broken clavicle...surgery or not?

[willy81]

smanfa, I welcome you to this forum. I am sorry for your accident, it is good that you read the past posts on this thread and you probably have realized that a broken clavicle cannot and will not heel as before without surgery. During the crash the two broken parts have moved away from each other and they cannot get aligned again without a surgery. As a result your broken clavicle will be shorter than before and your trunk will deform, you are going to have a lot of back muscle pain which will for ever, you probably have read this already here. The only way to feel as before is if you find an experienced doctor and go for the surgery. The surgery is not very serious, there might be some minor complications such as a minor inflammation but they are treated easily. There will be some surface nerve damage sice they will cut your skin but they repair after some time. Personally I am very happy I had the surgery in less than 24 hours after the accident, now I am about less than 12 months post op and I have returned to all my sports with no problem. I have started even playing football. My advice to you is to find a good doctor and don't waste your time, even if the bone is fixed without the surgery your trunk will stay deformed for the rest of your life and this is will not be nice. The doctors who advised you against the surgery they did so just because they don't feel comfortable to operate you, it is how they feel and not what should be done, this point has been explained to us by an orthopedic doctor who contributes here on this thread from time to time, if you go back a few pages you will read what he has written about this. Yes, I would like to a ask you too, where do you live? Can you upload your xrays? keep in touch, *****. PS: Brad, how are you doing? Is your ATV ready?

 

[willy81]

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,,,

some questions about the post operation pain where exactly do you feel pain? is it the cut? around it? is it inside, in the bone/plate? is it the skin?

 

[bsbs1876]

Originally Posted by willy81 .

smanfa,

I welcome you to this forum.
I am sorry for your accident, it is good that you read the past posts on this thread and you probably have realized that a broken clavicle cannot and will not heel as before without surgery.
During the crash the two broken parts have moved away from each other and they cannot get aligned again without a surgery.
As a result your broken clavicle will be shorter than before and your trunk will deform, you are going to have a lot of back muscle pain which will for ever, you probably have read this already here.

The only way to feel as before is if you find an experienced doctor and go for the surgery.
The surgery is not very serious, there might be some minor complications such as a minor inflammation but they are treated easily.
There will be some surface nerve damage sice they will cut your skin but they repair after some time.

Personally I am very happy I had the surgery in less than 24 hours after the accident, now I am about less than 12 months post op and I have returned to all my sports with no problem. I have started even playing football.

My advice to you is to find a good doctor and don't waste your time, even if the bone is fixed without the surgery your trunk will stay deformed for the rest of your life and this is will not be nice.

The doctors who advised you against the surgery they did so just because they don't feel comfortable to operate you, it is how they feel and not what should be done, this point has been explained to us by an orthopedic doctor who contributes here on this thread from time to time, if you go back a few pages you will read what he has written about this.

Yes, I would like to a ask you too, where do you live?

Can you upload your xrays?

keep in touch,

*****.



PS: Brad, how are you doing? Is your ATV ready?

*****, I've been back out on the trails and I'm also back in the gym working out with 20 lb weights. The operated side is a lot weaker right now but I'm working on restoring the balance.

Based on my experience I would have to disagree that the surgery is not serious. The incision made on me is very long and lots of soft tissue was dissected. As a result I continue to have some nerve damage type pains (burning/shooting) 3 months post op. I really hope this clears up because it is a constant nag some days. I am thinking that it could have to do with hardware irritating the inside of the skin. Hopefully when it get removed it will help with this. My break was closer to the middle though so it is different than *****'s. Every break is different from the next in fact.

 

[willy81]

Brad, in 2006 I had a really bad accident, after an off balance fall I had my right shoulder dislocated, as a consequence I needed a Rotator cuff repair since several tendons were torn. That surgery, even it was arthroscopic, consider a serious one. The damage was really serious and the doctor had to go really deep into my glenohumeral joint. The surgery to realign a broken clavicle is much easier and all work is away from serious points such as the glenohumeral joint, it is quite near to the surface, in fact the doctor does not cut any muscle or he cuts it too little. The collar bone is just underneath the skin, no muscle in between. Recovery also takes much shorter. To this respect I consider the surgery to repair a broken clavicle rather routine and easy, of course complications could appear but still are far more easy to treat.

