broken clavicle...surgery or not?

[screwed]

Originally Posted by Clara M .

Well I guess I will, depends on how it looks in a year or so....when i asked if it will go through the skin, this surgeon said well it might but in time it will go down and attach itself more and more to the rest of the collarbone, so in other words I guess it won't stick out only if I start playing american football!/img/vbsmilies/smilies/smile.gif which I actually did at some point a few months ago, and it was a lot of fun! now I have to wait lol
I don't know does it sound ok to cut out some bone fragment that isn't attached to the collarbone and the rest has healed normally?
I mean it will look like a V shaped thing there and well it will be seen because girls wear tank tops and stuff like that...lol
and besides does it matter>? the skin isn't irritated (not itchy, red or hurting)

haha! yeah best to wait for a bit. The bit of bone I have that didn't attach is now being "absorbed" by me. It used to look like a..... well, a very spiky thing, now it's more like a deformed egg shape. And the bit of collar bone where the small piece should be will just grow new bone. If it's not irritating in anyway, then leave it. Just keep an eye on it.

 

[bsbs1876]

Back when I broke my collarbone some doctors said that they would do this same procedure that Clara is speaking of and just shave the bone down a bit. I thought about possibly doing this but as the years go on my scapula is winging and my shoulder is pushed out of alignment so I would rather just have the bone properly aligned and back to it's normal length/position. The plate is obviously much more invasive but I think as a 25 year old I need to look at the long run and try to prevent future back or shoulder problems.

 

[Driver72]

Hi ***** and BSBS,

I tried to reply to your posts but I can't see my reply anywhere on this site. Do you? If not, I'll re-post it...

Best,
D72

 

[Driver72]

Actually, I now vaguely remember getting a message about my post being held up for moderation... Anyone know what that's supposed to mean? I didn't use any bad language there or anything...

 

[RSturm]

3 months update on my case with surgery (See post 930 for a comparison with my previous fracture that I let heal without surgery http://www.cyclingforums.com/t/133419/broken-clavicle-surgery-or-not/930#post_4054753)

As I had a substantial shoulder separation this time as well (as you can see on the x-ray in post 930), the surgeon tried to address that with a Bosworth screw in addition to the plate/screws for the clavicle. As I said, the recovery was hard and surgery is really no something that you should do as a first treatment for a simple fracture.

After about 3 months, the X-ray showed that the Bosworth screw came out the bone and now was bent and useless (it's the third screw from the left in the picture below, the long one). It may have pulled the AC joint together for the first two months, things looked much more aligned there, but now was its own problem. Could have been left in there for the time being, but it looked rather disconcerting and I wanted to get this out.



So I had all the hardware removed in a second surgery last week. The surgeon thought removing all the hardware at 3 months is rather "aggressive" (his term) and he would have preferred to keep the plate in for at least 6 months (and ideally forever), but no point in 2 surgeries, so everything came out now.

Recovery was easier, but, again, this is not minor surgery and the risk of complications is substantial. I need to be careful again as the fracture points may not at full strength and the screw holes weaken the bone in addition, so was told not to lift anything over 1 pound for the next few weeks. However, I feel ok and was out on a 3 hour ride 3 days after surgery. Minor fall could cause bigger damage, though.



My left shoulder x-ray looked worse in terms of displacement than many other x-rays posted here and yet healed just fine by itself. My right shoulder will eventually be ok, too, although total time is going to be much longer.
While this thread has a lot of cheerleading for surgery, remember that this is not minor surgery. The risks of complications such as infections are substantial. For the large majority of breaks, the side effects of surgery (even when there are no complications) probably outweigh the benefits. Success is not guaranteed and there are lots of failures (also read the thread about plate breaking and other problems). Leave surgery for difficult cases and when a bone didn't heal on its own, very few broken clavicles need surgery.

 

[ezcompany]

Happy New Year!

Just dropping by to say Hi and see how is everyone doing.

 

[willy81]

Originally Posted by Driver72 .

Hi ***** and BSBS,

I tried to reply to your posts but I can't see my reply anywhere on this site. Do you? If not, I'll re-post it...

Best,
D72

No, I see nothing, please post again, all opinions are valuable

did you try to post a photo? probably it does not accept too high resolution photos,
I had a similar problem a few months ago

 

[willy81]

Originally Posted by ezcompany .

Happy New Year!

