broken clavicle...surgery or not?

factory61

Tried to get by with just a long pin since it's less invasive. Don't recommend it if you are going to try and remain active. Plate and screws are much more sturdy, but they will probably have to disrupt some muscle and other "soft" tissue.

It also depends how many pieces the clavical has broken into and where the fractures are located.

axejunkie

Just thought I would share my experience here - I broke my collarbone playing flag football on January 13 (yes, flag football - another player dove and landed on my chest while I was on the ground). I saw an orthopaedic surgeon and he felt surgery would be the best route, saying there was more than 2cm of separation and I would likely have a shorter bone and less range of motion without surgery.

I had surgery 12 days after breaking it. The doctor pinned the bone together and I was in a sling for 10 days. Lots of pain and percocet was my best friend for a week or so.

I started physical therapy at 6 weeks and that went for a month. I made some good progress and got most of my motion back.

I had follow-up surgery on May 17 to remove the pin and that was much easier than first one - took about 20 minutes to perform and I didn't need a sling. I'd say I'm at 90% now, just need to get some strength back which I'm working on.

All in all I'm satisfied with how things went. Course I'll never know how things would've gone without surgery, but the shorter bone reasoning was enough to scare me. Hope this helps some of you in the same situation I was.

santanaf

I wanted to take a minute to share my story since I found so much useful information on this board. This thread helped me to make my decision to go for surgery.

I am a very active 29 year old male. I lift weights 4 times per week, play baseball and softball, run, cycle, and work on my house, doing everything from electrical to plumbing to heavy contrsuction in my spare time. I am a computer programmer by day.

I had a trip to the Bahamas scheduled beginning 5/30/07...

On 5/22/07 while playing center field in a softball game, a ball was hit into shallow left center and I was sprinting to the location. Going to make a back handed catch I decided the only way to make it was to lay myself out. As I dove the ball carried under my and my glove did as well, this placed all of my momentum and weight onto the top of my left shoulder, which forced my shoulder down and fractured my clavicle.... hence this post.

Here is the initial x-ray http://www.santantonio.net/files/xray.jpg

I immediatly knew it was broken. The clavicle end was pushing up against my skin and I could clearly feel the bump where the skin was slightly tenting. The pain was bad, but not terrible. I was able to run off the field after it happened yelling "I'm out I'm out". I called my wife and told her I was broken and to meet me at the hospital.

Since I drive a manual transmission, with the encouragement of my teamates I decided to call an ambulance. The ambulance came and the worst part was the ride in the stretcher over the bumpy gravel road. I didn't take anything for the pain because I really don't do well with any sort of narcotics. I get nausious easily and vommiting all night is way worse than the pain.

When I got to the hospital I got the above x-ray taken and was given a sling. When they were putting the sling on me the pain was so bad that I started to vommit. Once that was done and some color came back into my face, I was ready to head home. Before I left the dr. on call talked to the ortho and told me the break was severe enough that I may need surgery.

By the morning of 5/23/07 the pain was managable. I slept on and off and kept waking myself up my moving my damn arm... stupid dreams. I was taking ibuprofin to keep swelling down, but that is all. We scheduled an ortho appt for later in the day.

The Orthopedic Surgeon I met with was part of Commonwealth Orthopedics in INOVA Alexandria complex. His name is Daniel E. Thompson. My wife and I were very happy with him and with the information that he presented. He told me that I would probably heal without surgery but there was the potential for a non-union. I gave me a timeline of 6 months with 2-3 in a sling. He then told me that surgery was an option, but totally up to me. He would use a titanium plate to join the two halves. He said the sucess rate is better, same 100% recovery time of 6 months, but I would be more comfortable in the short term. Without surgery I would heal with a shorter shoulder and a lump, with surgery I would have symetry again but would have a scar. I told him I was taking only ibuprofin for pain and he was fairly surprised.

I opted for surgery and was scheduled just two days later by Dr. Thompson's excellent surgery scheduling assitant. They worked with us to get us an appt on 5/25/07 at 1:00 pm.

I didn't eat from 12:00am on the day of surgery and drank only two sips of water.

Between the initial consult and the surgery I took nothing for pain since it wasn't really necessary. I was having surgery at INOVA Alexandria Hospital in Virginia, and met with my anesthesiologist regarding my concerns with anesthesia. She performed a local block on my shoulder and put me under very light sedation. I don't remember much about that day, although I had many conversations with the Dr. about treatment, rehab, the sling vs figure 8, and even an patient who broke the titanium plate... I have no recollection of this.

