broken clavicle...surgery or not?

[Curb]

Hey Doc, thank you very much. But I have to ask you just one more important question and I think other people on this board with similar clavicle breaks will appreciate your answer if you know it. Maybe a tough question but here is the question:
As I mentioned, my break is held together with this hard plate and 6 screws which seem to be fastened in place pretty good. But there is a small space in between waiting for bone to fill in. Over time, is this plate and screw strong enough to support normal activities such and cycling, which I received my break from, push up, normal picking up stings around 20 pounds, weight lifting curls carrying groceries.
Although right now, since it's been 7 weeks since surgery, and I removed the sling last week, I would not dare to do anything stupid like those activities above. However, the doctor gave me a prescription to give to the PT guy do more aggressive range of motion and some light weights and he said I can start putting both hands on the handle bars while I am on my trainer (which I only rest lightly with the injured side).

So you see my confusion, is this plate suppose to act and support the clavicle just like a normal clavicle, or is the plate suppose to act as a temporary device to support the clavicle until the bone grows back? Then what happens if the bone doesn't grow back. The Ortho said I can leave this plate in for the rest of my life which I don’t really care as long as itr suppose to act like a normal clavicle.

These are the questions I tried to ask the orthro but never got a chance to ask because I was rushed out of the office.

If you can shed some clarification on this subject I'll bet a lot of others other than me would like to hear it.

Thanks

Curb good luck with your injury. All the folks on this board are active and are anxious to get back to their activities. The doctors are more rushed these days. HMOs have reduced reimbursments and the docs are naturally trying to see more patients.Its best to have your questions prepared in your head and ask them in order of importance. He or she may be 1.5 hours behind, you never know how many questions you are going to get in. The good thing about clavicles is if he got them straight and close there is a very good chance it will heal. Clavicles just have a lower rate of non unions then other bones. Calcium and a little Vit D can't hurt. Its cheap insurance. Just don't overdo the D(fat soluble). I'm a big believer in 2nd opinions, but they are harder to get with insurance companies now. Your best bet is to go online. Find out where the ortho did a fellowship(ie the foot and ankle institute or the shoulder institute of Emory) Make friends with the lady in your primary care group who handles referals and get good referals. Again good luck.

 

[alienator]

Hey Doc, thank you very much. But I have to ask you just one more important question and I think other people on this board with similar clavicle breaks will appreciate your answer if you know it. Maybe a tough question but here is the question:
As I mentioned, my break is held together with this hard plate and 6 screws which seem to be fastened in place pretty good. But there is a small space in between waiting for bone to fill in. Over time, is this plate and screw strong enough to support normal activities such and cycling, which I received my break from, push up, normal picking up stings around 20 pounds, weight lifting curls carrying groceries.
Although right now, since it's been 7 weeks since surgery, and I removed the sling last week, I would not dare to do anything stupid like those activities above. However, the doctor gave me a prescription to give to the PT guy do more aggressive range of motion and some light weights and he said I can start putting both hands on the handle bars while I am on my trainer (which I only rest lightly with the injured side).

So you see my confusion, is this plate suppose to act and support the clavicle just like a normal clavicle, or is the plate suppose to act as a temporary device to support the clavicle until the bone grows back? Then what happens if the bone doesn't grow back. The Ortho said I can leave this plate in for the rest of my life which I don’t really care as long as itr suppose to act like a normal clavicle.

I think you should call your orthopod for the answers for your case. However, the plate and screws are not necessarily load bearing members as good as bone. They've been known to break in cases where loading was too great. Also, one of their major purposes is to approximate the position of the bone ends for good healing.

As for the bone growing back, bone has an amazing ability to fill in voids in its structure. After a nasty leg fracture, I was left with a fibula in many pieces and many large voids between those pieces. Surgery to repair would have caused more damage, and other injuries in the leg had priority. After a year, there were still portions of the bone you could see through. After 2.5 years, the bone had completely healed. So be patient. 7 weeks is not that long when you're talking about bone with significant bits missing.

