broken clavicle...surgery or not?

[clavicolarotta]

I would find myself a new doctor.

The gap between my bones was greater than yours and my doctor told me that they would never realign and that basically I wouldn't have full use of my right arm, which is my dominant arm.

I wouldn't let it go too long. There was a 10 day delay between the break and my orthpedic consultation. He operated on me 2 days later. he said the longer i waited the warse it would be.

Can you find another specialist?

 

[SpyroMike]

Does anyone know a good orth. in Las Vegas, nv., thats willing to see an uninsured cash customer? Im uninsured, but need to find someone who care about a persons injury just a lil bit, all I want is an opinion to see if I need surgery or not, calling all the orthopedics in town, noone will see me since I'm a cash customer, wow, the medical program in this country is just ******, im very frustrated, all I want is to heal correctly, and this bone still pushing up on my skin tells me no, im not!

 

[scotty_b]

Whilst on the subject, can anyone provide a professional view on this one, which happened to me two weeks ago when my front tyre exploded.
I see the consultant next week and want to go into the appointment with as much info as possible. Personally I find it difficult to see how the two bits will get back together on their own (The large sliver of bone has a tendon attached to it, which I assume is pretty important to the stability of the shoulder). Any thoughts will be welcomed...

 

[SpyroMike]

Whilst on the subject, can anyone provide a professional view on this one, which happened to me two weeks ago when my front tyre exploded.
I see the consultant next week and want to go into the appointment with as much info as possible. Personally I find it difficult to see how the two bits will get back together on their own (The large sliver of bone has a tendon attached to it, which I assume is pretty important to the stability of the shoulder). Any thoughts will be welcomed...

This is what I can tell you buddy, this type of injury for #1 sucks, I feel for you, Im one month into it.
I pray to god that for starters you have insurance! My break does not have a tendon attached, but you can see mine is very similar!
Myfirst doctor was a piece of sh**, pardon my french, #1 is finding a good doctor Scotty is it, my name is Steve.
My first doctor said surgery was not necessary, which was a bunch of bullcrap! Second doctor and my new doctor says surgery is definitely an option, and for a 100% sure heal, surgery is necessary. Also he stated is was entirely up to me, surgery, or the "caveman" style heal as I chose to go through, takes 18 weeks to heal, and there will always be a lump on my shoulder, andwhat happens 96% of the time is bone grows inbetween the breaks, and that is your heal, with the bone never going straight back into place. There is the possibility 2-4%, that this will grow back in a non-union fashion, where in 6 months down the road, if cartilage grows between the bones, I need surgery regardless.
I dont know why this just went to this typeof letters, but if you are close to Las Vegas, I'd see Dr Lee at desert orthopedics.
If you have insurance, GET THE SURGERY!!
You'll heal much faster, and its 100%, and youll be closer to 100% usage of your arm after a year or so where as ill be lucky to get back to 80% after 1-2 years. Or if you dont have insurance, and have means to come accross 3600 or are just that fortunate, Dr Lee made me that offer, which is 50%, but cash required up front just makes it unfeasible for me.

I wish you well, and the only way i have slept over 4 hours was to pop 2-3 pain pills before bed. Be carefull, anymore could result in od, and that would not be good for the situation. Im taking generics, so if you have brand name loritab or percoset, i wouldnt risk taking more than 2. I am not a doctor, am just relating what ive gone through, what I've experienced through this, hope it helps out Scott, best of luck to you,

Steven

 

[Outdors1]

Whilst on the subject, can anyone provide a professional view on this one, which happened to me two weeks ago when my front tyre exploded.
I see the consultant next week and want to go into the appointment with as much info as possible. Personally I find it difficult to see how the two bits will get back together on their own (The large sliver of bone has a tendon attached to it, which I assume is pretty important to the stability of the shoulder). Any thoughts will be welcomed...

I have been searching this thread for someone with the same kind of break and it seems you have it! I too have a piece of bone that was pulled down by tendons that are still connected in addition to a midclavicular fracture. My original ER doc and Sports med doctor had me do the sling and wait and then I ws sent to a shoulder specialist who said drink milk and wait. In November they decided 8 weeks was enough waiting since it happened Sept. 4th and nothing has grown into the space. They started me on the new sonic frequency machine every night that stimulates the bone to grow faster, but it does not appear to be working for me. I still suggest asking about it though, because it can't hurt and does work 80% of the time. Here's a link to an Heath and Human Services article on it.

http://www.cms.hhs.gov/determinationprocess/downloads/id29TA.pdf

They tell me that if it doesn't work they will have to take a tendon out of my hamstring and make afigure 8 to tie the piece back up to my shoulder/clavicle. To say the least, I'm praying the machine works.

