broken clavicle...surgery or not?

[willy81]

it does not matter how many centimeters your fracture was. Since you had the surgery your Doctor re-aligned the two parts as they were before the accident. this is my XRays back in July 2012, before and after the operation http://www.cyclingforums.com/t/133419/broken-clavicle-surgery-or-not/750#post_4039725 I believe after the 7th, 8th week you will feel a lot better. You don't need to raise your arm at 90 deg for physio, you can do the same exercise if you bend over and let your arm hang freely, this exercise is called The Pendulum, don't rush it, Collar bone takes a lot of load when you raise your arm, now this load is taken by the plate but it can break until your bone creates some Hard Calus, it starts around the 6th week. Read the link I posted yesterday, it is a bout the heeling process. Upload here your Xrays if you can make a photo of them.

 

[berygu]

Hey, *****, Bsbs, Alienator!
Do you think at 6 months post op it's possible to break the bone again by making exercices with a domyos-fit-band-10kg-fitness ?
I am having some pain the recent days.

 

[Dane Girl]

Hello. I am not a cyclist however I do admire all of you that are!! I am a Great Dane enthusiast and 3 months ago my Dane accidentally pulled me down and I broke my collarbone. I knew instantly because I heard the crack. But I didn't go to the ER until 2 days later. When I did go they said I needed surgery that day. It I had already eaten something so they said that they couldn't do it that day and I needed to see an ortho and then schedule the surgery. Well the ortho I saw thought that we should wait to see if it would heal on its own. It is a complete diagonal diplaced distal fracture. Myself and everyone I knew did not see how it could possibly heal together by the way that the X-Ray looked. But I began the waiting like the ortho said. After a couple more visits and X-rays the ortho refered me to a trauma specialist. The trauma specialist said the decision was up to me but if I wanted more range of motion to go for the surgery but I could certainly live with it the way that it is even if it never heales together! I thought that would be absurd. I few weeks later I decided on surgery because after 10 weeks there were no signs of any healing at all and I was sure it would never heal together and I did not want to stay this way forever. I can do a lot of normal activities just because I got used to using one arm but I do have a lot of pain still and I can only lift my left arm a little less than shoulder height. I get fatigued very easy. I have a lot of shoulder blade pain and major pain in my shoulder joint. I am still unsure about the surgery though. It is scheduled for Dec. 3rd so it is coming up soon. I am very very scared. I am very sensitive and maybe even allergic to prescription pain meds. I am worried I will have an anesthesia reaction. I have had tachycardia in the past with pain meds and it really worries me. Also I am very thin. 108 lbs and 5'5" and I have no tissue over my clavicle. I don't mind about a scar or seeing the plate but I am worried about the plate causing me a lot of pain. I need my shoulder to have proper use so that I can hold onto my Great Dane. I had her in obedience classes to train her but halfway through our classes I had this accident and couldn't finish them. My objective was to train her to be a therapy Dog. In any case if she is trained or not I need good strength in my shoulder because Dogs can be unpredictable and she also has a high prey drive so if she sees a bunny I have to hold tight. I also want to be able to do exercise like riding my bike, shooting hoops at home and other simple exercises to stay healthy. I also do lots of cleaning and cooking at home so I want to be able to do all these things without pain and with normal strength in my shoulder. Anyone have an opinion about whether I should go ahead with the surgery or not. I am afraid of the anesthesia but also about other complications and the pain afterward because I am unable to use prescription pain meds because of my sensitivity. My preop appt is this coming Wednesday so I need to decide about it by then.

Thanks for any input! Signed, Very nervous Girl

 

[Anything But]

Willy81 wow, there were posts yesterday that I completely missed. My surgeon said there wouldn't be much callus. I don't know if it's mainly because the clavicle is different kind of bone than other bones in the body (there's no cartilage when growing up the same way as in humerus, radius or other bones, so it breaks easily in children too) or if it's because of the plate. The break was actually quite clean except for the 2 cm fragment which won't be filled in with any bone. The fracture will heal, but the missing chunk will be missing and the bone is left a bit thinner, not shorter. I don't know how thick or thin the fragment is. Berygu, at least I got a full permission to do slalom 4 months after the operation. I know I will fall every now and then. And I have a lot of speed doing so. Maybe I should hope I'll fall down only when I'm curving right. I have to try to get the x-rays here. I've got them on cd.