Again, the best thing to do is to talk with and ask question of your orthopod. He/she is the one that knows your case best. As feetorfish said, a second opinion can also be good.

 

[Curb]

Thanks again Alien and Feetorfish. I will schedule and appointment once agan and ask somemore question and get a second opinion.

It's good to have you guys in this forum looking after us newbies. And No Doubt, we damn sure appreciate your responses.
Regards!

I think you should call your orthopod for the answers for your case. However, the plate and screws are not necessarily load bearing members as good as bone. They've been known to break in cases where loading was too great. Also, one of their major purposes is to approximate the position of the bone ends for good healing.

As for the bone growing back, bone has an amazing ability to fill in voids in its structure. After a nasty leg fracture, I was left with a fibula in many pieces and many large voids between those pieces. Surgery to repair would have caused more damage, and other injuries in the leg had priority. After a year, there were still portions of the bone you could see through. After 2.5 years, the bone had completely healed. So be patient. 7 weeks is not that long when you're talking about bone with significant bits missing.

Again, the best thing to do is to talk with and ask question of your orthopod. He/she is the one that knows your case best. As feetorfish said, a second opinion can also be good.

 

[logicdevice]

Thanx for you all out here , I hav appointment to Doc tomarrow and i will sure ask so many questions about surgery and natural healing process.
But i m still confused why most of the Surgeons do not refer clavical fracture for surgery , what are the side effect / infections . Anyone knows here ?

 

[feetorfish]

I agree with alienator that the hardware is not there to take the load. Rigid fixation is there to allow the very delicate new bone formation and blood vessels to grow across the fracture site. The less motion early on, the faster the healing. But understand that surgery disrupts all the soft tissue structures around the fracture site that may not have been disrupted during your fall. Remember the clavicle breaks even though you may have landed on your outstretched hand, so the soft tissues around the clavicle are intact. So if the ends of the bone look close enough thats why a surgeon may elect not to operate.
Starting to do range of motion exercises is a good idea. Its an art deciding when to stop immobilization and start motion. Wait too long and you have a frozen shoulder or a tight elbow. Your orthopedist is the one to tell you when to start range of motion.. They will look at the films and decide how happy they are with position,alignment and apposition, and most importantly signs of healing. This varys from case to case for a lot of reasons. So there is no cookbook answer as to when to start. As far as worrying if the bone will grow back, the clavicle has a very high rate of healing, unlike other parts of other bones.

Hey Doc, thank you very much. But I have to ask you just one more important question and I think other people on this board with similar clavicle breaks will appreciate your answer if you know it. Maybe a tough question but here is the question:
As I mentioned, my break is held together with this hard plate and 6 screws which seem to be fastened in place pretty good. But there is a small space in between waiting for bone to fill in. Over time, is this plate and screw strong enough to support normal activities such and cycling, which I received my break from, push up, normal picking up stings around 20 pounds, weight lifting curls carrying groceries.
Although right now, since it's been 7 weeks since surgery, and I removed the sling last week, I would not dare to do anything stupid like those activities above. However, the doctor gave me a prescription to give to the PT guy do more aggressive range of motion and some light weights and he said I can start putting both hands on the handle bars while I am on my trainer (which I only rest lightly with the injured side).

So you see my confusion, is this plate suppose to act and support the clavicle just like a normal clavicle, or is the plate suppose to act as a temporary device to support the clavicle until the bone grows back? Then what happens if the bone doesn't grow back. The Ortho said I can leave this plate in for the rest of my life which I don’t really care as long as itr suppose to act like a normal clavicle.

These are the questions I tried to ask the orthro but never got a chance to ask because I was rushed out of the office.

If you can shed some clarification on this subject I'll bet a lot of others other than me would like to hear it.

Thanks

 

[Curb]

Ok, I have no more questions. My questions have been thoroughly answered by Alienator and Feetorfish!

Everyone in this forum please take notice of the posts and answers I received from these two individuals. They took the time out to share their personal experience and opinions with me and the rest of us. I am extra very please with the detailed information I received from them about my broken and plated clavicle.

