broken clavicle...surgery or not?

[67Rally]

Originally Posted by bsbs1876 .


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

Hardly. I have a healthy dose of reality and fear when it comes to not riding. I was morbidly obese for 15 years and I am back in shape and living the good life at 180-185 lbs. Cycling saved my life so keeping momentum is imperative to me.

Don't get me wrong, I was in pain all through my recovery. I was willing to risk falling so soon after my surgery because of my mindset. I am no speed demon. I am not a racer (though I ride hard and keep a brisk pace), preferring long distances with average speeds of 19-20 mph.

We are all unique as are our injuries. Do as much as your body and doctors will let you. Don't slack off. Find the balance.

 

[bbninja]

HI all i am 20 months post op and i have been getting this wierd rash for the past 3 months on my belly that comes and goes its wierd. They say my allergy levels are high in my bloodwork but i have never been allergic to anything and had zero issues when the plate was put in, anyways heres my question

Can you develop a allergy to titanium 16 months after it was inserted into your body? Could my body possibly be rejecting it now? I am at a lost as i have tried everything to do with soaps, shampoo, detergent all that good stuff with no results. Ever heard of allergic reaction to titanium years after having it inserted>?

 

[bsbs1876]

Originally Posted by bbninja .

HI all i am 20 months post op and i have been getting this wierd rash for the past 3 months on my belly that comes and goes its wierd. They say my allergy levels are high in my bloodwork but i have never been allergic to anything and had zero issues when the plate was put in, anyways heres my question

Can you develop a allergy to titanium 16 months after it was inserted into your body? Could my body possibly be rejecting it now? I am at a lost as i have tried everything to do with soaps, shampoo, detergent all that good stuff with no results. Ever heard of allergic reaction to titanium years after having it inserted>?

On your belly?... Sounds unrelated to me. I can't imagine the metal on your collar bone linking to a stomach rash but I'm no doctor.

 

[ambal]

Originally Posted by pnkcoral .
He spends about 30 seconds and says, "Well call me next week and we will make an appointment." The cost of this appearance which was billed as fracture treatment was a mere $3400! So, you see I really didn't get a warm and fuzzy feeling from him to later do the plate and screws..especially when he gives me a nebulous price range on that operation as $20K-$40K.

Well that's great value. Take a holiday to somewhere in asia and get it done.

 

[alienator]

HI all i am 20 months post op and i have been getting this wierd rash for the past 3 months on my belly that comes and goes its wierd. They say my allergy levels are high in my bloodwork but i have never been allergic to anything and had zero issues when the plate was put in, anyways heres my question Can you develop a allergy to titanium 16 months after it was inserted into your body? Could my body possibly be rejecting it now? I am at a lost as i have tried everything to do with soaps, shampoo, detergent all that good stuff with no results. Ever heard of allergic reaction to titanium years after having it inserted>?

I've had a titanium rod in a tibia for about 11 years with no issues. However, that doesn't mean much given that according to some sources (MELISA Foundation), up to 4% of the population tests positive for some allergy to titanium. While titanium is highly corrosion resistant, it is not corrosion proof. Conditions in the body can lead to corrosion, especially when coupled with certain finish qualities of titanium implants. I'd ask your doctor for a titanium level test, or maybe the best option would be to go to the MELISA Foundation site for titanium and find the link to clinics that can perform a titanium allergy test for you. I don't know that titanium rejection is an issue. From what I understand about rejection (I require anti-rejection meds), you're likely to see issues other than what you're seeing, issues like pain over the implant site, fever, changes in blood chemistry (particularly in serum amylase and urine amylase), and eventually systemic changes which can include organ failure. There may be other signs and symptoms. I'd definitely recommend following up with your doc while also checking out the MELISA Foundation site. Always be persistent with your doc about getting your questions answered and your concerns addressed.