 

[NattyBumpo]

I have suffered three broken clavicles, one right side and two left. All three healed in a 'malunion', doctor-speak for a noticeable lump on the bone. This happened in part because I toss and turn a lot in my sleep, so the figure of eight brace, which is the standard conservative treatment, is completely ineffective at keeping the bone fragments oriented so they will heal with a neat and 'un-lumpy' appearance.

After the second fracture on the left side, the two malunions left a lump large enough to cause irritation to the overlying tissue, so I had an orthopedist surgically "groom" the lumps to make them less prominent. I also should note that the bone broke the second time at a new spot and not at the original fx site, which supports the old wive's tale that a broken bone heals back stronger.

Another problem with the malunions is they change (at least very slightly) the relationship of the chest and shoulder muscles to the underlying bone structure from the angles and distances that mother nature intended to something completely arbitrary. In my case, both shoulders have more 'droop' than before the breaks, and the left side droop is more than the right. And the changes in the configuration of the "mechanical linkages" made by all the muscles and bones has left me more susceptible to shoulder problems, like rotator cuffs tears.

Long story short, I have had (and continue to have) some consequential shoulder problems directly traceable to the fact that I failed to insist that the fx clavicles be 'pinned.' I will not deign to tell anyone else how they need to be treated but, in my case, it was a mistake not to have the fractures pinned or plated.

 

[willy81]

Hey, *****, Bsbs, Alienator! Do you think at 6 months post op it's possible to break the bone again by making exercices with a domyos-fit-band-10kg-fitness ? I am having some pain the recent days.

the progress of your heeling process can be seen in an Xray, when the black gaps turn into white means that Hard Calus is present, six months post-op is quite long so I would guess it is not possible to harm your shoulder by lifting 10Kgs, I lifted 10 Kgs much earlier, after 2.5 months, if I remember correctly. By six months I tried some wrestling with a friend who accidentally fell over my and threw me down on my affected shoulder, but still my collar bone was strong enough to take the load as normal. The pain is from the surrounding muscles which come back slowly, your recent pain means more fibers get back to work.

 

[willy81]

Dane Gril, there is nothing to be afraid of if you have an experienced doctor, this kind of surgeries are routine and the anesthesia is not as strong as you might think, in fact they give you in the beginning a light anesthesia and then they paralyze with drugs your affected side so it is not possible to feel the pain, not because you are under a deep anesthesia but because your side has been temporally paralyzed. Your break is very typical, very clean fracture,I had a similar one, you will be ok and your bone will heel just fine, there is nothing to worry about. Your choice to go ahead with the surgery is absolutely correct, otherwise the bone would never realign as before.

 

[willy81]

I have to try to get the x-rays here. I've got them on cd.

right, let's see your fracture

 

[willy81]

NattyBumpo, why don't you visit a doctor and ask him to fix your collar bones? I suppose you will much better in the long run, say 3-4 years post-op

 

[Anything But]

Okay, here comes. Lets see if I can get the pictures here. Seems quite clean.

To Dane girl
I always thought it's best if I wouldn't need an operation but if there would be any doubts about the healing without it, I would have one. Almost turned around at the hospital when I was told about the risks. Then I realized they have to tell the risks, however small.

I had a larynx mask. Throat was a bit sore the next two days. I didn't really need any pain killers, but I suppose everyone's different. Before operation I was asked about any allergies. Some people are allergic to nsaid's (such as asperin) and can only have paracethamol, or stronger pain killers. I thought I'd be more nervous about the operation, but I had figured out they would't be near any critical organ and it's quite an easy operation even with its possible complications.
But I couldn't have taken my dogs for a walk after the operation.

But here comes the pictures if I can manage it. there should be four, two before and two post op. Unfortunately, first one is the last one and after that they come in right order.

 

[alienator]

Hey, *****, Bsbs, Alienator! Do you think at 6 months post op it's possible to break the bone again by making exercices with a domyos-fit-band-10kg-fitness ? I am having some pain the recent days.