 

[ambal]

There's a dude in another thread who's father fell in a race in the 80's and broke his collarbone and he's only just had it reset this week. Even hinault and merckx arn't that tough.

 

[johnboy61]

Hi Sam,

I wanted to weigh in with my experience especially since your break seems very similar to mine. I broke mine three weeks ago on May 18th by laying down a motorcycle going into a left turn. Other than a severely located left clavicle, I did not have a scratch on me. At the time, I knew it was broken but was not sure how badly until I saw the x-rays 5 hours later. Mine was broken into two pieces, mid-shaft, with the outer half laying over the inner half, so I had a nice bump showing. Also there was bone "shard" - in the shape of a knife - aimed toward my lung, but my lung was not punctured (lucky there).

When I began visiting orthopedic docs the following Monday (ironically on my 52nd birthday!) I also encountered resistance for surgery from both surgeons I visited, one of them is a top sports orthopedic surgeon in Atlanta (where I live), who recommended the self-healing path and that I come back in 6 weeks to check the score. This shocked me given the severity of the break. He did not really go into all of the risks associated with surgery at that time, and I did not ask because I thought for sure I was a slam-dunk case for surgery. I left his office somewhat bewildered.

After considering things for a whole 24 hours, I chose the surgery. I called the surgeon back and told him I wanted the surgery in order to 1) heal fastest and 2) heal most completely - to get back to original condition. Also, with two young, active sons, and a trip abroad looming in late June, I just wanted to get on with things. He agreed to do the procedure, expedited my case and two days later I went under the knife. As for the associated risks, we never had any detailed conversations about the risks of the surgery. I suppose they are real, but with modern-day surgical techniques performed by a highly qualified (and experienced) surgeon, and on a healthy patient (non-smoking seems to be a really key factor in healing), I honestly did not have a lot of concern about the risks. He put in a plate and screws and the surgery took 3 hours, about twice as long as he expected, but a good surgeon does it the way it must be done. (He removed the bone shard - could not do anything to reattach it).

So here I am, 2 weeks yesterday since the surgery. I was off the narcotic pain killers probably 3-4 days after the surgery, and am now only taking over the counter acetaminophen and ibuprofen, and mostly at night when the pain flares up a bit (I am not sitting around but am otherwise being careful). On Monday this week (10 days after surgery) I went to a physical therapist who assessed my situation, took some benchmark measurements on my right (healthy) arm to see what "success" will look like on my left arm eventually. He started me on some basic PT (stretching for range of motion) exercises this week, and I am doing them. Every day seems to get a bit better.

My advice: get the surgery and have the best surgeon available do it for you. Follow the orders, keep the sling on for as long as you can. Within a week you should see good improvement and less pain.

Good luck - I am curious to know your decision and outcome.

P.S. The narcotic pain killers (I had percocets) will constipate you, as you will be taking them every 3 hours for several days to stay ahead of the pain. Make sure you take a stool softener every time you take the narcotics, otherwise you will be hating life

 

[ambal]

Originally Posted by johnboy61 .

P.S. The narcotic pain killers (I had percocets) will constipate you, as you will be taking them every 3 hours for several days to stay ahead of the pain. Make sure you take a stool softener every time you take the narcotics, otherwise you will be hating life

To many pain killers and you can go a week without shitting.

 

[alienator]

To many pain killers and you can go a week without shitting.

Percocets are prescribed typically at either every 6 hours or every 4-6. Given that they've got acetaminophen (Tylenol), they definitely should not be taken less than every 4 hours. What's the most common overdose in the US? Tylenol. One of the benefits of Tylenol overdose is liver damage. Another is a very painful, unfast death. With that said, narcotics can constipate a person, but whether or not this happens and the severity of it if it does happen varies with the person, their activity level, their hydration, and other factors. Don't be fooled however by the wonders of narcotic pain relief: if you're taking the max dose (or too much) and you're just laying around, it won't be long before you're trying to **** concrete blocks.

