broken clavicle...surgery or not?

[alyson]

hi guys i know its been a long time but docs wouldn't do my surgery in march cuz i smoke but now he doing it 2nd june... how is everyone doing..aly....

 

[bsbs1876]

Hey Aly,

I am around 9 weeks post op now. The pain is pretty much gone and the shoulder feels pretty stable. I use it for pretty much everything now. I have not gotten the clearance from my doctor to start lifting weights yet so I have fallen kind of out of shape. I can't wait to get back to that so I can build some muscle back up again. The only complaint I still have is the tightness, sensitivity and numbness around the site. I wonder if this is normal still this far in? I think the plate is causing a lot of it and I can't wait to take it out already. I see my doctor again on the 14th of this month for a CT scan so he can tell me whether or not it's safe to begin more vigorous activity.

 

[67Rally]

Wow! After having spent time away from this thread, it is cool to see that people are still using it and still gaining insight into their own injuries as well as adding their healing/recovery experiences.

Injury diagnosis (injury date: 7/14/2012):

• Clavicle break - distal end (2+ inches broken away; end separated into multiple fragments).
• Coracoclavicular Ligament - grade 3 rupture - total separation of ligament from clavicle and coracoid process

Repair (surgery date: 7/30/2012):

• Clavicular plate (not a hook plate) w/9 screws securing the bone fragments (long incision). Plate is permanently installed.
• Synthetic coracoclavicular ligament "rope" secured to the clavicle and coracoid process (three arthroscopic incisions)

I wanted to provide an update to my own healing process. I am more than 9 months post-op.

• The surgical wounds have healed and the scars are fading. Though they are still discernible, they are beginning to blend in with the surrounding skin color/texture.
• The pain is almost non-existent.
• Range of motion is 98% (if not fully restored)
• Strength is fully restored (able to do all levels of exercise - lifting, push-ups, etc.)
• Flexibility is at 90-95% and still increasing.
• Clavicular plate doesn't interfere with normal life (except for certain placement of back-pack shoulder straps)
• Physical therapy commenced week of 8/12/2012 (2x/week)
• PT concluded 9/15/2012.

Current Riding Status

• I began cycling on the trainer beginning on 8/2/2012.
• I have been cycling on the road since 9/11/12.
• Longest ride since surgery - 65 miles

I hope that this helps some of you to arrive at the right decision for your healing and recover.

 

[bsbs1876]

Originally Posted by josephyu .

Hi Friends,

I wanted to toss out my views on a couple of the questions:
1. Why do surgeons disagree on which clavicle fractures need treatment? There is still a large group of ortho docs who feel that nearly all clavicle fractures should be treated without surgery. In the past, scientific studies rated a patient as having a good outcome if she had decent shoulder motion and a healed fracture. Newer studies are looking at a LOT more parameters and saying that patients are NOT doing as well as we thought. I would not necessarily say one group of doctors is right or wrong because each patient is individualized and you must consider the risks of surgery. Also, a surgeon may not feel comfortable with that particular procedure. When a surgeon says you don't need surgery, he may be saying he doesn't feel comfortable doing the surgery.
2. When does the plate come out? No good answer. Based on orthopedic wisdom that has been passed down generations, that length of time is typically 1 year. However, as the long as the bone is radiographically healed, IMHO the plate can be removed. This differs from patient to patient. I assess radiographic healing by looking at 2 orthogonal views of the clavicle bone and I look at bridging callous.
3. Which middle third clavicle fractures need surgery? Most don't need surgery. The ones that do are the following: (1) fractures that don't make contact (displaced by more than 100%), (2) fractures shortened by 1.5 cm, (3) severely comminuted fractures. I did a video explaining this... http://www.totalsportsmedicine.com/#!clavicle-fractures/c3gx
4. When is the best time to get surgery? Ideally, within 2 weeks. The surgery is just easier. After 4 weeks, bone has started to form and you are often chipping away a partially healed clavicle fracture.
5. When can fractures be pinned? You need two conditions: (1) a displaced fracture which is not too comminuted (2) surgeon that pins clavicle fractures. Only 5-10% of surgeons pin or plate. Most plate.
6. Is my recovery normal? Tough question to answer because "recovery" means different things to everyone. Most people get numbness outside the skin incision. Superficial skin nerves are cut during surgery. Cramping in the first few weeks are normal. Cold insensitivity is common because the plate is so superficial and conducts cold.