That's a question for your doctor or PT, not for anyone here to answer. It's certainly not for willy81 to answer.

 

[alienator]

Dane Gril, there is nothing to be afraid of if you have an experienced doctor, this kind of surgeries are routine and the anesthesia is not as strong as you might think, in fact they give you in the beginning a light anesthesia and then they paralyze with drugs your affected side so it is not possible to feel the pain, not because you are under a deep anesthesia but because your side has been temporally paralyzed. Your break is very typical, very clean fracture,I had a similar one, you will be ok and your bone will heel just fine, there is nothing to worry about. Your choice to go ahead with the surgery is absolutely correct, otherwise the bone would never realign as before.

There goes willy81 practicing medicine, again, giving medical outcomes and guarantees! Those are things that only an idiot would do. Good doctors don't even make such guarantees.

 

[alienator]

NattyBumpo, why don't you visit a doctor and ask him to fix your collar bones? I suppose you will much better in the long run, say 3-4 years post-op

3-4 years? Is that what your extensive medical training tells you........or is it you just posing as someone knowledgeable after your collarbone was broken. You know, willard, being unlucky doesn't mean you're qualified to give medical advice. That's something only an asshat would do.

 

[Dane Girl]

Thanks for the replies Willy81 and Anything But. I feel like surgery is the best choice for me, it is just being scared that is holding me back. I really am sick of my shoulder aching and not really getting any better. It seems to be at a stand still at this point or maybe even tightening up a bit more in some areas. I feel like if I do not get the surgery my arm will heal in this particular position and I will never be able to raise my arm again. I am definitely not looking for someone to tell me exactly what I should do here like a doctor would. I am looking for opinions from people who have personally gone through this and have experience dealing with a broken clavicle with surgery, without surgery and the outcomes. After reading many stories on this forum I have come to the conclusion that in general it seems that most people that have had the surgery are quite happy with their decision. I just wanted a little reassurance from anyone who had a similar break as mine. So thanks Willy81. And Anything But, thanks for the pictures of your X-rays. Your clavicle looks very inline now and I hope that mine can be too. How are you feeling now? I forgot to mention that I am 40 years old and my family has a history of osteoporosis so I don't know if I may have a problem with that also being so thin. I am worried about my bone not healing under the plate because of this. I am also a vegetarian. I will talk with my doctor about this at my preop appt and some other things too. I can never seem to ask him everything I want in one visit and they won't answer any questions over the phone. Appts only. I always think of something else to ask him after I have already left even though I take a list with me! Also another troubling thing I have been experiencing is my left hand turning purple if I hang my arm down to my side. The ortho said that since my bone is broken and cannot support my arm, the weight of my arm is pulling it down and compressing something and cutting off the blood flow. It is very disturbing and my hand becomes tingly and numb if I let my arm hang down too long. So I avoid doing that. I think restoring my collarbone back to the way it is supposed to be will hopefully eliminate this problem. I really wish that I had already had the surgery back when the break happened. I really did not think that it would heal in the position that it is in. All of the time waiting for it to heal and it could have been healed already. After reading so many surgery success stories I wish I had went that way to begin with. My ortho did not say anything about a bone graft but I have read on here that if you wait to get surgery that you may need one. Not sure how common it is to have to have one. Thanks for this forum. It has helped me feel better about getting the surgery. And it helps to know others that have gone through this experience and are able to return to normal life again. I am so tired of sitting on the couch!! I know I will have to for a while after the surgery too. At least I will know that my bone is in the right position and hopefully healing. My left shoulder is significantly shortened and my clothes fall off of my shoulder all day long. Can't wait for that to be remedied as well! Thanks for any help or further encouragement!