Just dropping by to say Hi and see how is everyone doing.

pretty good,
quite strong but a bit hesitant for full commitment

 

[screwed]

Originally Posted by Driver72 .

Hi ***** and BSBS,

I tried to reply to your posts but I can't see my reply anywhere on this site. Do you? If not, I'll re-post it...

Best,
D72

No I couldn't see anything. If there was a picture in it, then it will be a few days before it gets posted.

 

[bsbs1876]

Originally Posted by ezcompany .

Happy New Year!

Just dropping by to say Hi and see how is everyone doing.

Happy New Year to you too, ezcompany! I am still waiting patiently for my surgery date. My surgeon is highly sought after I suppose. How are you doing? Is your workout routine returning to normal finally? I can't wait until 3 months post op so I can get back into working out and hopefully one day have equal strength in both shoulders. I am still working out right now pre op but the injured shoulder (from 3 years back) takes a toll on me most days.

 

[Driver72]

No, I didn't post any photos either... So I don't know.

Anyway, to BSBS, I just wanted to say that luckily, I don't smoke, so that one at least is off the least. I did drink some alcohol (couple of beers) and also did about 15 mins of fast waltz-type dancing (and a small bit of stepping) two days prior to the refracture (10 days from plate removal), with my arm raised to below shoulder height in the classis couples-dancing position for about 5 mins maybe. And I did carry some Xmas shopping bags the day before but nothing too heavy, a few pounds maybe, and not for too long, I made sure to carry most bags in the other hand. Could any of that have contributed, you think? None of this would have broken a healthy bone, there were no huge loads or high-energy impacts.

To *****, I have a different question. How did your doctors know to postpone your plate removal from 7 to 18 months? Did they open the skin, then stitch you back together when they saw that the bone hadn't healed up completely? Or did they do any special diagnostics, e.g. to measure bone density or something? An X-ray won't give any clues, as far as I know... I found out after the event that apparently bones with plates with them rebuild slower than those without because they don't get as much "exercise", as some of the load is carried by the plate, which sounds logical. But is there any way to actually measure this in a patient? My X-ray looked normal.

Have a good weekend, everyone,
D72

 

[Driver72]

No, I didn't post any photos either... So I don't know.

Anyway, to BSBS, I just wanted to say that luckily, I don't smoke, so that one at least is off the least. I did drink some alcohol (couple of beers) and also did about 15 mins of fast waltz-type dancing (and a small bit of stepping) two days prior to the refracture (10 days from plate removal), with my arm raised to below shoulder height in the classis couples-dancing position for about 5 mins maybe. And I did carry some Xmas shopping bags the day before but nothing too heavy, a few pounds maybe, and not for too long, I made sure to carry most bags in the other hand. Could any of that have contributed, you think? None of this would have broken a healthy bone, there were no huge loads or high-energy impacts.

To *****, I have a different question. How did your doctors know to postpone your plate removal from 7 to 18 months? Did they open the skin, then stitch you back together when they saw that the bone hadn't healed up completely? Or did they do any special diagnostics, e.g. to measure bone density or something? An X-ray won't give any clues, as far as I know... I found out after the event that apparently bones with plates with them rebuild slower than those without because they don't get as much "exercise", as some of the load is carried by the plate, which sounds logical. But is there any way to actually measure this in a patient? My X-ray looked normal.

Have a good weekend, everyone,
D72

 

[bsbs1876]

Originally Posted by Driver72 .

No, I didn't post any photos either... So I don't know.

Anyway, to BSBS, I just wanted to say that luckily, I don't smoke, so that one at least is off the least. I did drink some alcohol (couple of beers) and also did about 15 mins of fast waltz-type dancing (and a small bit of stepping) two days prior to the refracture (10 days from plate removal), with my arm raised to below shoulder height in the classis couples-dancing position for about 5 mins maybe. And I did carry some Xmas shopping bags the day before but nothing too heavy, a few pounds maybe, and not for too long, I made sure to carry most bags in the other hand. Could any of that have contributed, you think? None of this would have broken a healthy bone, there were no huge loads or high-energy impacts.

To *****, I have a different question. How did your doctors know to postpone your plate removal from 7 to 18 months? Did they open the skin, then stitch you back together when they saw that the bone hadn't healed up completely? Or did they do any special diagnostics, e.g. to measure bone density or something? An X-ray won't give any clues, as far as I know... I found out after the event that apparently bones with plates with them rebuild slower than those without because they don't get as much "exercise", as some of the load is carried by the plate, which sounds logical. But is there any way to actually measure this in a patient? My X-ray looked normal.