 

[alienator]

Sorry about all the repeat messages.. All the fractures, bruised bones, ribs, etc. seem to be healing up nicely. Thanks. They were all pretty serious..for instance someone told me that I was lucky that the sternum didn't punch through and shear off the aorta to my heart. Yikes! The pain level on those are down from what they were originally. But, they all still hurt alot should I roll on them, bump into one, or in the case of the knees, walk to much.  Subsequently, the clavicle seemed a lot better today too. I walked a quit a bit and then I do these easy exercises I made up that simulate the various swimming strokes.  Now, what I have been looking into with the clavicle situation was first trying to find out if my AC and CC ligaments are still attached. It was hard to believe that with two CT scans, two MRI's, and ten portable and stationary x-rays that nobody got an MRI that showed those two ligaments. Then I was also wondering that if the two broken pieces of collarbone can displace themselves..then is there any chance that they could straignten themselves back up.  I think someone said on this thread that there is a channel of muscle, nerves, etc. that has formed around them, originally. If that was the case you would think that they could be manipulated back into place? However, I feel that I am flying by the seat of my pants on this broken clavicle deal. First, since I was a trauma patient I was funneled into a situation with various assigned doctors. The Ortho Doc litterally walks into my room at the hopital and was more interested in operating on the knee than the clavicle. Primarily, because the clavicle wasn't displaced at that time. He spends about 30 seconds and says, "Well call me next week and we will make an appointment."  The cost of this appearance which was billed as fracture treatment was a mere $3400!  So, you see I really didn't get a warm and fuzzy feeling from him to later do the plate and screws..especially when he gives me a nebulous price range on that operation as $20K-$40K. Therefore, I started phoning around to different surgeons in the area. There is probably 20-25 who do the plate operations in the Valley here. However, they will not touch anyone who has been in an auto accident. At first I could not believe it and thought that it was just that particular type of office. But, phoned about 10-15 more and they would not touch it with a ten foot pole. It did not matter if it was an insurance claim, health care provider, or even cash. When I would push the point a couple of them even hung-up on me. The reasoning behind their noncompliance is there is just to much paper work, chance for lawsuits, and long wait times for their money. That is why I just concentrated on a settlement and figured I would take some cash, go to an experienced surgeon for the operation, and tell him that I fell off my roof or something. All I have to say is that our medical system must really be screwed up if you have to lie in order to get an operation and not become a cripple. Sideways..

The solution to the doctors' liability concerns is to make-up a reason for the fracture that wouldn't involve a potential lawsuit. There are many such reasons. Another option is to be seen in an ER for a complaint related to your injury and get a referral to the orthopod on call. On call doctors have to see and treat you. The cost given to you is outrageous. One way to get the doctor to reduce that cost is to have your insurance company negotiate a price on your behalf such that whatever agreement they come to with the doctor puts a limit on what you can be charged. I was approved for a surgery that was going to cost several hundred thousand dollars. Before a I was given the final stamp of approval by the insurance company, they negotiated the price way down, both in terms of what they were going to pay and what I was going to pay. My costs were limited to $3000. Best of all, this was an out-of-network claim. That is, the hospital where this was done was not on the insurance company's list of approved providers for this procedure, and hospitals that were on the list were only 2 hours away. So, get on the phone to the insurance company and tell your story. Do whatever begging and pleading you need to in order for the insurance company to help you out. Whatever you do, don't let anyone operate on you that you haven't met or interacted with. It's never a smart idea to show up in a foreign country to have a complete stranger perform surgery on you. Think about it: follow up will be non-existent, and if something goes wrong further down the road, you'll be on your own again to find someone that help.

 

[alyson]

Well i go in hospital monday foc says he may have take bone from my hip, has anyone else had this done plz i,m really nervous now thanx, aly

 

[alyson]

Well i go in hospital monday doc says he may have take bone from my hip, has anyone else had this done plz i,m really nervous now thanx, aly

 

[risen]

Did you were helmet and racing protectors?