After surgery I woke up around 5:00pm feeling very nausious with my sling back on an a lot of iodine on me. My left arm was 100% numb and dead to me. I could feel nothing, it was so creepy. As I woke up I was very dizzy and started vommiting a lot when I started to be moved. I was perscribed Phenergan for nausea and Percocet for pain from the intitial hospital visit, and abenol (I think) as a stronger than advil alternative, but I was hoping to take nothing.

On the way home I kept throwing up in the car and when I got home I went straight away to bed. I slept the rest of the day on and off and didn't eat anything. The pain wasn't anything yet, but my arm/shoulder was still dead and the dizzyness was severe, so I laid very very still. The last time I threw up was at 8:00 pm

At 11:15 pm I woke my wife up and told her the pain in my sternum area was starting to come in a little bit, so she gave the the abenol in hopes of heading it off. The feeling was slowly coming back into my arm. The Dr. said to stay ahead of the pain with painkillers, but my nausea was keeping me from taking anything. I then woke up again at about 1:30 pm with what felt like an Elephant standing in the middle of my chest. The ibuprofin I was taking was doing nothing. I was literally writing in pain, but I didn't feel dizzy or nauseaus anymore... woot.

I tried to just take the pain but I couldn't. After a conversation with the on call Dr. and 4 hours of excrutiating pain in my sternum and shoulder, I took two percocet and was out and asleep without pain in about 15-20 minutes. I slept soundly. When I woke up around 12:00 pm, by jerking my arm again, I didn't have much pain, but I didn't much feel like getting out of bed. After a day of eating saltines and bananas, and drinking Gatorade, I ventured out of bed around 5:00 pm and headed to the television. I didn't have much pain but was taking 1 percocet every 6 hours that first day.

By 5/27/07, Sunday, I was not taking painkillers during the day only to sleep, and that was only because I was scared of the pain from the first night.

My mobility after surgery was greatly improved, and the scar is not too bad. My trip to the bahamas was decidedly low key, but not painful. By day 3 post opp I was completely off of pain meds and had little to no swelling.

My followup appt gave me this cool x-ray http://www.santantonio.net/files/screws.jpg

I am 10 days out and I had my stitches out and had a good conversation with my Doc. Right now the main problem is that am *without* pain. This means I don't really know my limitations. I don't feel like I need my sling at all, but I wear it to protect myself from people when taking the metro to work. I need to keep stopping myself from doing things I shouldn't now.

Physical therapy starts on Monday, 6/11/07, and I hope to be completely without sling by 6/25/07. I will post back here as time progresses.

If anything, I can say get the surgery. By coincidence, a co-workers 22 year old son had almost the same break doing almost the same thing within 1 day of mine. He has opted for the natural healing method with sling. He is still in a lot of pain right now and has limited mobility.

santanaf

Well, I am now at 1 month post op. Everything has been great for the last 2 weeks especially. As I stated in my previous post, surgery was good, somewhat painful in the short term, but has since been fine.

The only serious pain I've really had in the last few weeks was at my CS joint on my sternum. This was mobilized a bit much during surgery so it feels a little off, sort of a sharp pain from time to time, but has been greatly reduced from weeks 3 to 4. I ran my right (non injured) shoulder into a door frame while trying to avoid someone with my slinged arm, and the jarring movement it send through to the CS joint on my left was terrible pain, but that is more or less the extent of the pain I've had.

I go to the Dr. today for my 1 month followup and I began PT about 2 weeks ago, 6 sessions so far. The PT has been wonderful, all passive ROM excercises, but just getting flexibility back into my weakened shoulder. After the first session I felt like I went from 30% to 60%. Now I am fully mobile in my injured shoulder, and oddly, I have a greater ROM in my injured shoudler than my uninjured one. Go figure.

PT is Mount Vernon Invoa Physical Therapy, working with Lisa, Laurie, and Beatrice. As I said before, all are great.

So my followup today I am guessing he will say, "You can stop using the sling, you can start stregthening in PT, and keep taking it easy."

I'm guessing another 2 weeks until the bone is completely healed.

Update on co-workers's son, he's still in a sling and still having a good deal of pain. He has limited to no use of his injured arm still. We will probably be 100% about the same time, but getting there for him is a harder journey.

