broken clavicle...surgery or not?

Tromesa

Hey Ryan,
My break was actually im the middle of my collar bone. I was told, similar to you, that approximately 95% of collar bone breaks heal by themselves, and that it's better to let them heal without surgery if possible. The difference with my break was they called it a "high energy" fracture. Which I am told refers to the impact - mine was 70km/hr head on car crash into a telegraph pole. Telegraph pole's don't move much!

HOWEVER, all the reading I have done seems to imply that clavicle breaks that AREN'T in the 'middle' of the bone DO more often require surgery. Apparently the majority of breaks are in the middle of the bone, and heal correctly, but that breaks closer to either end do require surgery. I read somewhere that if one of the following applies, it's more likely you may require surgery:
- High energy fracture
- the break is towards either end of the bone
- the bone pierces the skin during the break
- more than 1.5cm (15mm) gap between the bones

Also, my specialist STRONGLY believed that smoking cigarettes slows the healing of bone. I was further proof of his claim, and I have now quit

I know how you all feel, I was very unsure of what to do. But all I can tell you is that my first 2 doctors told me that it would probably be UNNECESSARY to have surgery, and it wasn't until 10 weeks that they sent me to a specialist in clavicles/shoulders... even THEN, the specialist recommended waiting to see how it goes, so it was literally 4 months after the accident, that the specialist finally said 'ok, you'll definitely need surgery'.

I was also told by the doctors that there are "two schools of thought" when it comes to the decision, and that some doctors don't recommend it, and some do. All I can say is that in my situation it seems to be working very well, and I'm glad I can finally move/lift things etc without worrying about damaging my shoudler.

I'm now 5 weeks post-shoudler op (with bone graft), and have almost 100% range of movement in my shoulder, however I'm not bearing full weight on it yet. I think actualy building up the muscle will probably take a few weeks.

I hope this helps people. I would recommend getting a few opinions, and try and track down a specialist in the field if possible. I'm in Sydney, Australia and am happy to recommend mine if it will help anyone!

Good luck

PS. Here's a link that I found quite informative:
http://www.jpy.com/john/clavicle/

Hope this helps!

RyanG3

Hi, Thanks for the information. I did see 2 more specialists (1 referred me on to another). They did say I have a non-union and the can help me out by plating and bone graft. So, its been nine months now since it was broken. The specialist that I saw last mentioned that he would have plated it in the beginning because the break was near the shoulder end. So, I will be doing the surgery in a few weeks and am very excited to get my shoulder back to normal. It makes me realize how different doctor opinions can be in this area. I was glad to give the natural healing a go, but after learning that this type of break normally becomes a non union, I would have pushed more earlier on. I could tell it wasn't healing, but the general practice doctor kept telling me to wait longer.

I'm just glad that it can be fixed now. Thanks for the information. How was the surgery after? Long healing time or pain?

Thanks,
Ryan

artmichalek

Two years ago I broke off the outer end of my right clavicle, about two inches in. The fracture was completely displaced, and both of my doctors recomended against surgery. New bone had to grow into a gap of about an inch, and it did eventually heal. It was eight weeks before I was given clearance to ride a stationary trainer, and four more before I was allowed on the road. As a result of the break, my shoulder shifted about downward 3/4", and my shoulder blade sticks out a bit on that side. Since the accident, I find that if I'm standing up for any length of time, the muscles on that side of my neck and back get extremely sore.

jon l

I broke my calvicle in about the middle: the 2 ends were overlapping, and there were lots of fragments floating around as well. That shoulder was ~ 5cm shorter than the other, but the skin didn't break . The doctor didn't really give me the option of leaving it, just said it would be best to plate'n'screw it, so I did. I had surgery the next day, and was back on the bike, going slowly, in 3 weeks time. It does sometimes get a little sore if I lay with that arm in the air, but it's fine, and I'm glad it was done.

Don't know about you guy's, but from my experience, I'd get it done again.

Jon L

Tromesa

Hey Ryan,

Glad to hear that you have a 'plan of action', and are moving forward. I for one am very glad I got the surgery done, and I'm sure you will be too. It's a little surprising that the GP you saw didn't recommend surgery in the first place (seeing as your break was closer to the end of the bone)... I totally agree with you - it makes you realise how different doctors opinions are. And it can be very frustrating, if this information about collar bones breaks is available on the internet, why the hell didnt he know!?!? But in my situation, I was also happy to give the natural healing a go, but didn't hesitate about the decision for surgery.

I'm now about 7-8 weeks post-op, and i have full range of movement in my shoulder, and no pain at all. I'm not bearing full weight yet (ie not lifting anything heavier than around 2.5 kg with the shoulder), but am starting to build up the muscle now. Im very happy with the results..

I have to warn you though, the hip graft is PAINFUL Don't be scared or anything, but just be aware that the hip graft will hurt more than the shoulder, so be prepared to sit/lay down for a few weeks after the operation, or if you walk, it will be very slowly! You'll probably want to avoid sneezing & coughing or even laughing too hard as well hehe... That lasted for about 5 weeks for me. But having been through it, I would definitely do it again, as the result is almost 100% recovery for the shoulder

Good luck!

Adam

seattlecyclist

There's no easy correct answer for everyone. The treatment is tailored to the individual. Risks of surgery are infection and non union, but also injury to the lovely things that are near your clavicle (subclavian artery and vein - those really do bleed like stink) and lungs (specifically collapsing one). There are actually reports of death due to migration of pins (at some time after surgery I might add) to the aorta. Strange but true.

