaks like mine, surgery is really the online option for active individuals like myself.  Being in medical sales, I was already familiar with the risks associated with internal fixation, and had already committed to being ok with surgery before I stepped into the Dr's office. 

 

I fell on Sunday, had surgery on friday at 1:00pm, and was home stuffing my face from starving myself for 18 hours by 5pm.  After having a bone displaced and sticking into soft tissue for a week, the pain from the surgery was relatively non-existent the first few days.  I went off pain medication after 2 days, and was doing my pendulum exercises 3 times daily.

 

At day 5, the pain took a turn for the worse.  I have broken more bones than anyone I have ever met, and nothing can be compared to the increasingly chronic nerve pain I felt starting on day 5.  It felt as though someone was holding a flame to my skin, right above the incision, and there was nothing I could do about it. Pain medications, ice, heat, ....nothing worked.  I stopped all exercises and the pain finally subsided after about 3 days.   I have not ready about anyone else experiencing nerve pain like this after surgery, but I thought I should mention it in case anyone else experiences it.  My Dr. said it was normal and that I should stop physical activity until it subsided.

 

I am now on day 13 of my recovery, and I can lift my arm parallel to the ground with no pain.  Any higher, and I feel the stress of the weight of my arm right where my clavicle break occurred. My pain free ROM has increased roughly 10 degrees a day.  My entire shoulder, from my upper chest to my trap, has no feeling.  I'm not too worried about this, as it is expected to grow back in a year or to. If not, cant win em all.

 

My doctor has cleared my to go back to light duty physical work  at my job starting next monday, so I feel as though the recovery is going very swiftly.  After only 17 days post surgery, I will be able to return to work at full capacity(only lightduty stuff anyways).

 

Thats my story, and thanks again to everyone who has contributed to this thread.

-TJ



Awesome post dude, I reckon this is the worst bone any cyclist can damage nonono2.gif Good luck with your recovery!

post #593 of 1857

Thanks man I appreciate it. I definitely do not wish a broken collarbone upon anyone, thats for sure.  At first I told people its not quite as bad as some broken ribs, but i disagree now.  I forgot to mention, this is my 2nd time breaking this clavicle.  Even though the first break was not displaced, it still took about 2.5-3 months before I felt normal again.  Having gone through both healing processes before, I would have to say that surgery is definitely the way to go if you are an active individual.  Without internal fixation, you are constantly worrying about moving the bones out of alignment.  With clavicle ORIF, you have to be doing something very stupid way too soon to break your plate/back screws out(assuming you had a competent surgeon in the first place).  I'm no M.D., and keep in mind I'm only 23, but anyone active enough to belong to this site should find that the pro's of surgery for a broken clavicle far outweigh the con's.

post #594 of 1857

Name says it all.  First off let me state that I don't cycle at all.  I came across this site on google search.  I broke my clavicle last week in three places.  Xray number 1 on Monday was bad and Xray number 2 on Wednesday was much worse.  The bones had gotten farther apart as opposed to closer together.   The orthopedic surgeon put me in a tight sling that I wear 24/7... the kind you wrap around your back so you immobilize your shoulders.    My next appointment is tomorrow.  So I'm debating on whether I should get the surgery.  This is first time I've broke a bone.  I'm a female so perhaps I am self conscious in nature and I don't like the bump that is on my neck... however compared to other google pictures, it isn't as bad as others.   Question 1 - is this bump going to get larger if I don't get the surgery?

 

This is xray 2 from Wednesday - http://img89.imageshack.us/img89/9430/collarbone.jpg 

 

My dad who is a doctor told me to let the bones heal on its own.  He thinks the bump will go away when the bones fuse together.  He is not orthopedic surgeon so maybe he is not correct with that thinking.   My friend who is a doctor as well told me she feels I should get the plate inserted because she thinks it looks bad.  She tells me I may have problems later on if I don't get surgery.  She saw these pictures.  Again she is not ortho. surgeon.

