broken clavicle...surgery or not?

[willy81]

bsbs, I would wait longer than 6 weeks regardless what Dr. Sanders says, my Dr. says 4 weeks, I will go for a very conservative period of 8 weeks. I don't care about getting out of shape, with healthy nutrition I will minimize the damage. When the holes will feel than I will hit the bench really hard. Of course one last xray will be needed to be sure that the holes mend too.

 

[bsbs1876]

Quote: Originally Posted by willy81 .

bsbs,

I would wait longer than 6 weeks regardless what Dr. Sanders says, my Dr. says 4 weeks, I will go for a very conservative period of 8 weeks.
I don't care about getting out of shape, with healthy nutrition I will minimize the damage.
When the holes will feel than I will hit the bench really hard.

Of course one last xray will be needed to be sure that the holes mend too.

For me it is all about progression. When the doctor gives the OK to do light lifting, that means 10-15 lbs. I am not a risk taker but I am also a firm believer that exercising to stay vascular and keep the blood circulating through your body is important during the healing process.

 

[willy81]

my concern is not what will happen after the metal removal, this is known, be extremely careful for 8 weeks, my concern is how well the clavicle has mended at the original fracture site, and this will be seen during the 2nd surgery, the Doctor will test the union then. He has told me that it looks like a perfect union but I would wait for the real test. Only then I will be sure that I cam commit it the same way as before.

 

[willy81]

I am also not looking forward to having 6 weeks of downtime.

one more comment on this particularly, 6 weeks is way too early, my Dr. have said at least 16 months after the op. Other Doctors have different opinion but the most I have asked said 12 months minimum. Don't rush it, give it time and keep in mind that all this seat belt irritation is only temporary.

 

[willy81]

CORRECTION what I meant above was 6 months is way to early to have the plate removed, as far as I remember your Dr. told you that you can have it removed in 6 months, didn't he? I remember you said something like this, I don't really remember if it was 6 months or 8. as for the 4, 6, or 8 weeks down time after the plate removal I think it is not really a problem to wait a little more to have the holes mend too. sorry for the confusion.

 

[bsbs1876]

Quote: Originally Posted by willy81 .

CORRECTION

what I meant above was 6 months is way to early to have the plate removed,
as far as I remember your Dr. told you that you can have it removed in 6 months, didn't he?
I remember you said something like this, I don't really remember if it was 6 months or 8.


as for the 4, 6, or 8 weeks down time after the plate removal I think it is not really a problem to wait a little more to have the holes mend too.

sorry for the confusion.

Hahahaha. Thanks for clarifying. I am sitting here thinking "there is no way I am waiting that long after I get the plate removed".

I have read a TON on the removal. I have read of people having it removed and continuing pretty much everything the next day. This is not something I will do, but it has been done. The thing is, each persons bone density and healing capabilities are different so it all depends. Waiting the 6 weeks is the safe route, but I have read multiple stories of people having it removed and continuing to run, do garden work, etc. with a day or two. Just about every person has also said that it was a walk in the park compared to putting the plate in and they were very relieved to have it out and happy with their decision.

Edit: to answer your question, my doctor originally said it could possible come out in 6 months, but then changed his mind to 9-12 months just to be sure... so I will wait at least 9 and then look into it.

 

[willy81]

I have read a TON on the removal.

Hi Brad, can you post a few links about this, I have not done any serious searching about this subject but if you have the links ready please post them. I would be very interested. As for the time between the 1st surgery and the removal I believe it should not be less than 12 months. This is most Doctors I have spoken to told me and my Doctor went even more conservative in the beginning saying 18 months and later compromised for 16 months. please post the links.