 

[alienator]

Well i go in hospital monday foc says he may have take bone from my hip, has anyone else had this done plz i,m really nervous now thanx, aly

I have had two surgeries in which the surgeons used bone grafts from my hip.....well, I guess both hips now. After the first surgery, the donor site was a bit painful for a few weeks when walking. The second surgery took a larger graft from the other hip, and I didn't really have any issues with that donor site. My surgeries were to rebuild a lower arm and to rebuild a tibia, so how YMMV since you're apparently having work done on a clavicle. I wouldn't get worried about the donor sites and pain associated with bone grafts. Just take your pain meds as indicated.

 

[bsbs1876]

So I just got back to the gym last week after being off for 3 and a half months. I am benching 15 lb dumbbells! Haha... and feeling very sore after. It's all about baby steps but I am glad to not be waiting any longer because I feel that the muscle memory is still there. My chest feels much stronger after just 2 sessions in the gym. I am not a body builder or anything but I work out for good health and fitness, doing a full body routine M-W-F. I thought I would post this progress on here for everyone. I was a little slower to get back to weights it seems but everyone is different. My doctor was very conservative and I followed his every word. He did not allow me to lift any weight until he assessed a CT scan of the bone and saw that it has united.

The plate does bother me a bit while working out. I can feel the skin tugging on it sometimes and I get odd pinching feelings if I bend certain ways. I don't know if this will get better with time or not but as I've said earlier in this thread I'll be removing it down the road anyway.

 

[Dave Marsi]

Originally Posted by bsbs1876 .

So I just got back to the gym last week after being off for 3 and a half months. I am benching 15 lb dumbbells! Haha... and feeling very sore after. It's all about baby steps but I am glad to not be waiting any longer because I feel that the muscle memory is still there. My chest feels much stronger after just 2 sessions in the gym. I am not a body builder or anything but I work out for good health and fitness, doing a full body routine M-W-F. I thought I would post this progress on here for everyone. I was a little slower to get back to weights it seems but everyone is different. My doctor was very conservative and I followed his every word. He did not allow me to lift any weight until he assessed a CT scan of the bone and saw that it has united.

The plate does bother me a bit while working out. I can feel the skin tugging on it sometimes and I get odd pinching feelings if I bend certain ways. I don't know if this will get better with time or not but as I've said earlier in this thread I'll be removing it down the road anyway.

So you had to get a CT to confirm a union has occurred? And the union took 3 months?! Holy **** I won't make it; I'm post-op 5 weeks today with a distal fracture and already losing my mind wearing this sling and being uni-armed! 67 Rally seemed to expedite his recovery progress by being tenacious, perhaps a bit too expedient. I'm not looking for another $16k surgery

 

[67Rally]

Originally Posted by Dave Marsi .

So you had to get a CT to confirm a union has occurred? And the union took 3 months?! Holy **** I won't make it; I'm post-op 5 weeks today with a distal fracture and already losing my mind wearing this sling and being uni-armed! 67 Rally seemed to expedite his recovery progress by being tenacious, perhaps a bit too expedient. I'm not looking for another $16k surgery

$16k surgery? When all was said and done, my bill (including PT) was over $100k! Everything pertaining to the surgery itself came in at $88k. My end of the bill was a fraction of the cost...but to consider that this was on par with my step-father's 7-bypass heart surgery (10 years later) is mind-boggling.

My x-ray at <2mos showed a union with my distal fracture though my docs said that it would be a year for the full calcification to be (nearly) as strong as pre-injury.

I was out of my sling after 6-7 weeks post-op and only wore it when my shoulder fatigued. Give it time, 5 weeks is a long time, but it is relatively short for the healing process.

 

[bsbs1876]

Originally Posted by Dave Marsi .

So you had to get a CT to confirm a union has occurred? And the union took 3 months?! Holy **** I won't make it; I'm post-op 5 weeks today with a distal fracture and already losing my mind wearing this sling and being uni-armed! 67 Rally seemed to expedite his recovery progress by being tenacious, perhaps a bit too expedient. I'm not looking for another $16k surgery

It had formed a union before then but I didn't get in for the CT until 3 months. I had X rays taken at 6 weeks which showed "some bone growth", but after the CT scan the doctor confirmed that it looks great and has formed a union. I was all for the surgeon's plan because I know that if there is not a proper union then the stress is on the hardware which can easily snap. Now that I know there is a union, my mind can be at ease. A lot of it is mental for me. If I don't know what's going on inside there then I will feel uneasy.