Keep me posted on what you find out.

Tim

 

[scotty_b]

Thanks for the response Tim (and too to Steven (SpyroMike) for his). It's quite scary stuff. I've gone through different levels of optimism, from the initial "oh good it's only a collar bone break, they heal easily" through to my current thoughts of gloom and doom. I've had a look through the linked document and there's some interesting stuff in there.

What kind of mobility do you currently have? are you still in a sling? Can you drive - or more importantly - ride a bike?! Or if it's easier - what can't you do?

My concern with this treatment is that even if it can bridge the gap (looking again at the x-ray I can't believe it will - surely it's just too far!), will it be able to provide enough tension in the tendon to provide shoulder stability? I'm currently thinking that surgery would be the best option (if possible) - get it over and done with, I can't imagine being in the same state that I'm in now in another 4 or 5 months and still have the prospect of surgery.

It sounds like i had a vaguely similar operation on my ankle where they took some donor tendon from above my ankle to sure up stability problems there (Evan's repair). It worked a treat.

I'll keep you posted
Regards, Scott.

ps. I found this quite informative... http://www.emedicine.com/orthoped/topic50.htm#target2

I have been searching this thread for someone with the same kind of break and it seems you have it! I too have a piece of bone that was pulled down by tendons that are still connected in addition to a midclavicular fracture. My original ER doc and Sports med doctor had me do the sling and wait and then I ws sent to a shoulder specialist who said drink milk and wait. In November they decided 8 weeks was enough waiting since it happened Sept. 4th and nothing has grown into the space. They started me on the new sonic frequency machine every night that stimulates the bone to grow faster, but it does not appear to be working for me. I still suggest asking about it though, because it can't hurt and does work 80% of the time. Here's a link to an Heath and Human Services article on it.

http://www.cms.hhs.gov/determinationprocess/downloads/id29TA.pdf

They tell me that if it doesn't work they will have to take a tendon out of my hamstring and make afigure 8 to tie the piece back up to my shoulder/clavicle. To say the least, I'm praying the machine works.

Keep me posted on what you find out.

Tim

 

[SAPer]

I broke my clavicle 7 months ago. It was a clean break. The doctor said to wear a figure-8 brace, so I did. Although my break is a nonunion, I now have a full range of movement and little pain BUT I can't do any weight on a bench press. I can barely do a push-up. I feel that my alignment is off, my neck is stiff, and, in general, I dislike the feeling of asymmetry. I am investigating options for surgery, which, due to where I live, I can't have for about another five months. My big question: Have any of you waited so long (approximately 1 year) for surgery, and if so, how much more difficult does it make the process, both during and after the operation?

Thanks for your time.

 

[Grammarsow]

After posting previously (thread #222) - Just got out of the hospital today from having the plate and 8 screws - sore, swollen and bruised, but not as painful as when I initially broke it, but got a 6 inch side on 'S' shaped incision, dead feeling in my shoulder and a sore / stiff neck.

Managed to get hold of some medurma but.........

Does anyone know if you can get triple antibiotic cream in the UK or a company that will ship to UK?

Any other hints / tips on rehab, making things easier and speed recovery would be appreciated - what's everybodys opinion on consuming more high calcium foods for example?

 

[skt785]

Hi all. It's been a pleasure reading through this thread and hearing about the various trials and tribulations you have all endured. I broke my collar bone in a very uninspiring bike accident (nothing downhill, nothing fast, no one else involved, no good reason really) last September. Very painful.

The break seemed pretty clean and the separation not overly distant, so I was given a sling and sent home. I seemed to be healing up okay for the first two weeks but at 4 and 6 weeks I didn't seem to be making any further progress. I could move around and do life tasks, even a little light lifting, but still felt soreness and weakness at the site of the break.

I finally went to get more x-rays and it appeared that the bone wasn't joining. At the ortho's advice I gave it another 4 weeks, which he said wouldn't cost me anything, but not much happened. I have pretty decent range of motion (probably 85% or so) and no pain in most positions, but can't push any kind of weight or really even lean forward on handlebars for very long, so the idea of getting on my bike again is a non-starter.