 

[alyson]

My pain is sort of inside but it doesn't help that i keep taking my sling off, i had internal stitches and sterastrips out side.

 

[alyson]

My pain is sort of inside but it doesn't help that i keep taking my sling off, i had internal stitches and sterastrips out side.

 

[willy81]

My pain is sort of inside but it doesn't help that i keep taking my sling off, i had internal stitches and sterastrips out side.

the same internal stitches and sterastrips I had too. give it some time the pain will diminish in a couple of weeks,

 

[alyson]

the same internal stitches and sterastrips I had too. give it some time the pain will diminish in a couple of weeks,

 

[smanfa]

Hello again!

Thanks to everyone who replied to my first post. My apologies in advance for writing a mini novel in response.

Alyson, sorry to hear about all the trouble that you had with your break. Hopefully your recovery is going well. John, I’m happy to hear that your post-op recovery seems to be going smoothly and I hope you get cleared for you trip at the end of the month! I’ll elaborate on my situation for you and everyone else later in this post.

Brad and *****, in response to your questions, I live in a rural town in British Columbia, Canada. I’ve posted my X-rays from May 21st and June 3rd for you. According to the radiologist’s report, it’s actually a comminuted fracture (i.e. there’s a third piece that is 8mm in between the two main fragments) and the bone displacement has increased from 8mm to 15mm since the initial X-rays.

These are my initial X-rays (same day, different angles):




These are my follow up X-rays after 13 days:



With regards to treatment, I did my fair share of research into current thoughts on clavicle treatment and also came to the conclusion that I would benefit from surgery since my fracture is in >2 pieces, displaced, and I’m female. However, my family doctor was against even discussing surgery with me after three visits. The only orthopedic surgeon in town (yes, only one – that’s a downfall of growing up in a small, rural town) said he wouldn’t operate on me after seeing my initial X-rays from May 21st, so my family doctor insisted that he couldn’t do anything more for me and that I would just have to wait for it to heal on its own. He also didn’t tell me that the bone was actually in THREE pieces until my third appointment with him. Due to the lack of/inaccurate information I received, he is now my ex-family doctor and my new doctor has sent my follow up X-rays from June 3rd to the ortho surgeon in town again to show him the increased displacement. I’m hoping to find out what the ortho’s recommendation is tomorrow. I would have gone for surgery without a doubt if I had the choice two weeks ago, but now I’m not really sure if I would opt for surgery if he offers it to me…

I know the majority of you recommend surgery, but hear me out. I’m well aware of the chance of a malunion or a nonunion. I’m also well aware of the potential biomechanical issues due to the asymmetry that results from a malunion. However, I have my reasons for being skeptical about surgery now. Over the past week, I can truthfully say that I’ve been feeling improvement with regards to pain. I stopped taking all pain meds after the first three days so that I could be conscious of movements that I should be avoiding. I was in a decent amount of pain with all movement during the first and second weeks. In the third week I started getting really sharp, localized pain whenever I got into an upright position from laying down, then it would stay sore for the majority of the time that I was upright. That was concerning, but since entering the fourth week, the sharp pain has progressively decreased and the bone just feels kind of sore when I pull my shoulders back or if I try to use my arm too much. I’m able to press my back flat against the wall with only slight pain at the moment and I can passively move my arm up almost 45 degrees laterally, but am still fairly limited with front to back motion. My range of motion in my upper arm is highest when my elbow is bent and/or when my arm is supported and I have very, very slowly been increasing the active use of my arm in general. Visibly, my broken side is neither noticeably lower nor shorter than the other. Also, my collarbones aren’t prominent, so although I can feel a bump (perhaps better described as a dip?) where the medial side is higher up than the lateral side, it’s difficult to determine which side is the broken side when you look at me. I’m currently at a point where, aside from not being able to raise my upper left arm and not being able to hold much more than a glass of water in my left hand, I’m starting to feel like a normal, functional, only slightly crippled person again.