The cost of my surgery was just north of $7,000. Thank God I have insurance. ER visit, PT, and Surgery will total about $10,000

Wish I hadn't tried to catch that ball.

phil_norhtstar

Very glad alll went well on your orif.
Got my left clavicle broken on May 14th. Had my orif performed that night too. All went well actually. No nausea, no dizziness, scar is quite long. About 10cm or so. Looks fine anyway. I was hoping to go back to work by the end of June. I spent 2 weeks vacation before travelling to city where i work. About an 8 hours drive. Just so, i had to see a new ortho for my follow up check ups. My first ortho gave me 6 weeks timeline for unpinning. My second ortho had to observe that period too. So, my second ortho decided to remove my pin on the said timeline after reading the result of my x-ray. It shows a good callus formation surrounding the break, good alignment. I am not into meds actually but i know that there's no bony union yet. Really! But then i have to trust what my ortho says. So my pin was removed that day. Unfortunately, i had it broken again. I don't know how it happens but i woke the next morning with a pain and bump in my shoulder. I knew it was broken, i could even hear a creeking sound everytime i move my shoulder. Now i am recovering on a figure 8 brace 'coz my ortho discourages orif on the clavicle. I insist to have a second surgery though. See, all the pain and waiting for recovery from my surgery was wasted. I don't know if my bone has still the chance to unite hearing that an orif might hinder the bones from healling naturally. I have to wait for an additional 4 weeks to see the result. Imagine how much time i've lost for just a simple crack on my shoulder? I don't know what to do, I want to blaim my ortho for what happened. I could have waited long enough until my bone totally unites before unpinning. Could somebody give me an opinion. Thanks!!!

dpc61820

I have a fairly similar break, but very different story. I broke my right collar bone in Nov 2005 and went with the non-surgical option. After a while I was fine for doing most things, including biking, but the damned bones never did come together and I had strength limitations and had particular issues (e.g., using my right arm for overhead stuff like painting ceilings; driving long periods, say 2-3 hours or more, I think because my right arm was left to hang without the necessary support).

I just had surgery a week ago. A few points for others:

1. You've heard this before, but it bears repeating--if you aren't happy with your doctor, there are more out there! (And hopefully you have a medical plan that will allow you to see someone else.) The doctor who had put me in a sling, then many weeks later a figure-8 brace back near the time of the original injury told me some 20 months later when I clearly still had no union that if I did get surgery it would involve a hip bone graft and that's no good, so come back in 6 weeks... I found another doctor. This guy said we'll do the internal brace (my post-op x-ray looks like santanaf's), no grafting, no messing with the hip bone...

2. It is true what someone said way back in this tread about the treatment being tailored to the patient. However, it's also very true that the treatment is highly doctor dependent. As illustrated above, two doctors can have a very different approach. Unfortunately (a little for me, a lot for him and his loved-ones) my second doctor had a mild stroke before he could do the surgery mentioned above. I wasn't going to go back to number one, so it was on to yet another. This guy was also up for the no-graft, plate and screws option, but his post-op approach was very different (question about that below). The stroke doctor had said I'd have my arm fully immobilized for a month (not because the bone needed it but rather because all the soft tissues would need time to recover) but the doctor I ended up using just put me in a sling and said even that was more as a reminder to not do extreme movements or lift anything heavy, and I can and should go ahead and use my right hand for little things like typing, brushing my teeth, eating...



3. Concerning the question that names this thread, consider factors like age and displacement. I see lots of information posted by people about themselves or their children concerning breaks suffered by teenagers. Useful information, certainly, but if you're like me (40), maybe not applicable. If you're older, think about the fact that that makes union without surgery less likely. Also, displacement...I was told by the ER doctor and all the others I've seen since as well as a zillion web pages that "surgery is rarely necessary..." Well, that may be true if the bones are close together, but if you have significant displacement (mine was over 3 cm) and other complications surgery may be more likely what you're going to need. It's worth talking about this with your doctor, and it's really worth getting a second opinion.


My questions...for those who have had surgery, what has been your post-op experience? How long have you needed the sling? When did you start strength training? Were you told to be careful about anything that could impinge bone formation or cause the screws to come out or whatever?

I'm asking because I haven't gotten much good information from my doctor on this stuff, and what he has told me is so different than the information I had gotten from the doctor who was to have done the operation.