So now it looks like surgery is it. I've been wearing a bone-stimulator for a couple of weeks but it sort of feels like voodoo. The guy I saw for a second opinion looked at a CT scan and said I actually had a small second break which was probably why the main fracture didn't join (interrupted blood supply to the area) and also didn't give the stimulator much hope. He pretty firmly recommended the plate and screws surgery.

It's been great to hear stories of people back in the gym after, I dunno, 72 hours, and a little frightening hearing the long recovery stories, but the upshot seems to be that the surgery generally works, that the area can be returned to full function, and that complications are generally rare or dealt with.

I have a followup consult next week and will probably schedule the surgery for early next month (after I return from my honeymoon). Will post a report post op, and thanks for sharing your stories.

 

[katiej2]

I'm just over 14 weeks post surgery. straight scar about 5-6 inches. Seeing consultant tomorrow. Once it's healed - about 3 weeks after op lots of massaging really improved appearance but the bit I didn't massage (as got infected after stitch taken out) stuck to the plate. Best to make sure it doesn't as it's uncomfortable. Need a good physio. I have excellent one in the Midlands. Shoulder was getting stiff after 6 weeks. Leave it longer than that to start getting movement back and you will soon run in to frozen shoulder type probs which my physio advised I didn't want. Some physio's may be a bit reluctant as for up to 12 weeks they're still worried about working plate and screws loose. Bone takes months not weeks to heal so it's alot of stress on the screws. Numbness subsides a bit. still a bit numb but it's not a problem.

I used good arm to get in and out of chairs and put pressure on radius ulna nerve which is still giving me problems so avoid doing that.

After posting previously (thread #222) - Just got out of the hospital today from having the plate and 8 screws - sore, swollen and bruised, but not as painful as when I initially broke it, but got a 6 inch side on 'S' shaped incision, dead feeling in my shoulder and a sore / stiff neck.

Managed to get hold of some medurma but.........

Does anyone know if you can get triple antibiotic cream in the UK or a company that will ship to UK?

Any other hints / tips on rehab, making things easier and speed recovery would be appreciated - what's everybodys opinion on consuming more high calcium foods for example?

 

[Pureshot78]

My big question: Have any of you waited so long (approximately 1 year) for surgery, and if so, how much more difficult does it make the process, both during and after the operation?

Thanks for your time.

From what I've read the best timeframe for surgery is < 3 weeks.
My particular injury is a variation on the Grade III AC separation.
Normally in a Grade III separation, the clavicle is displaced because the Acromioclaviclular (AC) and Corococlavicular (CC) ligaments are torn.

In my case there was a complete (and rather clean) fracture of the clavicle on the distal (near the shoulder) end. The AC ligaments remained intact. The displacement of my clavicle was ~ 2.6 CM. The displacement was caused by the tearing of the CC ligaments.

The first Ortho (HMO referred) said i didn't need surgery. He said that most people end up having the surgery but for cosmetic reasons. I saw him the day after the accident, so i was still pretty druged up and hadn't done any research. He scheduled a follow up in 2 weeks and off i went.

I immediately sought out a second opinion, which i ended up paying for out of my pocket. The second Ortho (SCOI in SCAL) said that I needed surgery primarly because the bone was too displaced to ever heal and the chance of rubbing through the skin was too great.

Had a big fight with the insurance company which isn't worth rehashing but the long and short of it is that I demanded that my first ortho do a particular surgery.

My surgery is scheduled for Thursday morning. This will be less than 3 weeks after the accident. Here's the game plan for my surgery.

1) Ortho will attempt to put a plate across the clavicle fracture and use a dacron chord to hold the clavicle down. Bone and CC ligament will heal on their own once pulled down into place.

2) If the distal end of my clavicle isn't stable enough for fixation of the plate, the distal end will be excised (removed) and then the ortho will drill two holes in the clavicle and use an allograft (cadavre tendon with sutures on the end) to pull the clavicle down into position. The body will use the allograft as a scaffold and will recreate the CC ligament / CC ligament will heal.

A little more background on my decision: I used to play golf professionally, and as a right handed player, having a gap between my left acromion and clavicle will always affect my backswing. I know that my shoulder will probably never been like it was before the accident, but I want the best chance for full recovery and since i'm inside the 3 week window, i'm willing to have my arm immobolized for 4 weeks to get that chance back.
Sucks for this race season, but at 28 years old, there are many, many to come.

My advice is to get out there and do positively as much research as possible online. Harass your physicians when you are in consulatations. You have a 3 week window to get in there and have the best chance of healing, so make some noise!

