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
recoverydoc said:
Hear are a few tips for scars. I work with many professional boxers and this is what I use on them.
1. make sure the wound is well covered in triple antibiotic (bacteria create more scar tissure)
2.Once the stiches are out or staples you can use any of the scar creams that are sold.(mederma)
3. After a few weeks you can add the scar gel pads by curad or spenco second skin. They are silcone gel pads that continure to promete healing and changes in the scar.
It takes 6 months for the scar tissue to heal completely and go threw a remodel phase and if you do these few things early and often it will make a difference in appeance.
[#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]
Killed the dog but went down hard. Bone was broke mid-shoulder with a 1 inch chunk overlapping both ends almost a "Z" shape.
