broken clavicle...surgery or not?

hi i wonder if some one can give me some advice.

i broke my collarbone about 5 weeks ago and have been back to the fracture clinic for three follow up appointments for xrays etc.

the first time i went the doctor told me that the bone was overlapping and to come back in 2 weeks to see how its doing..i was offered surgery (i think) by the doctor (he was mumbling.. alot) to which i replied that as long as it works fine and i am not too disfigured then i dont really mind.

i went back two weeks later and was told that the bone was still overlapping and to come back again in another 2 weeks to see how its getting on.

i went back again and was told that the bone still had a gap of about 1.5cm but was starting to close and the bone was starting to fuse. when i asked about surgery the doctor asked if i would do it...i said the same as before-as long as i have full mobility when its healed and as long as im not to deformed etc.

she went to her "boss" in the clinic to ask his opinion and he said to have me back again in around 3 weeks to see how it looks again.

i swim alot and have a physical job that requires full mobilty (which i need to get back to asap).

i have read up about this type of injury and there is alot of people who say that getting the surgery is the better option as the healing process is faster,you can return to light activities is around a week and your mobility will be alot better.

can request the surgery now? if so who do i ask?

the bone is protruding quite signifigantly and i am still very uncomfortable.

i dont want to be pushy with the doctors but i really dont want to go back in 3 weeks only to be told i need surgery and have to take more time off but at the same time i dont want to be stuck with a shoulder that doesnt give me the movement i need if i dont get the surgery.
any advice would be greatly appreciated.

thanks for your time in advance

rory

ps im 26 if that makes any difference

 

Hello Rory (and others considering surgery)

I am a 27 year old female and fractured the mid-shaft of my left clavicle 2 weeks ago. It was displaced and had an overlap of about 2 cm, so I was given the option of 'open reduction internal fixation' surgery by the NHS doctor. I was told the risks of not having the operation - non-union, malunion, longer time for healing etc. I read the research and decided to have the operation - 2 days ago now. So perhaps I can offer some advice on that side of things.

The operation apparently went well, and I now have a plate and 6 pins holding the clavicle in place. My posture feels normal again, the pain in the back of my shoulder blade from the dropping shoulder has gone and it feels pretty strong already. However, the experience of the operation was pretty horrible. It involves a general anaesthetic that 2 days later I still feel sick from, I have a large wound (about 4 inches), it's very sore and I have to wear a sling. I also had to spend a full day in the hospital ward (fortunately the doctors let me go home for the night).

Perhaps in a week or so I will notice the results more and feel more positive about the operation but I would advise you think carefully about whether to go through with it.

I found the following reading useful for making my decision:

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijos/vol5n1/clavicle.xml

Robinson CM, Court-Brown CM, McQueen MM, et al; Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004 Jul;86-A(7):1359-65. [abstract]

Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007 Jan;89(1):1-10. [abstract]

Rory - As you are unable to work without full mobility of the shoulder, it sounds like surgery may be the best option. You need to make it clear to the doctors what your priorities are. Have you spoken to a consultant surgeon? They would be able to offer the best advice and arrange the operation. At the end of the day, it's your decision and your future, so don't worry about being pushy!

Hope this helps.

Sophie

 

Hey Rory and other newbie’s, here is the video again.

Please take the time to watch it.

If you cannot not make up your mind, go to another doctor and get a second opinion. We all know that it's a hassle to go to other doctors, so find another one in your network, make the appointment, sit down in the office and fill out the insurance forms and pay your little co-pay.

Of course being new patient this new doctor might rush you out (typical) or, he might give you some excellent advice.

Try and find one that’s in with a bunch of other orthopedics specialists like I did. I was lucky, I am a cyclist, I race part time. In that group of Orthopedics that I stumble up on in was an Orthopedic surgeon that was a semi pro cyclist, and that’s all he did was repair other cyclist color bones and shoulders.

He used the best stuff on me. And he has seen and repaired ever kind of clavicle collar bone break.

My collar bone was broke in 3 pieces. There was no question about getting it plated.



But again look at the video link below. Good luck.


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

 

No one broke their clavicle since march of this year?