Hell, I might as well cut you two guys a check, you certainly earn it!

Why can’t our physicians provide information like this? I know they are busy but we pay them and the insurance to correct and maintain our health. I guess it all depends on who you get I suppose.



I hope you all get the answers to your questions like I have received.

I will try and help out and answer some of your questions if I recognize some of the same symptoms that I am having.



BUT THANK YOU AGAIN ALIENATOR AND FEETORFISH.

I agree with alienator that the hardware is not there to take the load. Rigid fixation is there to allow the very delicate new bone formation and blood vessels to grow across the fracture site. The less motion early on, the faster the healing. But understand that surgery disrupts all the soft tissue structures around the fracture site that may not have been disrupted during your fall. Remember the clavicle breaks even though you may have landed on your outstretched hand, so the soft tissues around the clavicle are intact. So if the ends of the bone look close enough thats why a surgeon may elect not to operate.
Starting to do range of motion exercises is a good idea. Its an art deciding when to stop immobilization and start motion. Wait too long and you have a frozen shoulder or a tight elbow. Your orthopedist is the one to tell you when to start range of motion.. They will look at the films and decide how happy they are with position,alignment and apposition, and most importantly signs of healing. This varys from case to case for a lot of reasons. So there is no cookbook answer as to when to start. As far as worrying if the bone will grow back, the clavicle has a very high rate of healing, unlike other parts of other bones.

 

[ocean123]

Hi Joe,
So, what did you decide? How's the recovery going?
ocean123

Yeh it certainly can be. Thanks for the advice, but living in a small town i saw my local doctors who recomended me to an otherpedic surgeon, who then recomended me to a shoulder specialist in a big city, he seemed confident about what he could do etc. but hes a doctor after all. (confidence is what they do well). He has also performed the surgery before on people who have broke the clavicle etc. and he thinks that surgery is the correct procedure and because of my age etc i will recover well from it.

After reading this forum post it has swayed my desicion to serioulsy considering getting the surgery, as before i was thinking "no way". Well originally i wanted to get it done, but then thinking about it and talkin to my family and freinds i decided no. But lately it has been aching like crazy.

Its just that 60% of the time it dosent bother me, but when it hurts its really hurts and makes things awkward to do. You can push through the pain etc if you really wanna do something, but i dont know if thats the answer anymore. And not getting it sorted, could things lead to arthrietes. I also get alot of neck pain, that seems to stem from my shoulder not being supported enough. Sometimes i wonder if alot of it is physcological, from finding out what is wrong, as i have always know something was different about my shoulders, just that in the last few yearas i have really discovered the problem.

Sorry about the legnth of my posts, i just have a lot to say, with little people in the same situation to say it to.

Thanks again,
Joe

 

[AGHealing]

Thanks to this Thread and Forum.

The only bone I've broken is my left clavicle, twice. I broke it when I was 12 years old and, just recently, two weeks ago. When I 12, the fracture was right in the middle of the bone. (I broke it playing "barnyard football", but did get the touchdown.") I was simply given a figure-8 foam brace on my way home from the hospital.
I'm 28 years old now. I was hit by a vehicle traveling ~35mph while I was crossing the street on my newly repaired track bike. No head, neck, back, or leg injuries but ....a clavicle in 4 pieces. (I am very lucky...thank God I only broke my clavicle!)

The Dr. gave me three options.

1. I could let it heal on its own and I would have a huge bump that would grow irritated if I wanted to hike or ride with a back pack around my shoulders.
2. I could get the plate and screws, but since I was such a thin dude it would probably look frankenstein-ish seeing that hardware popping out of the skin like no bodies business. Not to mention the other factors like the risk of the screws not holding their own and a shiner of a scar later on.
3. I could get a pin drilled through the center of the clavicle threading the the pieces of bone like a necklace. Not siked about the thought of a 3 to 4 inch metal rod being drilled in me for 3 to 4 months and then having it backed out in another surgery.