My operation was July 2, 2007, it's now July 11. I'm still in the sling some of the day, but find it such a bother and don't really feel like I need it. But I don't want to over-do things.

I wish that damned pedestrian had taken a glance before stepping into the bike lane I was racing down...

santanaf

Well dpc61820, I figure I would give an update and my experience so far.

My healing seems to be going well. The slowness and taking 4 weeks between doctor's appts is killing me. Also, the welth of information on the internet is making me paranoid.

I'm male, 29, very active and in good shape, so I should heal fine, but I've read so many nonunion stories and indicents where people have the internal plate fixation and just don't heal, or they "heal" and get the plate removed and their bone breaks at the hospital or at night while sleeping.

It probably won't but it this happens I have a backup plan. There is a Dr. in the Cleveland Clinic that does stem cell bone regernation in clavicle injuries by harvesting stem cells from your own marrow. Its a pretty cool idea, hopefully I will never know first hand.

Anyhow, I digress. My recovery is going well. After my 4 week followup my Dr. told me I could stop using the sling, but to still take it very easy. The x-ray does not look much different from the one I posted from my first followup, but there is some fuzziness. I am allowed to continue ROM excercises and can even start light strength trainign with the rubber bands and starting with 1 lb weights at PT. The PT is really great and I love going.

As of two days from now I am 7 weeks post op. My ROM mobility is up to 100%, which has surprised a lot of people. My PT after week 4 started with pulley excercises, the hand bike with light resistence and only 25% effort on the injured arm, and 1 lb weight and easiest rubberband work. Now a few weeks later I am doing more agressive rubberband and hand bike work, and a whopping 2 lb of lateral raises and similar excercises. Its strange doing the 1-2lbs, since about 6 weeks ago I was doing the same thing with 30lb DBs.

The biggest change after my 4 week was that I was given the ok to start running again "As long as I don't fall." I love running and was missing it. Since my surgery my left arm and shoulder had felt kind of lethargic and sometimes tingly. It wasn't bad or painful, I just knew it didn't feel normal. My first run was only about 0.5 miles, and my left pec/shoulder felt very tight. It felt a lot like 2 days after lifing really heavy on your chest when you haven't lifted for a while. The next day I felt fine and started at my PT routine. Later that night I was watching Transformers sitting still for 2 hours, when I went to move my arm it felt like it weighed 400 lbs. I moved it around and it felt good again, but my shoulder had gotten very stiff just sitting there. The next day I felt fine. A few days later I went out for a run at work with some friends arount the DC monuments. The run was about 3 miles and I experienced that initial stiffness for about the first 1/2 mile, but then my shoulder felt great. Since then I have gone on several runs of 2-5 miles and I feel perfect, even on the run where one of the Cherry Blossoms branches around the Tidal Basin attacked my injured shoulder, I swear it attacked me, I totally didn't blindly run into it...

So I have my next followup on 7/24, and I am really hoping for some good bone healing to have taken place. I am really nervous, and like I said, paranoid about proper healing, but I'm also really anxious to get the ok to return to normal weight lifting. I just hate being afraid of hurting myself and undoing the healing that has been done.

As far as your questions, I "used" my sling for 4 weeks, but had it off often. I didn't wear it when I slept, when I worked at the computer, and anytime I was sitting and not moving much. Also, there were several instances where I didn't wear it while walking around. I always wore it when I was out in public areas to remind other people not to bump into me.

I started passive ROM PT at 2 1/2 weeks and light strength training at 4 weeks. They main thing I have been warned about was lifting your arm above your head, basically DONT, not until you are cleared to do so. They seems to be the major limiting factor for each person. The doctor makes a judgement call for when you are ready to have your hand above your head. For me, after my 4 week, he said that the bone had begun to heal and as a result it wasn't all on the plate, so I could start doing things. Eventually the plate won't even matter, but until then, I still need to keep it light.

The primary point I have had made to me over and over is that "Pain is supposed to be your limiting factor, if it hurts, don't do it, if it starts to feel like it might start to hurt, don't do it, if after you do something, it starts to hurt later, don't do it again." For me this didn't work, I haven't had pain, so I had to stay in my sling, I think if I had pain earlier, I wouldn't have needed to stay slinged, go figure, I would have known my limitations. The problem is, like a lot of people who are on this forum, I like to push it a little too far.