Some orthos want to do a "modified weaver dunn" or whatever where they either use sutures or an allograft and then move another ligament to the end of the clavicle. There have not been any studies that show that the last step improves the recovery time and in my personal opinion it just doesn't make sense to take a ligament away from another part in the shoulder to bolster the clavicle. It's there for a reason.

YMMV

 

[Dustin07]

How's everyone doing? This thread about this article reminded me of this clavicle thread and my participation here, LOL.

So I'll just post my experience for those of you with breaks that are unsure what to do. Unfortunately I don't have a copy of my x-rays to post, but my clavicle broke and separated so that there was about 1-2 inches of gap. I really doubt it would have aligned by itself with the figure-8. after a couple weeks it was still pretty far apart. We opted for a steel plate.

So it's been, what....7 1/2 months so far. Everything is pretty cool. I can feel the plate through the skin clear as day. As long as I continue to work out (mostly chest and shoulder exercises) there is no pain. If I stop for more than a couple days I start to get sharp shooting pains in the shoulder for some reason.

The scar is wicked cool about 4 inches long, 1/4 wide. I scar big though. I think there are some pictures on my myspace.


good luck to those of you still trying to figure out how to proceed.

 

[mereidth]

I broke both clavicles (into many pieces) in a skiing accident in 2006 when I was 47 years old. Surgery was really the only choice because I had nothing to support one side or the other. Both were pinned with 7" long screws. One poked through the skin so they removed that screw early (luckily the bone had started to heal well). The other remained in place for about 6 weeks.

Three months later I was working out and lifting weights again. My range of motion is complete on one side and almost 100% on the other....I find that hanging from a bar is a good way to stretch out the "bad" side. Although it's been a little over a year since the surgery I still sometimes feel a dull ache throughout my collarbone area; maybe that will go away someday. Amazing what a good surgeon can do these days!

 

[ahinalu]

^ Yeah, the pain and weird feelings go away after a couple of years. You will get

some electric sensations if you hit it (backpacks, carrying lumber/ice, etc). You
also get the feeling back after a couple years too.

 

[yzf_jimmy]

Hey guys. I just broke my clavicle in the middle of the bone- clean break with very little pain (lucky for me). One of those going fast on my dirtbike and all of a sudden im out of control accidents- no idea what went wrong, but probably got something to do with stiffening up the front shocks.

Anyway the bones don't line up by about 2.5cm (an inch i guess). The doc at the hospital said they would probably just let it heal but he set up a appointment for a specialist. The accident was just over a week ago and my appointment is in 2 days. My question is if left on its own will the bones heal as strong side by side or will it always be a weak link, or if i have the surgery will it heal stronger than left to its own devices. I plan to continue riding my bike and i will fall (Guaranteed) and i dont really want a weak link i have to worry about. Also im 21 and fit so surgery has less chance of getting complicated on me. Any advice is appreciated

cheers
James

B.T.W- awesome thread, alot of useful info

 

[yzf_jimmy]

Well Im not going for the surgery, the doc said there was a bit of a gap between the two breaks (about 0.7mm) but he rekons it should heal fine. The fact that im in no pain and have about 80% movement probably backed up his opinion not to go for it aswell.

Did many of you guys have it as easy as me?? i mean i had very little pain when i did my break, and i had 70% of my movement back by the next day. Doc says i can do a bit of exercise aswell, just go easy and use my pain as a guide to slow down.

There was another guy like me, he did his on a mtb, just a few kays down from where I did mine (the bike park and mx park are in the same forest). Same day, fractured the same, but he could barely move his arm, and you could see he was in pain. Needless to say he was brassed off when he sees me using my arm like nothing happened , lol

Anyway, we'll see how it goes aye

 

[Dustin07]

sounds like you've got it pretty easy, all things considered. My gap was about 1-2 inches and I was knocked unconcious. There was a significant amount of pain, although the dr. told me he thought I had a pretty huge tolerance for pain since I didn't 'appear' too uncomfortable, LOL.

if I had .7mm gap... basically NO gap, then I would NOT have opted for surgery.