For athletes, paratroopers, and a variety of others whose livelihood depends on getting back to the activities that caused the break, surgery, by someone skilled in it, is my recommendation. I would have it myself. Just realize the risks can be substantial, even in teh best of hands.

Ask your surgeon about an "intermedullary screw"

My 2 cents.

byfred

I broke mine May 29th, 2003. My doctor told me "that as long as both ends are in the same room, they will eventually get back together" He put that "figure #8" strap on me, sent me home, with instructions to return in 3 weeks to begin therapy. I put in 2 or 3 really painful nights in bed, and it was all uphill from there. When I returned for "therapy", I already had full movement, and he sent me home again, with instructions "not to move any pianos". I was back on my bicycle that day, three weeks from my fall and did a 3000 mile Bike Tour that summer. I haven't had a bit of trouble with it at all, and I'm 66 years old.
During that first 3 weeks, I found that it was VERY painful to use a fly-swatter........something to do with "quick movements", I would imagine.
Just take things a little easy and I'm sure you will be just fine.

RyanG3

Hi Adam,
Did have the surgery and I am still pretty sore. It has been about 2 weeks. I can definitely feel the support for my shoulder already though. The doctor said he almost did a hip graft but was able to save enough bone from the collar bone cleanup to re-use He did have to cut a lot of muscle away and re-sew under the bone that I grew over the collar bone. Did you have considerable pain during the recovery? I still can't do a whole lot without sharp pains in my shoulder. I'm told not to lift more than 2.5kg for the next 4 more weeks and see how it is then. So far, just the support in my arm seems to be worth the effort. It doesn't feel like it is "hanging" there anymore.

Yes, it would be good to give doctors internet training (for those who have none) to keep up with the latest. It has greatly helped my awareness.

THanks,
Ryan

vickieflores

I'm not really a cyclist, but broke my collar bone in July 2003 falling off a horse and think that whilst surgery may be the answer you do need to be aware of the risks/complications involved.
Initially I went along the route of wait and see and when things hadn't improved and there was no sign of union after 2 months I had surgery to pin/plate my clavicle.
Initially this seemed successful - the pain vanished overnight and I was back at work within a week. A couple of weeks after that I experienced a numbness in my middle and ring fingers and over the next 2 weeks this numbness spread up my arm towards my elbow to the point where i'd lost all feeling in 2 fingers and half my arm. To cut a long story short, the plate and pins were removed 4 weeks later and x-rays showed that there had been some union. The feeling returned to my fingers and arm and MRI scans have shown there to be no permanent nerve damage.
Unfortunately over the next few months I began experiencing increased pain in my neck and the original fracture site which revealed that there is no union. After many scans I had my clavicle pinned/plated and bone grafted again a week ago. ...so far so good!
Whilst I definitely agree that in some cases surgery is the best option, please be aware that there are risks and that I was lucky that the nerve damage wasn't permanent - even so I'm still here with a broken collar bone almost a year and a half after the original accident, so it isn't always the quickest way either!
From what I've read though, it seems to be doctors who favour the "wait and see" approach, whilst patients generally report that they are very glad that they went ahead with the surgery (i.e. I was one of the very few unlucky ones). On balance I'd probably still say "go for it" but just be aware that there are risks.

I'd be very interested if anyone has any advice on what I should / should not do to give it the best chance of union this time round, as I've looked on the Internet but not really found anything particularly helpful from a patient perspective.

byfred

When I hear the stories some of you have experienced, I wonder if it really was the "clavical" that I broke. It really hasn't given me any problem at all. In fact, I can almost believe that Tyler Hamilton was able to ride the Tour de France with his broken. I could NEVER have done that in a 1000 years.

pcoopes

Hi Guys

I've just been told today that I will need surgery on my broken collar bone. It was snapped in half when I was hit by a motorcyclist six months ago (I was a pedestrian).

Just wondered how you guys have found everything since. How much healing time was involved after the surgery?

I'm debating whether to have the surgery here in London or to wait until I get home to Perth so I am trying to find out more about the after surgery recovery.

Look forward to hearing from you or anyone else!

Thanks
Peta

Steve P

I don't understand how some of your guys were able to do a "swm marathon" and just go on about using that arm. When I broke my collar bone I couldn't even move that arm. I pretty much just sat on a couch for about two weeks wearing that weird figure eight contraption they put on you. I seriously could not move my arm though because it hurt so bad. The doctors never even mentioned surgery to me my bone just healed on it's own. It only took about a month to heal up and I could actually do stuff again. It's just blowing my mind that some of you are tlaking about still being able to do stuff with it broken because I couldn't move it hurt so bad.

P.S. I broke mine on a road bike during a really fast descent...I hit a pot hole in the road that I didn't see.

byfred

Mine only hurt for the first three weeks.........the most painful thing was to use a fly-swatter. I never even thought of surgery and my doctor never mentioned it either. It's been all up hill since then and I have full movement and no pain, just a lump on the site of the fracture.

byfred

pcoopes

Mine didn't hurt too badly after the first few weeks, its more just restrictive in that I can't seem to lift heavy objects or sleep on my side etc.

The bones are still separated after six months and the Doctors think there may be a muscle in the way preventing them from rejoining and healing. This is why some cases do require surgery and some don't.

Hey - you guys who have had surgery - can I ask what the scarring is like??

Thanks!
Peta