Have a good weekend, everyone,
D72

Hi D72,

I think some of the activities you were taking part in 2 weeks after having the plate taken out were probably too strenuous. The screw holes take longer than that to completely fill in and make the bone stable again. I feel like this could have definitely contributed to the bone breaking again. I know that when/if I get the plate removed I will be keeping the sling on and keeping the sling dormant for a good month just to be on the safe side.

A bit of alcohol shouldn't really matter. I will be partaking in beers within a week or two after my surgery I will tell you that for sure!

How are you doing now with the second plate installed? I am assuming they probably plan to keep this one in this time. It's hard to say exactly why this happened to you but it is a rare occurrence. You don't hear about this happening all that often unless you fall on the shoulder and really smack it up again. It shouldn't just happen from every day activities unless something has gone wrong or the healing process did not fully complete.

Cheers,
B

 

[Driver72]

Thanks BSBS. What you wrote last is the essence of the question I'm asking myself: could my activities have produced this result on their own, i.e. assuming no medical error and a good healing of the bone? It seems unlikely to my mind but perhaps I don't understand. In other words, did they contribute the final 10% to an underlying medical problem with the bone or can this sort of light activity produce such result even when everything is fine otherwise? All my doctor warned me of was the risk of high-energy impacts, such as when you fall while skiing. He never said I have to behave like I was made of porcelaine for a month, you see...

As to the second plate, it doesn't give me any problems for the time being, it's just that I have to re-do some of the rehab I've already had once. But they (an assembly of the clinic's doctors) actually say it's fine to remove that one too, just wait a year this time. I'm thinking, I'll wait even more than that, just to be on the safe side and maybe I'll have tomography or something before I do it.

What actually surprises me in your previous post is that you continue to suffer 3 years on. Me, I've had no problem while carrying the plate, either the first or the second one. Except for the premature removal, I've felt quite fine, I gave up on painkiller the day after the op each time. It's true that the muscle mass on the affected side is somewhat reduced but that should come back easily with some gym exercise...

 

[RSturm]

I got my plate out early (3 months) because of another issue and my doctor considered this a "very aggressive" move and would have preferred to wait. But my discharge instructions were essentially to act as if I'm made out of porcelain for now. No lifting anything over 1 pound. Very different from my previous clavicle fracture on the other side where I was back to full activities without constraints after 3 months.

 

[bsbs1876]

Originally Posted by Driver72 .

Thanks BSBS. What you wrote last is the essence of the question I'm asking myself: could my activities have produced this result on their own, i.e. assuming no medical error and a good healing of the bone? It seems unlikely to my mind but perhaps I don't understand. In other words, did they contribute the final 10% to an underlying medical problem with the bone or can this sort of light activity produce such result even when everything is fine otherwise? All my doctor warned me of was the risk of high-energy impacts, such as when you fall while skiing. He never said I have to behave like I was made of porcelaine for a month, you see...

As to the second plate, it doesn't give me any problems for the time being, it's just that I have to re-do some of the rehab I've already had once. But they (an assembly of the clinic's doctors) actually say it's fine to remove that one too, just wait a year this time. I'm thinking, I'll wait even more than that, just to be on the safe side and maybe I'll have tomography or something before I do it.

What actually surprises me in your previous post is that you continue to suffer 3 years on. Me, I've had no problem while carrying the plate, either the first or the second one. Except for the premature removal, I've felt quite fine, I gave up on painkiller the day after the op each time. It's true that the muscle mass on the affected side is somewhat reduced but that should come back easily with some gym exercise...

I have been suffering from a malunited clavicle for 3 years, Driver 72. I chose to let it heal naturally back then and I am just going to have the surgery with plate and screws next month finally. The bone formed a union, but in such a terrible position that my shoulder is pushed out of position so I have chronic pain and weakness. I have been waiting for the surgery for many months now because it was the earliest I could get in with my surgeon of choice (I saw 3). I live in Canada too so surgery is covered by our health care system which can cause delays.

My shoulder has been usable this whole time but I just really want to be 100% again. I think in the long run surgery will be the only way to get there, as time has proven to me that I will never be 100% if I leave it now.