I was having a discussion online with a different orthopedic surgeon the other day and he informed me that the bone near the end is "spongy" bone which does heal faster than the "tubular" bone in the middle area. This explains why clavicle hook plates are routinely removed at 3-6 months post op, and regular clavicle plates are usually removed later than that. I am most likely looking at 9 months with mine in.

EDIT: Ps. I was out of my sling completely after like 2 or 3 weeks. I didn't find it did that much. I was very careful with the arm and didn't do much with it but the sling drove me crazy. I also think it contributed towards better healing and prevented frozen shoulder because I continued to use the arm for small things like eating, drinking, typing pretty much from 1 day post op. I don't like the idea of keeping a joint completely immobilized. I believe that the site needs blood flow to properly heal which requires at least some light movement right from the start. The only time I wore my sling was if I was in a public place with lots of people who would need to know that I am injured and not touch me.

 

[Dave Marsi]

$100K, WOW. I received a bargain surgery through the local hospital because the accident occurred a month before my new job's medical benefits kicked in, just my luck. So I'll be footing most of this bill over the course of, say...eternity. Moreover I think they might've used bargain hardware, perhaps scrap metals from the engineering dept, as it's still pretty tender. It's nice to have found this support group however; we're 'united' in a special way I guess.

 

[alyson]

Well had surgery yesterday, didn't have to have bone graft but i am in agony,,,

 

[67Rally]

Originally Posted by alyson .

Well had surgery yesterday, didn't have to have bone graft but i am in agony,,,

Take it easy, get your rest and manage your pain. I hope you have a good supply of films or your Netflix queue is up to date. Once you're though these first few days, you'll be on your way!

 

[smanfa]

Ayo,

Unfortunately, I've recently joined the ranks of the broken clavicle-d. I've spent the last two days reading a good portion of this 90 page long thread and figured that I might as well add my experience and seek out some more opinions on how I should handle my break.

I'm a 21 year old active female and was biking to work on May 17th when a truck in the oncoming lane made a left turn and completely cut me off... What's a girl to do but try to make a decent sized dent? Fortunately, it was only a broken clavicle. Anyway, I believe that it's the middle third of my left clavicle that is broken clean in half and the pieces are 100% displaced with the medial piece angled up and the distal piece angled down. When I was discharged from the ER, I received a simple sling and some T3s and was told that I would need to keep it still, that I would be sore for a while, and that it would heal on it's own. A week after my accident, my family doctor gave me a referral for a figure 8 brace and told me the same thing.

In the first week, I spent the majority of my time upright with the sling. Since the second week, I've spent the majority of my time laying in bed because I feel like the bones have a better chance of lining up without the weight of my arm pulling down on the distal end and my sternocleidomastoid muscle pulling up on the medial end. I haven't really bothered with the figure 8 brace due to discomfort.

I had another X-ray done yesterday and there doesn't appear to be any improvement in the displacement since my initial X-ray 2.5 weeks ago. That's my interpretation from seeing the X-rays at least, but I will be discussing them with my doctor one-on-one tomorrow. Not sure if my logic is sound, but I'm going to request that my next X-rays are laying down to see if the bones are any closer together and have a better chance of healing from that position. Anyway, it was really frustrating and discouraging to see that the two bones are still so far apart on yesterday's X-rays and it is making me consider pushing for surgery when I see my family doctor again tomorrow. However, four doctors in total have taken brief looks at my initial X-rays so far and they've all said that surgery isn't necessary.