So, as of right now, I have 11 more weeks until September, plus another 6 weeks until I will be required to meet any potentially tough physical demands. According to one of the journal articles that I’ve read, average union time is 28.4 weeks non-operatively and 16.4 weeks operatively. The non-operative average is a little longer than I have to heal, but if I continue to experience decreases in pain and if signs of callus formation can be confirmed in the next week or two, I think I’m going to stick with the conservative route and I’m hoping I’ll be able to start physio next week. However, if next week’s X-rays show that the bones getting even more displaced and/or are shortening significantly and/or the surgeon strongly recommends surgery, I’ll definitely be considering it. Depending on when the surgery would be performed, I’d still have close to 16 weeks of relatively little physical exertion, which is a pretty good recovery time buffer. I just hate the idea of being flat on my back and in massive amounts of pain again. I won’t complain if I can successfully avoid the scar and perpetual numbness from the nerve damage either. And as a side note to both defend my decision and to inform any of the future broken clavicle-d who are skeptical about immediately opting for surgery, another study that I read about determined that there’s no significant difference in bone union between surgeries that are performed ASAP and surgeries that are performed years later. So if you think you might be a lucky one with minimal issues with the conservative route (a fortunate pack that I'm aspiring to be in), then at least you know the option will be there and still viable if that doesn't work out and you end up having to take the surgical route years from your break anyway... however, a bone graft might be taken from your thigh if you have surgery done later (the need for the bone graft is controversial though). If any of you are interested in the journal articles that I’ve taken all of my tidbits of info from just let me know and I can post links to them for you.

Anyway, I’ll post about what I actually end up doing later on. Hopefully the conservative approach works out for me. Otherwise you can all say I told you so.

Sam

 

[pnkcoral]

Smanfa,

I love B.C. I am a fourth generation Canadian, even though I was brought up in California. I am currently trying to get my Canadian citizenship. My Dad was from Alberta and B.C. so every summer as kids we would head up to Vancouver and Victoria for swim meets, fishing, and lots of fun. However, of all the recent postings, I can relate to yours the most.

I explained what happened to me in earlier posts: car crash, 16 broken bones mainly in the chest area, and one of them was a 100% displaced clavicle. Fortunately, due to a series of happenstances ( to sick from injuries to operate, insurance issues, etc) I held off on the plate and screw job on my clavicle. I believe my break was similiar to yours except that yours broke in two places, instead of only one for myself. Now, I like to think that when it comes to surgeries we have selective hearing. We hear what we want to hear according to our individual situations. Those situations may include things like our money situation, health care coverage, past health experinces, surgeons advice and yes even these internet boards.

Now , this is where it gets interesting. My general surgeon that was part of my trauma team at first appeared to be old school. Right after the accident there was no displacement in the clavicle. So, he said no sweat it will heal up nice "au natural." But, later when it got 100% displaced he joined the Ortho doc in pushing for surgery. Well, I had been a competitive swimmer my whole life and one thing I know is when my body is not right. And, it was really not up for a surgery. I was pooling up fluids in my lungs because of being on my back the whole time, running a temperature off and on and basically in a weakened state and and on heavy pain medication. But, that didn't seem to bother them, the would just say, "Don't worry you will be home in no time and it will heal up nice." I felt like saying yes but will I be dead or alive?

Anyway, at six weeks I started going up to a new hot springs spa that has a 25 yard pool and swimming again. At seven weeks I was swimming a half mile to a mile with no pain and full rotation. Today, 4 months practically to the day since the accident I am swimming two miles hard a day in a small lake. However, I use swim fins to take some of the presurre off the shoulder. I feel that my collar bone healing up is one of the wonders of nature. It has formed somewhat of a knot over the break... though it is hard to even see it in the mirror but I can definitely feel it. When I used to straighten out my arms in bed to move my legs..somewhat like a person would do with paralyzed legs, I would hear a clicking sound from the bones moving. I would get a little pain so I would back off. Now there is none of that even though the other day I was staining our fence and wiping it down with my arm that was affected. The clavicle bone is like a strut and moving the arm and shoulder a certain way will affect it..sometimes painfully. I definitely can still feel it .. it is still not 100% but that will come later. The whole trick is to exercise the arm and shoulder so that it gets stronger but not to over do it or heaven forbid rebreak it.