 

[bsbs1876]

Here are two of the forum discussions. I have actually been active on the slowtwitch one (I am "bradhere").

http://forum.slowtwitch.com/forum/Slowtwitch_Forums_C1/Triathlon_Forum_F1/Anyone_had_the_plate_removed_from_their_broken_collarbone_P4307021/

http://forums.mtbr.com/rider-down-injuries-recovery/collarbone-plate-removal-545773.html

There was also a study done in which it shows that 96% of people were happy to have their plate removed and actually recommended the procedure. 86% of patients were happy to keep theirs. Because of this the consensus is to leave plates in unless requested by the patient.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249928/

The main reason people were happy to keep it is because they did not think it warranted another operation. This is a valid reason and opinion. The good news is that the ones who had the courage to go through with it were happy and recommended having it done.

 

[willy81]

thanks for the links Brad,

 

[berygu]

 

[berygu]

Hi all,
Very interesting thread, i too had a clavicle fracture 5 months ago from playing soccer. I saw 3 doctors before i made my decision, first made me have an xray, then put me in a figure 8 brace and made another xray, but the displacement of the fracture was the same, told me to leave it like this to heal because with surgery there is a big risk of infection. After 1-2 days i went to see another doctor, unfortenetly in that time there were holidays in my country and i could only see the doctors in the emergency room...this second doctor made me another figure 8 brace more tight , made another xray, the displacament looked the same. The second day i went to another hospital, i saw a more experienced doctor, this one told me the decision is mine, i can leave it too heal by wearing the figure 8 brace 4-6 weeks and i will have a bump in the place of the fracture, or make the surgery. I wanted to have the surgery because i read about the effects of the malunion are not only the bumb, but the asymmetry of the shoulders. I didn't want to look like a freak after the fracture heals (if it heals). So i had the surgery 5 days after the accident, the pain after i woke up was very very big , i was put in a sling and the second day i went home. I wore the sling 7-8 weeks i think (i know., very much time, didn't move almost at all this time the shoulder) , the fracture healed very well i guess, but i am still making hard PT (kinetotherapy) to regain full ROM and strength. I guess i had frozen shoulder, now i have almost full ROM and acceptable strenght, the problem is that the deltoid still feels stiff and hurts when i stretch it. I attached 2 xrays , one before the surgery and one recently done.

 

[berygu]

 

[alienator]

Hi all, I guess i had frozen shoulder, now i have almost full ROM and acceptable strenght, the problem is that the deltoid still feels stiff and hurts when i stretch it. I attached 2 xrays , one before the surgery and one recently done.

Were you diagnosed with adhesive capsulitis (frozen shoulder)?

 

[berygu]

No, but i think this is what it's called the stiffnes of the shoulder.
A few weeks from the surgery, the doctor saw that i don't move at all my hand and i lost my mobility and send me to a physical therapist, but the physical therapist from that hospital didn't have that much time for me, he told me to come 1 week later, and he said that it's better to not hurry with the PT because the screws could move and the fracture may not heal and develop pseudoarthrosis. I was scared from the pseudoarthrosis thing and used the dessault bandage 2 more weeks (8 weeks with dessault bandage in total

) to be 100% sure that the fracture heals before i start rehab...so i started light rehab at week 9 post surgery, and at week 12 seeing not much improvements i decided to search the internet for a privat PT clinic and found one that i go since then, and i can say i am much better, but i make hard exercises every day.
The conclusion is that i was stupid to stay with the dessault sling for 8 long weeks and not move almost at all my shoulder, indeed the fracture seems to be healed in the good position, but i had to make a lot of hard exercises to regain my ROM an strenght, and i am not 100% even now 5 months post surgery ...as i said my deltoit area still feels stiff and hurts.

 

[berygu]

Quote: Originally Posted by alienator .


Were you diagnosed with adhesive capsulitis (frozen shoulder)?
The doctor said can be adherences , but it will pass with time...the PT said it was kind of a frozen shoulder...important is that i am now better from the hard exercises i do and i hope to be 100% back again.