 

If nobody has, then that is great news, is it not?

This thread is a great resource. A quick *bump* will be enough to get it to the top of the pile again.

 

Broke my clavicle 1 week ago in bicycle vs car accident, me on the bike...and under the car.

Went in for week-after check at fracture clinic and found out it's broken in two places with 2cm gap between one of the breaks that doc said may form a 'fibrous' union. They looked at it and basically didn't really give me a choice - 'we'll plate that' doc says looking at me for my reply, me uncertain, 'oookay'. doc walks out of room and his understudy fixes up the paperwork. My surgery is next week.

What's all this talk of choice, and healing naturally? My impression is that if there's a separation in the bone get it pinned/plated/whatever.

Having to wait a week for the fracture clinic appointment was annoying. My surgery will be two weeks after accident. Does anyone think the delay will be a problem?

FYI: Left clavical. Left arm fully operational but can't salute Hitler. Broken clavical protrudes under skin and is annoying.

Edit:
Better just clarify that the break with the 2cm gap is near the shoulder end, with other break in the middle. Looks like end breaks are more likely to be plated? Maybe that's why there wasn't much discussion of natural heal.

Might see if I can get an appointment with another doctor see what they say. So far all advice has come from Royal Brisbane Hospital here in Brisbane. Biggest hospital in this city of 4 million so I figure they gotta know what they're doing.

 

I broke mine Aug 22nd, ran over a dog Killed the dog but went down hard. Bone was broke mid-shoulder with a 1 inch chunk overlapping both ends almost a "Z" shape.
I was on my trainer at 10 days, at 2 weeks doc let me ride outside working my way up in mileage. 15 miles to start then more as I was comfortable. At 8 weeks I rode back to back 60 miles days(and was sore as hell). By 3 months, Nov 22nd I rode the Tour De Tucson race 109 miles in 5 hr 16 minutes and last week was back on my MTB for our weekly night rides. I am still getting my courage back up, riding at night plus back on the MTB after 3 months

Very little loss of movement or range, left arm was week from no lifting for 3 months but I am doing yoga strength for that, light weight work as well. Painfull as hell for the first several weeks, sleeping was the worst, every time you roll over you wake up. Now, I will aim to kill when I see a dog

 

It's been 14 months since i broke my clv in 3 pieces. got the ti plate. went through pt and all that stuff. i took my time getting back on the bike and riding in the club. i started to peak later in august and sept.of this year. anyway, it's best to get the plate. i dont even feel mine now. i lsft weight and push up and ride over 100 miles on the weekend on my road bike with fast guys. avg speed is 22-23 mph. Also I had to wait a whole week before i got sugery and the bone was sticking up like a little tent. i promise you, you will be ok once the surgery is over and you let your body handle the healing. just dont do nothing stupid like trying to ride real far to soon or lift heavy weights. let me know if youneed further details. gotta run

 

An update to those that have read my previous posts way back on page 24.

It’s now been almost a year and 1/2 since the surgery, and all is looking good.

The numbness has gone away, the strength has returned, the only lasting effects are little divot and a little bump, and I can not throw a ball as far as I could in the past...that however, could be an age thing as I approach 40.


I still see little on the single screw/pin method, which surprises me as I needed no rehab/physical therapy and have 99% of the motion of the other arm.



Overall, in my opinion, in my case the surgery was a positive.



Steve

 

I wasn't even given the option -- surgery was required, as the collarbone was in 6 pieces. Now I have a stainless plate and 8 screws, anchoring a collarbone to an arthritic shoulder that is so deteriorated, it looks like a separation in x-rays. Does 'come loose' repeatedly....

Most of the mobility is back, after 4 months; can't scratch the back of my left shoulder (R c-bone was broken), and lifting is compromised, but I'm back riding, and that's the biggest thing. I can still work, I can still ride; I just can't wrestle my little nephew anymore (stout little snot!).

Never broke a bone before I turned 40; now, a week short of 50, I have three (each wrist, too, at separate times over the last 6 years).

 

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.

 

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_archive/2006/bmx_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?
View attachment 10662

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.