 

http://img191.imageshack.us/img191/13/collarbone2.jpg 

 

http://img840.imageshack.us/img840/11/collarbone3.jpg 

 

My mom tells me the bump is not THAT noticeable and I don't need surgery.  As you can see I am getting conflicting advice and I hate it.  I'm concerned with the scar left during surgery.   Is it a large scar?  When I wear low cut shirts, I would imagine it is noticeable. 

 

Also, for those who didn't have surgery, did you have any complications after you healed?   

post #595 of 1857

Ok so it seems my first post didn't post so I will try again.   First off, let me state that I don't cycle.  I came across this site on google and saw this thread.  So last week, I broke my clavicle in three places.  Xray number 1 on Monday was bad and Xray number 2 on Wednesday was worse.  The bones had gotten farther apart as opposed to closer together.  This is xray number 2. 

 

http://img89.imageshack.us/img89/9430/collarbone.jpg 

 

The orthopedic surgeon felt on Wednesday that surgery might be a good idea but he explained some people heal fine on their own.  My concern is the bump on my shoulder now.  I am a female so perhaps I am self conscious by nature and I don't like the bump.  But compared to other pictures I've seen on google.. it is not as bad.   My dad who is a physician told me to not have the surgery and let the bones heal on their own and overtime, when bones fuse together, the bump will go away.  I know this isn't always the case.  He feels I don't need the surgery.  My mom tells me not to get the surgery because the bump is not noticeable.   My friend who is a physican tells me to get the surgery because if I let it heal naturally, I may have problems later on... and she said it looks really bad.. the bump.  So I'm getting conflicting advice.

 

These are the pics she saw:  http://img840.imageshack.us/img840/11/collarbone3.jpg   and http://img191.imageshack.us/i/collarbone2.jpg

 

Questions for you guys and girls.. 1) will the bump get larger?  I'm concerned with the surgery.   2) If I decide to go with it, how big will the scar be?  I would imagine if I wear low cut shirts, it will be noticeable.  3) Also will the plate under my skin be visible to others?  My dad says I will be able to feel the plate if I touch my skin.  Is this true?   So I'm very torn on what to do.  I hate this.  Tomorrow is my next appt with the surgeon and he will take new xrays and see how I am progressing.

 

Any advice?  Did you guys have a noticeable bump as well? 


Edited by NeedAdviceNow - 12/14/10 at 9:51am
post #596 of 1857
Quote:
Originally Posted by NeedAdviceNow View Post

 Xray number 1 on Monday was bad and Xray number 2 on Wednesday was worse.  The bones had gotten farther apart as opposed to closer together.  This is xray number 2. 

 

http://img89.imageshack.us/img89/9430/collarbone.jpg 

 

 



Ouch, those are nasty breaks! I can't offer medical advise, though i'm very interested to know how you manged to smash yourself up like this?

post #597 of 1857

To answer some of your questions, I am approaching 3 weeks post op, and my scar looks like a small line at this point. Aside from my shaved chest in that areas(haha), i dont think many people would even notice it with my shirt off.  My plate definately protrudes an extra few millimeters from my bone and is noticeable to the touch, but not from just looking at it.  I have significantly more muscle and probably fat than you though, so yours should be slightly more noticeable. 

 

In my opinion, letting the clavicle heal on its own when its displaced will compromise the integrity of the bone since it no longer has the same flexing properties.  When it heals at a different angle(out of alignment), new pressure points are created.  Aside from deformity, that would be my biggest concern.  The size of your scar is completely dependent upon your own healing abilities, and how they stitch you up.  I was just telling my girlfriend that i wont even have a cool scar to go with my story since its healing so well. 