 

[Anything But]

Originally Posted by Dane Girl

Hello. I am not a cyclist however I do admire all of you that are!! I am a Great Dane enthusiast and 3 months ago my Dane accidentally pulled me down and I broke my collarbone. I knew instantly because I heard the crack. But I didn't go to the ER until 2 days later. When I did go they said I needed surgery that day. It I had already eaten something so they said that they couldn't do it that day and I needed to see an ortho and then schedule the surgery. Well the ortho I saw thought that we should wait to see if it would heal on its own. It is a complete diagonal diplaced distal fracture. Myself and everyone I knew did not see how it could possibly heal together by the way that the X-Ray looked. But I began the waiting like the ortho said. After a couple more visits and X-rays the ortho refered me to a trauma specialist. The trauma specialist said the decision was up to me but if I wanted more range of motion to go for the surgery but I could certainly live with it the way that it is even if it never heales together! I thought that would be absurd. I few weeks later I decided on surgery because after 10 weeks there were no signs of any healing at all and I was sure it would never heal together and I did not want to stay this way forever. I can do a lot of normal activities just because I got used to using one arm but I do have a lot of pain still and I can only lift my left arm a little less than shoulder height. I get fatigued very easy. I have a lot of shoulder blade pain and major pain in my shoulder joint.

I am still unsure about the surgery though. It is scheduled for Dec. 3rd so it is coming up soon. I am very very scared. I am very sensitive and maybe even allergic to prescription pain meds. I am worried I will have an anesthesia reaction. I have had tachycardia in the past with pain meds and it really worries me. Also I am very thin. 108 lbs and 5'5" and I have no tissue over my clavicle. I don't mind about a scar or seeing the plate but I am worried about the plate causing me a lot of pain. I need my shoulder to have proper use so that I can hold onto my Great Dane. I had her in obedience classes to train her but halfway through our classes I had this accident and couldn't finish them. My objective was to train her to be a therapy Dog. In any case if she is trained or not I need good strength in my shoulder because Dogs can be unpredictable and she also has a high prey drive so if she sees a bunny I have to hold tight. I also want to be able to do exercise like riding my bike, shooting hoops at home and other simple exercises to stay healthy. I also do lots of cleaning and cooking at home so I want to be able to do all these things without pain and with normal strength in my shoulder.

Anyone have an opinion about whether I should go ahead with the surgery or not. I am afraid of the anesthesia but also about other complications and the pain afterward because I am unable to use prescription pain meds because of my sensitivity. My preop appt is this coming Wednesday so I need to decide about it by then.
Thanks for any input!
Signed,
Very nervous Girl

Hi Dane Girl!

I replied something earlier about my operation. I have been scared for any operation before and was sure I'd freak out just as I'd go to the table. I didn't. Even if I had, I would've calmed down when they gave me benzodiazepine. The fasting did make it quite strong.

The anesthesiologists know a lot about medicines and really, they know how to secure the airways if needed (like in a severe allergic reaction). I was under anesthesia, so I went confidently into sleep and woke up when they took the larynx mask of. After that I was fully orientated which I hadn't expected and which I suppose depends on many things.

I too think it's absurd that a healthy young person would have a broken clavicle in the body. I know people who won't have the clavicles to begin with, and they are doing fine. However, during my search for knowledge I crossed an information that a broken, severely shattered clavicle that can't be fixed is usually trimmed off. Gone. That's not what I'd want.

You said you weren't happy about the broken clavicle. Are you just afraid of the operation and trying to get affirmation?

I myself didn't have too much pain. First, yes of course I had pain. Then it occurred every now and then. Sometimes the was strange feeling of pressure without any pain. Sometimes it felt like when you had a loose tooth as a child and you'd twist it. Probably the bone scratching the pectoralis. So the pain was bigger than with a loose tooth.

After the surgery the most painful part of my body was around the shoulder joint (it lasted about 12 hours) and the sternocleidomastoid muscle. The latter took a couple of days before I felt ok with it. I took painkillers on two nights to secure I'd get some sleep. Otherwise, to me there's really no big pain. That's not the case with majority here, if I'm correct. Now I have itching and a sort of a pain that feels like if you are having contact lenses for too long and your eyes are really dry and somewhat irritated (probably something to do with the numbness and itching together). I know, it probably sounds absurd, but that how I'd describe it. 1 weeks after the operation I didn't do much, but when I had to walk outside the house, there was more discomfort and pain. At home, the pace is really quite slow and I felt fine.