 

[Garden Girl]

Hello everyone. I'm working on reading everyones stories and thought I'd share mine. I'm a highly active 38 year old mother of 5 kids. I compete in triathalons, hike, camp, and canoe as well as own my own greenhouse where I do an extreme a mount of heavy lifting. Well just 1 week ago, I had a car accident that has left me with a multipule fracture in the middle of my left clavical. I've been placed in a arm sling for now. I have seen one doc who says I may possiblely end up having a non union but says surgery is an option but my choice at this point. I consulted another one who feels that we should wait and see how I do before choosing surgery but again it's my choice. It's considered a high impact fracture due to the speed at which the other car was travelling before it t-boned my car. I experienced pain at the accident site but it wasn't bad enough for me to have morphin. As long as I was still it didn't bother me. Right now I am also not in much pain. I take no pain killers at all and only feel pain with certain kinds of movements. I find this rather strange considering the multiple pieces (4) that my bone is in. Any one experience this? All I want is to heal with 100% mobility and strength. I don't know if I should allow it to heal on it's own or go for surgery. I know of two people who never did heal right and they have nothing but problems, but they also did not have the same kind of fracture as me. Any one out there have multiple middle fractures?

 

[waspo]

Garden Girl, going by what I've read here with your type of break and how active and demanding your life is, I'd seriously think about surgery. Or, atleast get a second opinion from a Sports Orth. Your recovery time will be better if not quicker and without knowing what the break looks like, I'd say you'd probably have less complications as well.

My friend broke his in 3 places (pocketbike racing) and just left it. Well, he had no choice really as he was expected to fly to Japan 2 weeks later. At the time, the Dr wanted to operate, but said he could do it once he came back. But, that was too late (2 months later). So, now he's got a bung arm.
Seriously think about it!

After breaking my right clavicle (pocketbike racing) just over a week now, my Dr said it will heal up fine without surgery and that it is a common break.

I have a mid fracture, partially seperated but when I'm laying on my back, the bones seam to touch each other. (not in allignment though.) So, I've been wearing a foam strap to form the figure-of-8 thingy which pulls my shoulders back and keeps them in reasonably stable condition. I also wear a sling.

I'm resting at home for 2 weeks to help it mend well, and spend most of the time in bed. (damn boring!!) Oh, and on the internet researching more about this type of break. (wish I hadn't now. lol!)

I didn't have much pain when I first broke it and it's still quite good as long as I don't make any sudden movements. It does ache sometimes, but I rarely take painkillers as I like to feel what's going on.

Anyway, going by what I've read, there's a lot of unhappy people out there who have had nothing but problems and complications.
This kinda shocked me a bit because if I hadn't have tried to find out more, I'd probably be laying back happily waiting for it to mend, which I'm optimistic about but now there is this doubt looming.

I went back to my Dr to try and get more info about how my arm will function after it heals.
Will I be back to 100%? Will I still be able to perform gymnastically with full strength? How long do I have to wait? bla..bla..bla!

At 36, I like to keep active and was really looking forward to getting back into weight training next week.

He looked at me strangely, and still didn't give me an answer.
I mentioned something about refering me to a Sports Orthopaedic Surgeon, and he laughed and said if I was planning to get it pinned or something that It would just be overkill!
But, if I've got money to throw around that there would be a specialist out there keen to do it.
I asked him to give me one anyway and I'd think about it.
He insisted that my shoulder wouldn't be a problem and that I would forget about it in a month, and that he's looked after 100's of broken clavicles without a problem.
I might add that he's a pretty good Dr IMHO and I trust what he's says since I've been going to him for 10 years now.

Judging by alot of the comments here, surgery has been the right thing for the type of break (multiples) or non-union type. Mine is relatively a simple mid break, so surgery for me would mainly be for esthetics, and probably a quicker recovery so I can get back to work, which is heavy and demanding on my shoulders. Also, to make sure I have full range of movement for my gymnastic activities. Yeah, basically back to 100% and my shoulder in better allignment symetrically. It kinda sags and is a bit shorter now, but only I can notice. My brother offered to break my other clavicle so they'd match. *******!! lol!

I'd also like to have a specialist monitor my progress.
I'd hate to go 6-8 weeks down the track, only to find out I had a non-union and need surgery anyway.
I'd dread getting a plate & screws and bone graph. Which is why I'd prefer to act now with having it pinned.

Ah...It's such a **** waiting game...what to do??!!
I know I can't leave it too long as it suppose to heal/bond within a certain time frame of roughly 10 to 20 days.
I'm going to arrange a consultation with a specialist this week and see what comes of it.

 

[waspo]

...Oh, and some of you might find the steps outlined here interesting: http://www.sandersclinic.net/news_archive/2006/bmx_tdy_sept.html