Dr. Yu, can I ask what is the earliest you have ever removed a plate from a clavicle?

 

[willy81]

Dr. Yu, can I ask what is the earliest you have ever removed a plate from a clavicle?

yes, good question, I would like to know too! It seems that I must have it removed anyway.

 

[bsbs1876]

Originally Posted by willy81 .


yes, good question, I would like to know too!

It seems that I must have it removed anyway.

Yeah I just find it weird how doctors have such different opinions. I was hoping mine wouldn't have to come out but it has really caught to the skin in an uncomfortable way on the end closest to my sternum. The skin is so thin there that I actually have constant bruising as a result and anything touching it is a big no no. Doc and I both agree that I should be pretty relieved taking it out. I am already having a hard time keeping my patience with this. I want it out so bad already and it has only been 3 months.

 

[willy81]

in the following days I will call my doctor to arrange an appointment, main issue to discuss is when I will get rid of the metal, I can't get used to it,

 

[bsbs1876]

*****, you should be able to remove your plate no problem by now. I would push for it when you see your doctor. I feel your pain. My shoulder feels good and stable lately but I am under strong belief that the plate is what's causing and will continue to cause ongoing issues for me. The irritation/nerve pain sort of feeling I get is directly where the plate is, more so on the end where it doesn't join the skin well. This can't be a coincidence. I have done some extensive research on plate removal over the past month and it looks like just about everyone is happy taking it out and it is a much much easier recovery. The exception would be those who return to sport too quickly and are unlucky with a refracture. Make sure to take it easy when your bone is swiss cheese!

 

[bsbs1876]

Originally Posted by willy81 .

in the following days I will call my doctor to arrange an appointment, main issue to discuss is when I will get rid of the metal, I can't get used to it,

Hey *****, what's the verdict? Did you schedule your surgery?

 

[willy81]

1

 

[willy81]

sorry for the multiple posts it is not my fault

 

[bsbs1876]

No problem, *****, but what we can't excuse you for is none of your posts making any sense!

 

[willy81]

you are right, sorry, there were 4 copies of the same message posted never mind I hope the mods will take care of the mess I was saying that, I have not visited my doctor yet because the surgery will take place after the end of the next October, November anyway, so no schedule yet, it is way to early, I can plan my surgery in short notice, say 10 days or less. probably I wait until autumn to visit my doctor, the muscles are getting tighter and the collar bone becomes more protrude, visible that's nice to see in the mirror. I am quite busy with different sports, even with soccer, what about you? you must be about 15 weeks post op, your post op complications did not delay the bone heeling anyway, do you feel strong? lift some weight? what about the muscles? are they tighter now?

 

[Dave Marsi]

Hello all, as of early May I joined the plate posse after coming up a bit short on a gap jump (if I only had a flux capacitor). My clavicle snapped off in a place my Dr deemed extremely rare, at the very tip, leaving only about 1" of bone to rig up with screws. He said due to this I could bear no weight for at least 6-8 weeks post-op, and then only minimal weight thereafter (follow up apt is on June 19). Has anyone else broken theirs in a similar way? I just want to ride my damn bike again, soon!

I tried every which way to post a photo but gave up, so I just attached it. Thanks in advance for any advice!

 

[bsbs1876]

Originally Posted by Dave Marsi .





Hello all, as of early May I joined the plate posse after coming up a bit short on a gap jump (if I only had a flux capacitor). My clavicle snapped off in a place my Dr deemed extremely rare, at the very tip, leaving only about 1" of bone to rig up with screws. He said due to this I could bear no weight for at least 6-8 weeks post-op, and then only minimal weight thereafter (follow up apt is on June 19). Has anyone else broken theirs in a similar way? I just want to ride my damn bike again, soon!

I tried every which way to post a photo but gave up, so I just attached it. Thanks in advance for any advice!

That's an interesting looking plate you got there. The fractures in the distal end are always the hardest to heal naturally and do require a surgical fix so it's good that your doctor knew that and took care of it for you.

Welcome to the club.

 

[67Rally]

Originally Posted by Dave Marsi .





Hello all, as of early May I joined the plate posse after coming up a bit short on a gap jump (if I only had a flux capacitor). My clavicle snapped off in a place my Dr deemed extremely rare, at the very tip, leaving only about 1" of bone to rig up with screws. He said due to this I could bear no weight for at least 6-8 weeks post-op, and then only minimal weight thereafter (follow up apt is on June 19). Has anyone else broken theirs in a similar way? I just want to ride my damn bike again, soon!