I opted for the "pin" surgery based on the recommendation of the Orthopedic Dr. I saw. (This thread helped a bunch in my decision as well.) I could definitely see the obtuse bone sticking through my skin. Non-union was a chance with the all the options. The doctor I was am seeing recieved his training is the army...which after some research on my own and through this thread is where this type of surgery was first used. The Dr. drilled a pin through the clavicle this week. I'm in the third day of recovery and the pain is subsiding. The 28th of this month I get a follow-up to the surgery. Thank you to all for your two cents!

 

[alienator]

Thanks to this Thread and Forum.

I opted for the "pin" surgery based on the recommendation of the Orthopedic Dr. I saw. (This thread helped a bunch in my decision as well.) I could definitely see the obtuse bone sticking through my skin. Non-union was a chance with the all the options. The doctor I was am seeing recieved his training is the army...which after some research on my own and through this thread is where this type of surgery was first used. The Dr. drilled a pin through the clavicle this week. I'm in the third day of recovery and the pain is subsiding. The 28th of this month I get a follow-up to the surgery. Thank you to all for your two cents!

Cool! Implanted hardware is always worth bonus points. If you get the hardware removed, make sure the doc gives it to you as a keepsake.

What's even better is getting another scar. Scars are just memories that never fade.

 

[AGHealing]

Cool! Implanted hardware is always worth bonus points. If you get the hardware removed, make sure the doc gives it to you as a keepsake.

What's even better is getting another scar. Scars are just memories that never fade.

Yeah, I don't have any tattoos so I'm kind of excited about the scar(s) left behind. Scars are unique abstract history maps with stories/ memories behind them.

I will definitely try to get my hands on the pin that's keeping me together when and if they decide to remove it. I don't know if they let you keep hardware that's been in your body, though. I was told by a oral surgeon, when I had a tooth removed, that he wouldn't let me have my own tooth after he had just yanked it out due to it being a possible "bio hazard". I actually ended up stealing my own tooth back after he had left the office to speak with another patient. I had my reasons for wanting the tooth back. (And no, it had nothing to do with the tooth fairy/$.)

 

[alienator]

Yeah, I don't have any tattoos so I'm kind of excited about the scar(s) left behind. Scars are unique abstract history maps with stories/ memories behind them.

I will definitely try to get my hands on the pin that's keeping me together when and if they decide to remove it. I don't know if they let you keep hardware that's been in your body, though. I was told by a oral surgeon, when I had a tooth removed, that he wouldn't let me have my own tooth after he had just yanked it out due to it being a possible "bio hazard". I actually ended up stealing my own tooth back after he had left the office to speak with another patient. I had my reasons for wanting the tooth back. (And no, it had nothing to do with the tooth fairy/$.)

They'll let you keep the pin. You're just not allowed to keep bio matter. I've got some screws, a plate, and a bone growth stimulator that I've had removed.

 

[katiej2]

Hi all,

I broke my left clavicle (and six ribs) in a t-bone mva 7 weeks ago while on hols in South Africa. The Orthopaed who treated me there would have operated when the friction burn from the seatbelt healed. I was very keen to have the surgery due to the reduced healing time - I find it unbearably frustrating sitting around waiting to heal and having to depend on my partner to complete the smallest of tasks for me. Unfortunately, by the time the burn healed, the Orth was on holiday and my partner was keen to return to the UK so he could get back to earning - in hindsight a mistake as I would be justabout good as new by now had I stayed for the op...

As suspected, treatment on the NHS is a very drawn out process and my first two appointments were with a doc who apparently was not authorised to make the decision about surgery, due to his locum status! I was v angry when I learned this as I felt 3 weeks had been wasted - I am however comforted somewhat after reading all your posts, and realising that this does drag on and I'm not necessarily being jerked around by the NHS.

I finally saw a consultant last week who is keen to operate as the displaced bone fragment is lying adjacent to the clav resulting in about a 2.5cm drop in the left shoulder and while the break is not causing any pain now (I've been off all meds for 3 weeks) and movement in my arm is improving, I do suffer an intense, burning muscle pain in my shoulder at times when I don't wear the sling, from what I can only presume to be the lack of support from the clavicle itself. It feels like there is a huge weight pulling down on my arm/shoulder. Will this improve or will I continue to suffer pain? I have already suffered from back pain for 17 of my 31 yrs and dont want to make it any worse.