 

My break was much more severe than yours, but I would still go through with the surgery looking back. Goodluck.

post #598 of 1857

I slipped in the bathtub and came crashing down on my right shoulder.  :(  Shower gel and water on tub floor can be a deadly weapon.  Who knew?

post #599 of 1857
Quote:
Originally Posted by NeedAdviceNow View Post

Ok so it seems my first post didn't post so I will try again.   First off, let me state that I don't cycle.  I came across this site on google and saw this thread.  So last week, I broke my clavicle in three places.  Xray number 1 on Monday was bad and Xray number 2 on Wednesday was worse.  The bones had gotten farther apart as opposed to closer together.  This is xray number 2. 

 

http://img89.imageshack.us/img89/9430/collarbone.jpg 

 

The orthopedic surgeon felt on Wednesday that surgery might be a good idea but he explained some people heal fine on their own.  My concern is the bump on my shoulder now.  I am a female so perhaps I am self conscious by nature and I don't like the bump.  But compared to other pictures I've seen on google.. it is not as bad.   My dad who is a physician told me to not have the surgery and let the bones heal on their own and overtime, when bones fuse together, the bump will go away.  I know this isn't always the case.  He feels I don't need the surgery.  My mom tells me not to get the surgery because the bump is not noticeable.   My friend who is a physican tells me to get the surgery because if I let it heal naturally, I may have problems later on... and she said it looks really bad.. the bump.  So I'm getting conflicting advice.

 

These are the pics she saw:  http://img840.imageshack.us/img840/11/collarbone3.jpg   and http://img191.imageshack.us/i/collarbone2.jpg

 

Questions for you guys and girls.. 1) will the bump get larger?  I'm concerned with the surgery.   2) If I decide to go with it, how big will the scar be?  I would imagine if I wear low cut shirts, it will be noticeable.  3) Also will the plate under my skin be visible to others?  My dad says I will be able to feel the plate if I touch my skin.  Is this true?   So I'm very torn on what to do.  I hate this.  Tomorrow is my next appt with the surgeon and he will take new xrays and see how I am progressing.

 

Any advice?  Did you guys have a noticeable bump as well? 


Hey there,

 

I'm not too sure if you have read much of the previous posts in this thread, but most of my posts would probably catch your attention. I am not a girl, and call me vain if you wish, but I was also concerned with the appearance of my broken collar bone. I am a thin man and my clavicles are very apparent, even with a t-shirt on. At the time of my break (over a year ago) I was not presented with the option of surgery. I saw 3 surgeons who all recommended not having the plate installed. One surgeon told me that if I was concerned about the bump that he could do a minimally invasive operation to smooth the jagged edge pointing up as a result of the break. I still have not gone through the procedure because I am waiting for the school year to end, but will be having this done for not only aesthetic reasons but also because it is a constant pain and discomfort for things in my every day life such as backpacks, guitar straps, heavy leather coats, seat belts, massages, hugs, hockey equipment etc. The scar will be smaller than the ORIF surgery scar would be and I will not have any hardware installed.

 

If it comes down to it and you decide to let it heal naturally, you do have options! I recommend bringing this up to your surgeon if he thinks it will heal on its own. I am not a medical professional, but judging by your x-rays I think that having the plate and screws installed may be a better option for your case, but it's impossible to tell until you give it time to try to bond. The reason I say this is because of the overlap that your break has caused. It's best to discuss everything on your mind with an orthopedic surgeon.

 

I wish you the best of luck with everything. Everyone in this thread can sympathize with each other. As stated by someone earlier, I would NEVER wish this injury upon anyone! It's a life long injury that will stay with your for the rest of your life whether it be pain and discomfort or just seeing it in the mirror every morning! :(

post #600 of 1857
Quote:
Originally Posted by NeedAdviceNow View Post

I slipped in the bathtub and came crashing down on my right shoulder.  :(  Shower gel and water on tub floor can be a deadly weapon.  Who knew?



Damn, bathrooms can be dangerous places. About 10 years ago, a guy I used to know slipped on the wet tile floor and died from hitting his head on them. We've been paranoid about keeping a dry bathroom floor ever since. frown.gif

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