 

[bsbs1876]

Quote: Originally Posted by berygu .
No, but i think this is what it's called the stiffnes of the shoulder.
A few weeks from the surgery, the doctor saw that i don't move at all my hand and i lost my mobility and send me to a physical therapist, but the physical therapist from that hospital didn't have that much time for me, he told me to come 1 week later, and he said that it's better to not hurry with the PT because the screws could move and the fracture may not heal and develop pseudoarthrosis. I was scared from the pseudoarthrosis thing and used the dessault bandage 2 more weeks (8 weeks with dessault bandage in total

) to be 100% sure that the fracture heals before i start rehab...so i started light rehab at week 9 post surgery, and at week 12 seeing not much improvements i decided to search the internet for a privat PT clinic and found one that i go since then, and i can say i am much better, but i make hard exercises every day.
The conclusion is that i was stupid to stay with the dessault sling for 8 long weeks and not move almost at all my shoulder, indeed the fracture seems to be healed in the good position, but i had to make a lot of hard exercises to regain my ROM an strenght, and i am not 100% even now 5 months post surgery ...as i said my deltoit area still feels stiff and hurts.



The frozen shoulder is no joke. I began PT at about 3 weeks post op because I was so scared of it. I gained full ROM pretty quickly. I am at 7 months post op now and my PT routine has turned into regular weight lifting using 50-60 lb dumbbells for many exercises. I still stay away from the barbells because I want to continue to even things out. I don't know if I could say it's 100%. The strength is a little bit lower but it doesn't hurt all that much. It is a bit uncomfortable with certain weather and straps but I think that is just because of the hardware which should come out some time in the future.

berygu, your last x ray looks good. It looks to have healed nicely. In a much nicer shape than if you left it alone. I left mine alone originally and I was so you say "a freak".... I guess... my shoulders looked very different, even noticeable with a T-shirt on. One trapezius muscle was half the size of the other. Now all that is noticeable is my scar, which I find pretty cool.

 

[alienator]

Adhesive capsulitis can be very severe. I had an excellent case of it after shoulder injuries and had to have a bit over 6mm burnt off the inside of my shoulder capsule. The worst part was that PT had to start the next day after surgery.

 

[berygu]

Quote: Originally Posted by bsbs1876 .


The frozen shoulder is no joke. I began PT at about 3 weeks post op because I was so scared of it. I gained full ROM pretty quickly. I am at 7 months post op now and my PT routine has turned into regular weight lifting using 50-60 lb dumbbells for many exercises. I still stay away from the barbells because I want to continue to even things out. I don't know if I could say it's 100%. The strength is a little bit lower but it doesn't hurt all that much. It is a bit uncomfortable with certain weather and straps but I think that is just because of the hardware which should come out some time in the future.

berygu, your last x ray looks good. It looks to have healed nicely. In a much nicer shape than if you left it alone. I left mine alone originally and I was so you say "a freak".... I guess... my shoulders looked very different, even noticeable with a T-shirt on. One trapezius muscle was half the size of the other. Now all that is noticeable is my scar, which I find pretty cool.

Bsbs1876, i know your story with the broken clavicle, i read almost all your posts. The same as you i believe i made the right decision. I know myself and i know that if i let it heal alone and ended up asymmetric i wanted to have the surgery to be like before (or almost like before) .
Unfortunately, i didn't know nothing about the frozen shoulder before i got the surgery, and at that time the priority to me was that the clavicle won't move at all from the screws and plate, so that it heals as straight as possible. I actually asked the first PT therapist what will happen if i will start PT later, he said i will regain full movements but it will take much longer, he said "you don't want to make PT 1 year". (I am 27 years old...so i said to my self no problem if i start later PT because for me it will be very quick the rehab, but it wasn't at all like that

) In the end i believe i ended up with frozen shoulder even if i didn't have the surgery, because i still remained in a sling for long time, probably longer time, and if it was a malunion then i couldn't do the rehab good because of the pain.
Bsbs, at 5 months post op you could do push ups ? And what was the weight of the dumbbells you worked with at that time? I do not know whether to start a more aggressive rehab, or stick with the exercises from the PT. At PT i only use 5 lb dumbbells

(1 dumbbell = 5 lb) .