The happy, but v unfortunately timed news is that I am 8 weeks pregnant!! I am already extremely concerned about all the xrays and meds administered while in hospital and up until the time I discovered the pregnancy and due to a backlog at my GP, I have been informed not to expect a call from the midwife or refferal to an Obs Gyn until at least 14-16 weeks (another 6 weeks until those concerns are addressed!) I have been assured that the risk of miscarriage / deformity from general anaesthetic during surgery are 'minimal' during the first trimester, and even less thereafter. There is, nevertheless, still a risk.

I have been left to make the decision and I really don't know what to do. If I decide not to have the surgery, I am most concerned about resultant (im)mobility of the shoulder and possible continuing muscle pain. There is a slight cosmetic concern as I am quite bony and the difference in shoulder height and shape is obvious, some clothes now even sag slightly on that shoulder. The bump where it heals on its own will also be obvious and I've been told it will take another 5 weeks until its healed (argh!). If I do have the surgery however, much quicker healing time (yay) but there is of course the cosmetic concern of scarring - so either way, I'll just have to grin and bear whichever I am left with. The pregnancy issue just complicates the situation, especially considering I don't know if any damage has already been done. Lastly my sick pay at work runs out shortly, and with a baby on the way, I'm keen to maintain an income and get back to a 'normal' life, before its all turned on its head in 7 months time. (Am I being selfish in the way I'm looking at this?) We have not yet told anyone about the pregnancy, hence my unburdening this rather lengthy explanation on you all - I really need to hear your thoughts, comments, experiences please... thanks

I am in the UK but was fortunate to be treated privately as the NHS said the bone had healed satisfactorily, which it had not. I've lost count of the xrays and painkillers. It took 5 months before I had the op. It was still around six weeks to recover with an op. The lump was very distressing for me. The fine scar was around 5 inches after the op and the swelling continued to improve for 6 months easily. In fact it faded very well and was much less obvious than the lump. I was left with a prominent plate and discomfort wearing seatbelts and rucksacks. So 12 months later I had the plate out and am now 4 days post surgery to remove the plate. In terms of strength and ability to return to being active without pain I don't believe in my case I'd have achieved that without the op. Best of luck. Most important thing is to have a good surgeon recommended.

 

[AGHealing]

They'll let you keep the pin. You're just not allowed to keep bio matter. I've got some screws, a plate, and a bone growth stimulator that I've had removed.

I just wanted to upload a pic of the break. Enjoy...I didn't.

Also, another draw back to the surgery was that the dr. said that he had to snip three nerves that rest in front of the clavicle. He said that the area is usually numb for a while with a large (3 inch) diameter patch that grows smaller as you heal. Does anyone have an experience with this? I still have my dressing on my shoulder so I can't quite tell yet. Also, is it unheard of to be able to regenerate such nerves?

 

[gplama]

Also, another draw back to the surgery was that the dr. said that he had to snip three nerves that rest in front of the clavicle. He said that the area is usually numb for a while with a large (3 inch) diameter patch that grows smaller as you heal. Does anyone have an experience with this?

Yes. 6 months post my Op the size of the numb area is about 1 inch long, 2 inches wide on the front of my shoulder. It isn't as numb as before, more tingly I'd call it. It has had no negative impact on my shoulder/arm/movement/etc.

 

[Curb]

Ok, it's been 10 weeks since I had my operation and was pinned with screws and plate. Yes, in from just below the clavicle, it was numb for a while but I got the feeling back. however, on the shoulder directly in the front, in a small localized area, it's still slightly numb. i dont care about it as log as my clavicle join properly with the plate and screws and ican get back on my bike!

I just wanted to upload a pic of the break. Enjoy...I didn't.