Lastly, I ran into a friend of mine who is a PA and sees a lot of clavicle breaks. He is in a rural area and it sounds like he does not see a lot of surgeries on collar bone breaks. He was telling me how the breaks seem to come together naturally and fuse together. Often stronger than before.
Except for people who smoke and then they only have a window of a about 4 hours a day that the break can mend. Now, I am in know way saying that you should not have surgery for your breaks. That is entirely up to you and what your surgeon recommends. And, with a double break it is probably a good idea. So, I wish you God speed. I just wanted to relate what happened to me. At some point I am going to go back in and have some x-rays taken and then I will post them here.

Good luck,

pnkcoral

 

[alyson]

Hi gang need a bit of advice, had my plate fitted 11 days ago and now my shoulder had started to click??

 

[willy81]

Hi gang need a bit of advice, had my plate fitted 11 days ago and now my shoulder had started to click??

what do you mean? the glenohumeral joint? or the collar bone? go have a new xray!

 

[willy81]

SAM, go have the surgery, you are woman, you can't live deformed for the rest of your life do what ever it takes, you can't realize now how your life will change in the long run without the surgery Brad (bsbs) can explain about it

 

[pnkcoral]

*****,

Funny that you should be concerned about the click in your shoulder. I went through the same sort of noise consternation with a lot of my breaks. I have eight broken ribs on my right side that have been quiet as a church mouse throughout the entire 4 months since my accident. But, they still hurt like the dickens especially after swimming or sleeping on that side all night. However, the two broken ribs on the left side make all kinds of noise. They make clicks, pops, and some weird noise I cannot even describe. The broken clavicle used to make a kind of click-pop up to about a month ago when I would put pressur on it in a certain way. I mentioned that in my earlier post.

I was so concerned about these noises that I talked to my general surgeon about them. He seemed to think they were caused by bone fragements moving around but I tended to disagree. I believe they are coming from the breaks themselves or from surrounding bones or ligaments. I think it would be pretty hard to break or shatter your collar bone and not have the surrounding shoulder or sternum somewhat affected? Furthermore, this is conjecture but I think that the surrounding skeletal structure is jockeying around and trying to fall back into position with these noises. Personally, I would not be to concerned unless you are in a lot of pain or think that you have rebroken it.

I gave up lifting weights after my accident, even though today I was in a sport store that had some weights. I was curious about the strenght on my arm on that collar break side. So, I did some curls with only about twenty pounds. It felt good and didn' t seem affect the break at all. But, I have no doubt that if I tried to do some heavy bench presses or something that would put extreme pressur on the clavicle that it would most likely seperate again. That is why I am sticking to swimming to build up my arms and legs again.

Good luck..

 

[alyson]

My clicking and pain is in the joint of my shoulder is this normal, i will post my pics later, thanks aly,xx

 

[pnkcoral]

Aly,

I do not know if it is normal but it is normal for me. I had all kinds of scans, x-rays, and mri's and nobody ever said that something was wrong with my shoulder. I do get some pain in there after I swim or use it a lot in the garden. I just figured that since I was favoring the shoulder and not trying to put to much pressure on the collar bone that it was moving the shoulder structure around or jockeying it into a more favorable position for the extra stress? Thus, the popping or clicking sounds. I do not worry anymore about my clavicle break. My general surgeon at first wanted to let it heal naturally, then for months tried to pressure me into having surgery, finally on my last visit tells me that my sort of break will heal naturally? Go figure? He then feels the break and says yes it is mending nicely. Then he says that even if it forms a non-union or mal-union you can always have it repaired later. He should have been a politician...

Rob