broken clavicle...surgery or not?

[bsbs1876]

Originally Posted by 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!

I think you made a good decision, Clara. If that many doctors tell you that you should not be having surgery then it is kind of hard to go against their word. That was the same case I was in. As I stated before I think it is a good idea to give the natural healing path a chance before jumping into surgery (depending on the break) but in my case I do regret taking that route because of all the success stories I read and hear about with the surgery. The plate puts everything back in the spot it is supposed to be in and your body just feels anatomically correct. This is especially important for active people like myself. I play hockey, golf, tennis, run and work out 4 times a week. If you don't do much to stay active then I doubt the injury would cause much trouble.

One great part about me waiting 3 years to get the surgery is that technology for this injury has come a long way - the plates are thinner and the surgeons are doing special stitches. Always gotta look on the bright side! Haha.

Warm regards,
Brad

 

[willy81]

Originally Posted by Driver72 .


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

probably my doctor handled my situation with a diplomatic way,
initially I was very frustrated getting back to my sports and told me could be 7 months, in fact it was his assistant, a couple of months later after a regular follow up with xrays he (the doctor himself not the assistant) told me that everything goes fine but the plate needs to stay at least 16 months, better would be 18 months.
I had only xrays no any other special diagnostic, you can judge how fast the calcium is deposited over a period of 2-3 months, probably I have a slow progress, I don't know. But judging from other cases the plate needs to stay in for 18 months.

The problem with this forum is that the old posters have disappeared. This thread started 7-8 years ago, where are the old posters who had the surgery to tell us about their progress? I am sure some of them should have undergone the second operation in order to have the plate/screws removed.

 

[willy81]

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.

did you have both plates removed now?
how strong you feel from that side where the plate stayed in longer?

 

[Clara M]

Originally Posted by bsbs1876 .


I think you made a good decision, Clara. If that many doctors tell you that you should not be having surgery then it is kind of hard to go against their word. That was the same case I was in. As I stated before I think it is a good idea to give the natural healing path a chance before jumping into surgery (depending on the break) but in my case I do regret taking that route because of all the success stories I read and hear about with the surgery. The plate puts everything back in the spot it is supposed to be in and your body just feels anatomically correct. This is especially important for active people like myself. I play hockey, golf, tennis, run and work out 4 times a week. If you don't do much to stay active then I doubt the injury would cause much trouble.

One great part about me waiting 3 years to get the surgery is that technology for this injury has come a long way - the plates are thinner and the surgeons are doing special stitches. Always gotta look on the bright side! Haha.

Warm regards,
Brad

Hey, I am curious how long will it be until i can jog again or even go for a long walk, let's say do some cardio, not running but walking at a faster pace? or is it too soon after 3 months and a week? I mean the doctor said 6 months after the accident I can start my normal routine, do sport and everything, I can drive a car as long as it doesn't hurt and so on...
but today for instance I drove a bit and because of the bumpy roads I felt a little discomfort doing it....so I am afraid it's not so smart to do that right now...but I have to get to work somehow...I am stressed like an old lady with 100 cats....oh man...
because I used to play a little football too and I used to run every second day and go to the gym etc I hope I will be back if not 100 % as before at least 90%...that's why I am still stressed out...will I have the strength I had before in that arm...I know it's too soon to judge it right now, it's only been 3 months

 

[ezcompany]

Originally Posted by willy81 .


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

Good to hear! What you mean full commitment?

 

[ezcompany]

Originally Posted by bsbs1876 .


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.

I see, you'll be fine and good as new when its all said and done! I'm doing pretty good. My workout routine has comeback to almost 100%. I'm slowly moving up to heavier weights at the machine bench. I can do my pushups now with no problem at all. All my friends and family said I look like I'm back in shape. I feel good and feel better, its almost as though my bad is much stronger and lean before I broke my collarbone. Things happens for a reason fellaz!

As far as the muscles goes, there's still some soreness and tightness after working out but it goes away after taking a hot shower and massaging my shoulder.

 

[willy81]

Originally Posted by ezcompany .

Good to hear! What you mean full commitment?

I have not returned yet to my main sport, windsurfing, where I had the accident six months ago.
I am thinking wait until the plate is out and the doctor will check personally that a perfect union has formed.
then wait 2-3 months for the holes to mend and then start windsurfing.

 

[nick00less]

Hey nick00less, How are you holding up? Have you returned to work lifting cases of beer? B

My arm feels great. I'm able to live life again. I can jog. I can run. I can move my arm. I can lift heavy objects. I can LIVE LIFE again. Except take a heavy hit to that area..but that's just common sense, otherwise it'll break again. I say this to encourage anyone who has doubts about surgery. It's been 10 weeks since my surgery and I don't regret it. If you have doubts consider this: if you've contemplated surgery off and on for months then those months could've been used for surgery/healing and by now you would've been done..healed..finally through with this process. Note*-with respect to everyone on here and keeping in mind that every recovery story is different just as every doctors skills are different..my advice to those who aren't getting surgery for many reasons, if what's currently being done isn't working..it's best to try something different. Oh and BSBS, I just got a full medical release from my doctor and I can return to work Monday. Lifting heavy beer

 

[willy81]

I have just learned something which could answer a lot of our questions.
An independent doctor told me that when a plate/screws are used to bring two pieces of bone together the healing process is quite slower than if their was no plate/screws used.
The reason being that the bones need some external stress in order to accelerate the healing process. in operated fractured bones this external stress is undertaken by the plate/screws which diminish the healing stimulation a lot and that's the reason it takes longer.