I tried every which way to post a photo but gave up, so I just attached it. Thanks in advance for any advice!

Welcome to the club!

I did this last summer, snapping off the distal end of my right clavicle. I added complexity to the break by having that end fragment into multiple pieces. To add insult to the injury, I also suffered a grad II separation of the AC joint and two grade three separations of the coracoclavicular ligament.

 

[bsbs1876]

Originally Posted by 67Rally .


Welcome to the club!

I did this last summer, snapping off the distal end of my right clavicle. I added complexity to the break by having that end fragment into multiple pieces. To add insult to the injury, I also suffered a grad II separation of the AC joint and two grade three separations of the coracoclavicular ligament.

And how are you doing these days? Any plans on removing any hardware?

 

[Dave Marsi]

Originally Posted by 67Rally .


Welcome to the club!

I did this last summer, snapping off the distal end of my right clavicle. I added complexity to the break by having that end fragment into multiple pieces. To add insult to the injury, I also suffered a grad II separation of the AC joint and two grade three separations of the coracoclavicular ligament.

I saw on the last page you were on the trainer a few days post-op and road riding within 5 weeks? Is this a typo or am I just not manning up enough?! Doc told me to give it a few months before I take to the road (though they're always conservative with recovery time). I'm concerned that I may prolong any union that is currently taking place, not to mention a little paranoid of clipping a low hanging branch. And do you plan to get that hardware removed?

 

[67Rally]

Originally Posted by Dave Marsi .

I saw on the last page you were on the trainer a few days post-op and road riding within 5 weeks? Is this a typo or am I just not manning up enough?! Doc told me to give it a few months before I take to the road (though they're always conservative with recovery time). I'm concerned that I may prolong any union that is currently taking place, not to mention a little paranoid of clipping a low hanging branch. And do you plan to get that hardware removed?

Man up? I don't know if I "manned-up" or I was just doggedly determined. I wrecked on a Saturday...and was on the trainer by the following Tuesday (I had my x-ray that day and learned the "good" news of the break). I rode on the trainer for the next 12 days leading up to the night before my surgery. I told my doctors (one did the plate the other repaired the ligaments) that I needed to get back on the trainer soon...one told me to ride when I "felt like it" while the other said take a couple weeks..."don't rush it." I rushed it. I pedaled hands-free for 2 weeks, the Thursday following my Monday surgery. I gradually started using my hands - first my left, then both (with little weight bearing on the repaired shoulder). One doc said I wouldn't ride for 3-4 months post-op while the other said that would be good in 6 weeks. I was riding on the road within 5. My docs and PTs both commented that because of my routine, I had accelerated my recovery.

My hardware is staying in. The plate doesn't seem to bother me as I approach 10 months post-op. I still have soreness in the AC joint (the plate isn't in there) but my strength has made a full return. I've ridden 2,500+ miles (maybe more) since returning to the road. Climbing, out of the saddle, etc...nothing bothers me.

 

[bsbs1876]

Originally Posted by 67Rally .


Man up? I don't know if I "manned-up" or I was just doggedly determined. I wrecked on a Saturday...and was on the trainer by the following Tuesday (I had my x-ray that day and learned the "good" news of the break). I rode on the trainer for the next 12 days leading up to the night before my surgery. I told my doctors (one did the plate the other repaired the ligaments) that I needed to get back on the trainer soon...one told me to ride when I "felt like it" while the other said take a couple weeks..."don't rush it." I rushed it. I pedaled hands-free for 2 weeks, the Thursday following my Monday surgery. I gradually started using my hands - first my left, then both (with little weight bearing on the repaired shoulder). One doc said I wouldn't ride for 3-4 months post-op while the other said that would be good in 6 weeks. I was riding on the road within 5. My docs and PTs both commented that because of my routine, I had accelerated my recovery.

My hardware is staying in. The plate doesn't seem to bother me as I approach 10 months post-op. I still have soreness in the AC joint (the plate isn't in there) but my strength has made a full return. I've ridden 2,500+ miles (maybe more) since returning to the road. Climbing, out of the saddle, etc...nothing bothers me.

You sound like a hard dude... My recovery wasn't nearly as quick as yours.