 

[bsbs1876]

Quote: Originally Posted by berygu .
Bsbs1876, i know your story with the broken clavicle, i read almost all your posts. The same as you i believe i made the right decision. I know myself and i know that if i let it heal alone and ended up asymmetric i wanted to have the surgery to be like before (or almost like before) .
Unfortunately, i didn't know nothing about the frozen shoulder before i got the surgery, and at that time the priority to me was that the clavicle won't move at all from the screws and plate, so that it heals as straight as possible. I actually asked the first PT therapist what will happen if i will start PT later, he said i will regain full movements but it will take much longer, he said "you don't want to make PT 1 year". (I am 27 years old...so i said to my self no problem if i start later PT because for me it will be very quick the rehab, but it wasn't at all like that

) In the end i believe i ended up with frozen shoulder even if i didn't have the surgery, because i still remained in a sling for long time, probably longer time, and if it was a malunion then i couldn't do the rehab good because of the pain.
Bsbs, at 5 months post op you could do push ups ? And what was the weight of the dumbbells you worked with at that time? I do not know whether to start a more aggressive rehab, or stick with the exercises from the PT. At PT i only use 5 lb dumbbells

(1 dumbbell = 5 lb) .


At 3 months I went to the gym and used 10-15 lb dumbbells. I progressed by about 10 lbs every 3-4 weeks. I think I was doing push ups by about 5 months. I now do 60+ push ups as a warm up before every work out. I could probably do more if I wanted to but I am focusing on the weights and resistance machines more.

Everyone is different though. Don't base yourself off of what others say. Feel your body out and try things lightly and see how they feel. Use pain as your indicator (not discomfort --- there is going to be discomfort and a bit of pain, but if it is is severe then go easy). One thing I truly believe is that a lot of what goes on post op for this surgery is psychological. People see the x ray and realize they have all this metal in them and think that they are disabled or something. Once I got through that idea it has been easy. I actually find that I am more sore if I skip a workout. It is the best therapy. Building the muscle around the area feels to support everything better and keeping the blood flow is important for healing. Just don't be dumb!

 

[berygu]

Quote: Originally Posted by bsbs1876 .

At 3 months I went to the gym and used 10-15 lb dumbbells. I progressed by about 10 lbs every 3-4 weeks. I think I was doing push ups by about 5 months. I now do 60+ push ups as a warm up before every work out. I could probably do more if I wanted to but I am focusing on the weights and resistance machines more.

Everyone is different though. Don't base yourself off of what others say. Feel your body out and try things lightly and see how they feel. Use pain as your indicator (not discomfort --- there is going to be discomfort and a bit of pain, but if it is is severe then go easy). One thing I truly believe is that a lot of what goes on post op for this surgery is psychological. People see the x ray and realize they have all this metal in them and think that they are disabled or something. Once I got through that idea it has been easy. I actually find that I am more sore if I skip a workout. It is the best therapy. Building the muscle around the area feels to support everything better and keeping the blood flow is important for healing. Just don't be dumb!

You read my mind , this is what i feel like with this metal in me...that i am disabled...that if i lift with the operated hand 10-15 lb i will break the plate/bone again. This is why i didn't even try to lift something havier than what i do at the PT but i feel that i could lift much much more. I don't know what i am expecting...i am already 5 months post op. Some guy told me that at 6 months he was confident in his hand (he didn't have surgery)...and i focused that i should probably wait 6 months before actually using my arm like the other one.
A friend of mine had the surgery in may like me...he didn't use the sling at all, his doctor left his hand free... he has full rom and no pain indeed , but his xray lookes like this


and if he lifts something havier sores. his doctor told him to wait until the end of october to go to work.