Then the big BUT: do you have someone to help you with your dog after the operation? I couldn't have handled my two small dogs, and when I finally took them for a walk, I harnessed them and attached to a running belt that's meant for running with dogs. I'm soon 4 weeks after the operation, and I wouldn't take a big dog on a leash. Their strength is much more than what they weigh, and you can't use the operated arm for quite some time. At least, ask your Dr. about this.

During the first week before operation, I slept a lot. During the 1-2 weeks after operation, I slept a lot. Now I feel almost normal, but maybe I've started to sleep better?
Now I can have buttons on clothes again, sleeves on shirts and I can make a ponytail (well, not too well but the hair's tied up) and put earrings on myself.

 

[bsbs1876]

I think I finally figured it out. Alienator keeps coming back to this thread to post his same message to further glorify his colossus post count on this forum so he can e-flex for all the ladies.

 

[bsbs1876]

Dane Girl, I'm not a doctor, but that x ray screams surgery in my opinion. There is so much overlap and displacement going on...

AB, surgery was the right choice for you too in my opinion. You girls both did a good job on breaking that bone.

My two cents as a collar bone victim only.

 

[alienator]

I think I finally figured it out. Alienator keeps coming back to this thread to post his same message to further glorify his colossus post count on this forum so he can e-flex for all the ladies.

Actually, as someone who worked in the medical field, I'm just concerned that people will actually take the irresponsible advice that people like willy81 dispenses. I could really care less about my post count, but apparently it's important to you. Good luck finding a post where I've discussed how _______ it is to have a lot posts. You'll also note that I've been on the forum a long time. That you're cool with all the irresponsible advice given really puts your words into perspective.

 

[Anything But]

Originally Posted by Dane Girl

Thanks for the replies Willy81 and Anything But. I feel like surgery is the best choice for me, it is just being scared that is holding me back. I really am sick of my shoulder aching and not really getting any better. It seems to be at a stand still at this point or maybe even tightening up a bit more in some areas. And Anything But, thanks for the pictures of your X-rays. Your clavicle looks very inline now and I hope that mine can be too. How are you feeling now?

I forgot to mention that I am 40 years old and my family has a history of osteoporosis so I don't know if I may have a problem with that also being so thin. I am worried about my bone not healing under the plate because of this. I am also a vegetarian. I will talk with my doctor about this at my preop appt and some other things too. I can never seem to ask him everything I want in one visit and they won't answer any questions over the phone. Appts only. I always think of something else to ask him after I have already left even though I take a list with me!

Also another troubling thing I have been experiencing is my left hand turning purple if I hang my arm down to my side. The ortho said that since my bone is broken and cannot support my arm, the weight of my arm is pulling it down and compressing something and cutting off the blood flow. I

I was writing a long story and didn't see this

My physiotherapist checked that I didn't have swelling on my hand. It happens a lot if you don't use your limb, even if there's no pressure against the veins. Even before the surgery I did some movement on my elbow and hand. I had to, otherwise it started to hurt. But then I had the sling. hated it.

I don't know if it helps or not, but I've taken vitamin D... I get enough calcium from food, but I want to make sure it gets absorbed. Possible osteoporosis doesn't sound too good, I hope you are just thin and not have malnutrition, either from dietary reasons or from poor absorption.

So, I mostly need some sort of peer support (we all do, don't we?). And reassurance that I'm doing things right and that I should just be patient. Even though I'm a bit anxious and a little bit stubborn so I'll probably end up trying some small stuff which I probably shouldn't.

 

[alienator]

Dane Girl, with a family history of osteoporosis, you might want to ask your orthopedic surgeon if meds used to treat osteoporosis would be appropriate before or after the surgery. There have been cases in which patients with complicated fractures or orthopedic surgeries have taken drugs like Fosamax to try to improve or speed healing. Definitely discuss your family's history of osteoporosis with your doctor. Also be sure to discuss the issues you've had with pain meds. It could be that you may not have that issue with all pain meds or that there might be an alternative to traditional pain meds. By all means you should discuss with your doctor any and all of your worries related to the surgery and the status of your clavicle, circulation, et al.