From what I understand is that even when I have the plate removed I will be quite vulnerable for several months, probably I need to get back to the sling for 6-12 weeks again.

 

[bsbs1876]

Originally Posted by 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.

Hi RSturm,

Though I agree with many of the points you have made in your post, I feel like based on your X ray and what you have told us that your situation is unusual. It looks as though there is a lot more hardware than usual that was installed in you which opens up possibility for problems. Very few people have ran into serious issues with this operation in this thread from what I have read and the chance of infection is actually very low (~1%).

Taking the natural route to see the outcome first is a great idea and the operation surely is not minor, but it is considered safe and has great outcomes in most people.

Regards,
B

 

[bsbs1876]

I see, you'll be fine and good as new when its all said and done! I'm doing pretty good. My workout routine has comeback to almost 100%. I'm slowly moving up to heavier weights at the machine bench. I can do my pushups now with no problem at all. All my friends and family said I look like I'm back in shape. I feel good and feel better, its almost as though my bad is much stronger and lean before I broke my collarbone. Things happens for a reason fellaz! As far as the muscles goes, there's still some soreness and tightness after working out but it goes away after taking a hot shower and massaging my shoulder. 

Good stuff, man! One other question for you or any others who are months into recovery - how is it sleeping on that shoulder? Are you able to okay now?

 

[RSturm]

I would think that most situations requiring surgery are unusual - just because the large majority of clavicle fractures heal just fine (the main study I found had a 97% healing rate for midshaft fractures). Some maybe a bit uneven and bumpy, but solid. So those of us that had surgery probably had a messier initial injury (or where unlucky to have a non- or malunion or were professional athletes couldn't afford to take 2 months off)

But reading the last few hundred messages, claims about benefits of surgery seem exaggerated and there is little awareness of downsides. Complication rates reported in the literature vary widely, but commonly are in the double digit range. When counting patients having a second surgery (including removal), rates are up to 50%. And refractures after plate removal are not uncommon either (and something I'm concerned about these days).

Anyway, I had one of each and definitely was much happier with the outcome and healing process on the non-surgery side.

 

[willy81]

Originally Posted by bsbs1876 .


Good stuff, man! One other question for you or any others who are months into recovery - how is it sleeping on that shoulder? Are you able to okay now?

after 2-3 months I could sleep on my operated shoulder

 

[willy81]

Originally Posted by bsbs1876 .


Hi RSturm,

Though I agree with many of the points you have made in your post, I feel like based on your X ray and what you have told us that your situation is unusual. It looks as though there is a lot more hardware than usual that was installed in you which opens up possibility for problems. Very few people have ran into serious issues with this operation in this thread from what I have read and the chance of infection is actually very low (~1%).

Taking the natural route to see the outcome first is a great idea and the operation surely is not minor, but it is considered safe and has great outcomes in most people.

Regards,
B

correct, it looks like RSturm has two plates installed, one perpendicular to each other, it looks as an unusual case

 

[bsbs1876]

Originally Posted by RSturm .

I would think that most situations requiring surgery are unusual - just because the large majority of clavicle fractures heal just fine (the main study I found had a 97% healing rate for midshaft fractures). Some maybe a bit uneven and bumpy, but solid. So those of us that had surgery probably had a messier initial injury (or where unlucky to have a non- or malunion or were professional athletes couldn't afford to take 2 months off)

But reading the last few hundred messages, claims about benefits of surgery seem exaggerated and there is little awareness of downsides. Complication rates reported in the literature vary widely, but commonly are in the double digit range. When counting patients having a second surgery (including removal), rates are up to 50%. And refractures after plate removal are not uncommon either (and something I'm concerned about these days).

Anyway, I had one of each and definitely was much happier with the outcome and healing process on the non-surgery side.

I suppose what it comes down to is that people will advocate for what they believe based on what happened to themselves. I am on the opposite end of the spectrum where I broke mine years ago and let it heal with a malunion and the shoulder is so messed up now. I just want the bone to be straight again. The funny part is that for the first 2 years things seemed alright but it is getting progressively worse as time goes by. Not so much pain in the actual bone itself but constant muscle soreness and fatigue in the surrounding areas like my neck, back, pectoral, and trap muscles on that side.

Also, how soon ago did you have the plate removed on the operated side? I feel like based on your posts that this was quite recent and it seems as though that would be far too soon to say that you are happier with the non-surgery route as you still need to allow time for everything to heal completely.

 

[willy81]

bsbs,
if you read back on this thread you will find a similar case like yours, there is someone who did not opt for the surgery and for several years he had problems like yours, eventually he had the surgery and got his life back.
Surgery guaranties that your bones will be perfectly aligned as before so the geometry of the surrounding muscles will not change and that you will be able to get to your ordinary activities soon, I drove my car two days after the operation with some pain though.

I think RSturm said he had the plate out in 3 months because of some other complications and his doctor asked him to treat it like porcelain.

 

[bsbs1876]

Think the drugs had anything to do with Lance Armstrong returning to the 2009 Tour de France so soon after breaking his collar bone and getting surgery? Haha

 

[willy81]

relax!

 

[bsbs1876]

Did I touch on a sensitive subject, *****?

 

[willy81]

it is sensitive to the pros, we can wait for full recovery without drugs

bsbs, when are you going to have the surgery?