My concerns with the conservative approach of letting it heal naturally are the length of time it might take since I seem to be on the road of a delayed union at best. Dealing with the potential complications of a malunion or non-union are not very appealing to me either because I am a 3rd year nursing student and will need to be able to meet the physical demands of my clinical rotations in the hospital come September in order to graduate on time. The last thing I want to do is compromise my longterm well-being by not allowing myself to heal properly though. I have from now until mid-October where I can allow for minimal physical exertion, but after that I might be hooped if I can't perform my program's physical requirements.

Any and all advice will be appreciated!

Sam

 

[alyson]

Hi hun i suffered for 16 months in pain as mine didn't heal, i had a plate fitted on Monday and it is painfull but hopefully i eill get some normality back. I would recommend surgery,,,

 

[bsbs1876]

Originally Posted by smanfa .

Ayo,

Unfortunately, I've recently joined the ranks of the broken clavicle-d. I've spent the last two days reading a good portion of this 90 page long thread and figured that I might as well add my experience and seek out some more opinions on how I should handle my break.

I'm a 21 year old active female and was biking to work on May 17th when a truck in the oncoming lane made a left turn and completely cut me off... What's a girl to do but try to make a decent sized dent? Fortunately, it was only a broken clavicle. Anyway, I believe that it's the middle third of my left clavicle that is broken clean in half and the pieces are 100% displaced with the medial piece angled up and the distal piece angled down. When I was discharged from the ER, I received a simple sling and some T3s and was told that I would need to keep it still, that I would be sore for a while, and that it would heal on it's own. A week after my accident, my family doctor gave me a referral for a figure 8 brace and told me the same thing.

In the first week, I spent the majority of my time upright with the sling. Since the second week, I've spent the majority of my time laying in bed because I feel like the bones have a better chance of lining up without the weight of my arm pulling down on the distal end and my sternocleidomastoid muscle pulling up on the medial end. I haven't really bothered with the figure 8 brace due to discomfort.

I had another X-ray done yesterday and there doesn't appear to be any improvement in the displacement since my initial X-ray 2.5 weeks ago. That's my interpretation from seeing the X-rays at least, but I will be discussing them with my doctor one-on-one tomorrow. Not sure if my logic is sound, but I'm going to request that my next X-rays are laying down to see if the bones are any closer together and have a better chance of healing from that position. Anyway, it was really frustrating and discouraging to see that the two bones are still so far apart on yesterday's X-rays and it is making me consider pushing for surgery when I see my family doctor again tomorrow. However, four doctors in total have taken brief looks at my initial X-rays so far and they've all said that surgery isn't necessary.

My concerns with the conservative approach of letting it heal naturally are the length of time it might take since I seem to be on the road of a delayed union at best. Dealing with the potential complications of a malunion or non-union are not very appealing to me either because I am a 3rd year nursing student and will need to be able to meet the physical demands of my clinical rotations in the hospital come September in order to graduate on time. The last thing I want to do is compromise my longterm well-being by not allowing myself to heal properly though. I have from now until mid-October where I can allow for minimal physical exertion, but after that I might be hooped if I can't perform my program's physical requirements.

Any and all advice will be appreciated!

Sam

Hi Sam,

I feel like I was in a very similar situation to you, but I am surprised that you are having so many doctors advise you against surgery if it is indeed fully displaced. Do you mind me asking what country you live in? I feel like this makes a big difference in the medical opinions you receive.

Ten years ago doctors would always give a sling and some pain medication but if you do your research on the web, which evidently you have, you will see that fully displaced clavicle fractures do much better with surgery. The amount of shortening is also a big factor (>15mm has reported long term loss of strength and function).

The operation is not without risk. I had some wound complication issues and am now dealing with a bit of nerve damage and hardware prominence which will hopefully be resolved with a second surgery to remove it. Your doctors may be right in that eventually the bones will form a union, but if the bones are not aligned properly it will cause a deformity and shortening. This will cause a muscle imbalance and make you asymmetrical. There are pros and cons to each type of treatment and it really comes down to weighing them against each other.

I wish you the best and hope you get the treatment you desire!

Brad