As for your situation, I am no doctor but I think multiple factors must have come in to play. Do you have any x rays that were taken throughout the process? I feel like over the years I have spent so much time researching broken clavicles because of my condition.

 

[bsbs1876]

Originally Posted by RSturm .

I got my plate out early (3 months) because of another issue and my doctor considered this a "very aggressive" move and would have preferred to wait. But my discharge instructions were essentially to act as if I'm made out of porcelain for now. No lifting anything over 1 pound. Very different from my previous clavicle fracture on the other side where I was back to full activities without constraints after 3 months.

That is incredibly early. Make sure you baby that thing!

 

[Clara M]

Originally Posted by bsbs1876 .

Back when I broke my collarbone some doctors said that they would do this same procedure that Clara is speaking of and just shave the bone down a bit. I thought about possibly doing this but as the years go on my scapula is winging and my shoulder is pushed out of alignment so I would rather just have the bone properly aligned and back to it's normal length/position. The plate is obviously much more invasive but I think as a 25 year old I need to look at the long run and try to prevent future back or shoulder problems.

well now that you're saying this I get a little worried...but it would be ridiculous for 3 doctors to be wrong...right??? I mean not one told me anything about problems in the future or chronic pain I might encounter later on....I mean it sound bad....uf uf scary!
I am now doing my PT alone at home and I will go for a check up next week....

has anybody else tried this procedure with the bone adjustment? because this last surgeon who specialized in sports injuries said in 6 months the bone should be healed completely....that means a normal bone takes up to 6 months to complete the healing process and that indeed the "spike" that looks nasty will eventually go back to it's original place...not completely but it will go closer to the collarbone and then I can thing about cutting it....it's ok now and if it gets closer I guess it will be hardly noticeable but my question is will I be able to jog or do any sports?

 

[bsbs1876]

Originally Posted by Clara M .

well now that you're saying this I get a little worried...but it would be ridiculous for 3 doctors to be wrong...right??? I mean not one told me anything about problems in the future or chronic pain I might encounter later on....I mean it sound bad....uf uf scary!
I am now doing my PT alone at home and I will go for a check up next week....

has anybody else tried this procedure with the bone adjustment? because this last surgeon who specialized in sports injuries said in 6 months the bone should be healed completely....that means a normal bone takes up to 6 months to complete the healing process and that indeed the "spike" that looks nasty will eventually go back to it's original place...not completely but it will go closer to the collarbone and then I can thing about cutting it....it's ok now and if it gets closer I guess it will be hardly noticeable but my question is will I be able to jog or do any sports?

Hi Clara,

I don't mean to scare you with my post. Sorry about that. Each break is different from the next so it all depends. I visited 3 surgeons when I initially broke mine and all of them said no surgery. I trusted their opinion and went on with my life. Then when I went back to see one of the surgeons for a follow up because I was experiencing pain and discomfort he said, and I quote, "What was I thinking back in 2009? Want to straighten it out?". So here I am today waiting for the operation.

Obviously you should take the professional medical advice that is given to you by the doctors. I strongly feel that because I live in Canada, where health care is free, that doctors will always try the natural route before costing the hospitals time and money. In my case the bone was not "displaced" which is when they will suggest surgery to join the two pieces back together. Mine was broken clean in the middle with the 2 pieces touching but on a very bad angle (kind of like this: ^). This causes shortening of the clavicle and affects the mechanics of the entire shoulder girdle. In your case it looks as though the position is a lot better than mine was so I don't think you would have the same issues that I have. Only time can tell how things will work out and I do agree with most doctors that you should at least TRY the natural healing method first and see how it works out. If results are good then you avoid the risks of surgery. If it doesn't work out then you can always have the operation done later on.

Regards,
Brad

 

[Clara M]

Hi Brad,
Yeah, that's exactly why I wanted to wait more and let it heal by itself, the surgeons confirmed that so I thought this is the best method. Here in Romania health care is free but sadly they are used to being paid by people in the ER always! so let's say u go in with a broken leg, they fix u up and u end up giving money to everybody from the nurse to the doctor to the technician that hands u the x-rays! if you don't pay they don't care about your case...it's sad but true! that's why many who can afford getting treatment in another neighboring country do so...it's just better, cleaner and sometimes even cheaper, not to mention that they are much more professional!

and the fact that health care is free leads to this here but if it wouldn't have been, they would probably just suggest an unnecessary surgery...so that you have to pay!...it's twisted!