Anyhow, I still feel good about surgery, just wish rehab and healing was a little quicker. And look at it this way, maybe this surgery now will just save your life later... if you get a weirdo boyfriend who is a terrible shot.

http://www.abcnews.go.com/2020/story?id=3275815

tkhbroken

I broke my left clavicle May 16, 2007. The first Surgeon I went to suggested surgery but it was one week after my accident and I was reluctant to take the plung. But it turns out, two months later, I have a non-union and have yet to take my arm out of the sling and use it for more than 15-20 mins. I felt confident about the no-op route because i got several other doctors opinion's and they all agreed that surgery was a last resort. But here I am, needing surgery and trying very hard to get all my insurance stuff together to get in and see a surgeon. I am 22, a female, never broken a bone before and I'm wondering what to expect from recovery. I am not a cyclist ( besides ridding my bike to class and what not). I got bucked off a two year old horse and landed right on my shoulder. Anyway, if anyone has any uplifting comments about recovery and the op itself i would love to hear them.

tkhbroken

I am two months in without operation. My initial surgeon reccomended surgery, but, I was scared and I thought i would let nature take it's course. Now, I know i made a mistake and i'm trying to get into surgery asap. With that being said, I know there many schools of thought about clavicles and i'm sure you can find a surgeon that agrees with surgery!

gplama

Hi dpc61820,

Page 20 of this thread has my x-rays and story.

Post surgery I was told to take it easy for the first three weeks, no lifting and the like. From week 3-6 I could start building up using the arm/shoulder again, and from week 6 onwards I was ok for full steam ahead.

As I've said in other posts, I was back on the bike in 4 days, and competed in a time trial 5 days post Op (the static TT position was key). I used the sling for two days post op 24/7, then for the next week when in public (so I wasn't bumped into!). Weeks 1-3 the shoulder was stiff so pulling things out of my jursey was difficult and sprinting was ruled out. From week 3 onwards I built up strength by doing a few 'light' sprints, and loosening up the shoulder by playing my Nintendo Wii. Who'd have thought a gaming console would aid in my recovery!?

I'm now 8 weeks down the track. My 6 week x-ray and checkup was all good news, and... (insert pause here) I can do 10 push ups with only a little discomfort.

santanaf

GPLama, by the way, thanks for all of the information shortly after you broke yours. Your accident, surgery, and report occured about two weeks prior to mine and was a major factor in my decision to get the surgery. I am not a cyclist or racer, but given my typical activity level a speedy recovery was crucial to my mental well being. Thanks in part to your posts and my eventual surgery, I can say that I am probably only half as depressed as I would be sitting around in a sling watching TV waiting for the bone to heal or nonunion. Thanks a bunch.

gplama

santanaf - thanks for your kind words. It makes posting information like that online all worth while.

pukka

Your surgery was necessary, as the amount of displacement was severe. Others that have breaks that are in alignment, do not need to have surgery.

There are many surgeons in Melbourne that repair clavicles, it's not that hard, but more often than not, you'll get referred to a private surgeon who specialises in shoulders.

Taking a look at those xrays, the alignment, post-op isn't that great, the bone is not straight.
If you come off again in the next 6 months or so, and land on that clavicle, you'll find that it'll snap badly, as the screws will pull out and make further surgical repair nigh on impossible.

Not to be a party poop, but this info needs to be out there too.

__________________
What am I on? I'm on my bike, busting my ass!

santanaf

My Doc was pretty strict about me not doing things, knowing that I am a person who will push it, and am no experiencing pain, so he cleared almost nothing for me until after the 4 weeks.

In reference to your comment about the bone alighment, keep in mind that the clavicle is a very very tricky bone on an xray. Its serpetine shape, the angle of the camera, and the 2 dimensional nature make it appear to be more mishapen than it actually is. If you get a chance, take a look at the plate typically used for internal fixation, it is contoured just for the clavicle.

The risk for a repeat fracture before complete healing from blunt force with a pin is much higher than with a plate, since the pin is load assistive and the plate is load bearing, but both can break. But with a pin, at least you get it easily removed, I will be keeping my plate for a very long time. I just don't want to get cut open again and it bothers me little, even though I am very skinny and you can see the plate protruding under my skin.

At any rate, each person has a different approach and a different Doc. If racing is your life, and you are willing to accept the risk if riding injuired, it is something that just has to happen. I, on the other hand, am a computer programmer, there is no reason I really need to take risks like that, so I will wait to heal