Also, another draw back to the surgery was that the dr. said that he had to snip three nerves that rest in front of the clavicle. He said that the area is usually numb for a while with a large (3 inch) diameter patch that grows smaller as you heal. Does anyone have an experience with this? I still have my dressing on my shoulder so I can't quite tell yet. Also, is it unheard of to be able to regenerate such nerves?

 

[alienator]

How the nerves heal is a function of damage to them. With any surgery, there's always a nerve somewhere that is damaged. That's why scars and the area around a surgical incision are numb for a while. I'd not worry about it too much. If it were a real concern, your doctor would have mentioned it as a risk before the surgery.

 

[AGHealing]

So I know that the body is going to need time to heal no matter what. But as far a nutrition and bone healing, is there any thing out there in particular that is good insurance? I'm a healthy eater anyway, but I've started taking cod liver oil (vitamin D in these winter months), spirulina powder (trace minerals), apples (vit. C, boron), kefir/ yogurt (calcium). Does anyone have any other diet suggestions? Also, does anyone know if painkillers inhibit the healing process?

Thanks for the all the responses. I have my post op appointment this coming Wednesday. I'll try to upload some more pics and give an update then.

 

[cptaylor]

So I know that the body is going to need time to heal no matter what. But as far a nutrition and bone healing, is there any thing out there in particular that is good insurance? I'm a healthy eater anyway, but I've started taking cod liver oil (vitamin D in these winter months), spirulina powder (trace minerals), apples (vit. C, boron), kefir/ yogurt (calcium). Does anyone have any other diet suggestions? Also, does anyone know if painkillers inhibit the healing process?

Thanks for the all the responses. I have my post op appointment this coming Wednesday. I'll try to upload some more pics and give an update then.

I had the same surgery almost 3 months ago. Probably with the same Dr. He said to not take Ibuprofren as there have been studies that it may inhibit bone growth.

I've been taking Boron and Oyster Shell Calcium and slapping on Mederma scar cream every chance I get.

 

[AGHealing]

OK, I had my one week check up post operation. Everything looks good. The dr. said my collarbone was in more pieces than what the x-ray had shown. He said I had strong bones (the yogurt I eat every morning has paid off!) and that the screw/pin was anchored quite well. I'm out of a sling in house and in a sling when roaming the streets to let others known I'm gimpy on that side. I seem to be gaining confidence with my injuryed left side on a daily basis.

I was told by the dr. to not treat the wound(s) with anything. I have been left the original "butterfly" bandages which he said would fall off eventually. Under the butterfly bandages I have dissolvable stiches. I want to treat the wound with a honey on gauze to help the process along. (Honey was used pre-WWII to treat wounds and is making a come back due to bacteria mutating around antibiotic creams.) I have never had dissolvable stitches before so I'm hoping it doesn't dissolve the stitches before they're done doing their job. I'll keep you posted.

 

[Curb]

I wouldn’t mess with it and especially put honey on it!
Just leave it alone. You're lucky to have that kind of break and have that screw type of fix instead of the plate and screws. i think the plate and screws are stronger and more robust but requires more extensive and open surgery and additional care but once in place seems to support a broken clavicle better.

How long did the Dr say you have tho leave your screw in?

OK, I had my one week check up post operation. Everything looks good. The dr. said my collarbone was in more pieces than what the x-ray had shown. He said I had strong bones (the yogurt I eat every morning has paid off!) and that the screw/pin was anchored quite well. I'm out of a sling in house and in a sling when roaming the streets to let others known I'm gimpy on that side. I seem to be gaining confidence with my injuryed left side on a daily basis.

I was told by the dr. to not treat the wound(s) with anything. I have been left the original "butterfly" bandages which he said would fall off eventually. Under the butterfly bandages I have dissolvable stiches. I want to treat the wound with a honey on gauze to help the process along. (Honey was used pre-WWII to treat wounds and is making a come back due to bacteria mutating around antibiotic creams.) I have never had dissolvable stitches before so I'm hoping it doesn't dissolve the stitches before they're done doing their job. I'll keep you posted.