broken clavicle...surgery or not?

Curb

Hi feet or fish, it's great you as a doctor is in this forum offering advice to us. We appreciate it.

The reason we are here is because our doctors, during our appointments, rush us in and out of their office. They don want to hear anything. They just come and say, it looks ok come see me in 2 months. When you ask an important question, they only give you small bits of information and sometimes it's wrong. So what do we have to do, we have go around asking other doctors their opinion. It really sucks.

There are great doctors out there, you just have to shop around but the insurance companies hold you back.



When I broke my clavicle in 3 pieces, the surgeon remove the small broken piece. He said it was to jagged to put back. He was able to plate and pin the clavicle bones close together where the tips is touching each other. The doctor said that the space in between will fill in with bone…WHEN!!!! I ask him. It will he said.

Don’t know if he is correct or not. Now I have to wonder should I go on a diet of calcium and vitamin D. Not knowing is not a good thing. I only wish my doctor was more talkative

Garden Girl

[QUOTE=dpc61820]Another post-op detail...my doctor has me using an ultrasound bone stimulator. It's pretty simple to use, and, although I can't really see why weak ultrasound would make bones grow better, the research

Hi I was wondering how things are going with the bone stimulator. My break occurred back in March and I'm functioning just fine despite the fact the bone has not healed yet. Since it hasn't joined yet but my body is still trying to repair it the doc has suggested a bone simulator. Even though initionally he had recommended surgery and I decided against it. He now agrees that surgery is not necessary due to my ability to have complete range of motion, strength and nearly no pain, even though it has not joined. I'd appriciate any comments on the stimulator.

alienator

I'd like to hear more about external ultrasound bone stim. When I needed bone stim, ultrasound was new on the scene. My PT called the Left Coast, Right Coast, and everywhere in between and couldn't get any definite data or parameters for tx.

I did use:

1. Fosamax--effect unknown or very little
2. External magnetic bone growth stim--effect unknown or very little
3. Surgically implanted electric bone growth stim--worked pretty well

feetorfish

Curb good luck with your injury. All the folks on this board are active and are anxious to get back to their activities. The doctors are more rushed these days. HMOs have reduced reimbursments and the docs are naturally trying to see more patients.Its best to have your questions prepared in your head and ask them in order of importance. He or she may be 1.5 hours behind, you never know how many questions you are going to get in. The good thing about clavicles is if he got them straight and close there is a very good chance it will heal. Clavicles just have a lower rate of non unions then other bones. Calcium and a little Vit D can't hurt. Its cheap insurance. Just don't overdo the D(fat soluble). I'm a big believer in 2nd opinions, but they are harder to get with insurance companies now. Your best bet is to go online. Find out where the ortho did a fellowship(ie the foot and ankle institute or the shoulder institute of Emory) Make friends with the lady in your primary care group who handles referals and get good referals. Again good luck.

feetorfish

I don't know what the rules are for bone growth stimulators are for clavicles. In the foot or ankle we generally use them when there is no visible signs of healing after 6-8 weeks depending on the insurance company. I think some may even require 12 weeks. In the foot it has to be a long bone(ie not the heel), so I guess the clavicle would be a fine candidate. Its proven therapy all the way back when we had to implant the wire under the skin. Now its just wrap the machine around the injured part. Insurance is always the tricky part. They are pricey.

Curb

Hey Doc, thank you very much. But I have to ask you just one more important question and I think other people on this board with similar clavicle breaks will appreciate your answer if you know it. Maybe a tough question but here is the question:
As I mentioned, my break is held together with this hard plate and 6 screws which seem to be fastened in place pretty good. But there is a small space in between waiting for bone to fill in. Over time, is this plate and screw strong enough to support normal activities such and cycling, which I received my break from, push up, normal picking up stings around 20 pounds, weight lifting curls carrying groceries.
Although right now, since it's been 7 weeks since surgery, and I removed the sling last week, I would not dare to do anything stupid like those activities above. However, the doctor gave me a prescription to give to the PT guy do more aggressive range of motion and some light weights and he said I can start putting both hands on the handle bars while I am on my trainer (which I only rest lightly with the injured side).

So you see my confusion, is this plate suppose to act and support the clavicle just like a normal clavicle, or is the plate suppose to act as a temporary device to support the clavicle until the bone grows back? Then what happens if the bone doesn't grow back. The Ortho said I can leave this plate in for the rest of my life which I don’t really care as long as itr suppose to act like a normal clavicle.

These are the questions I tried to ask the orthro but never got a chance to ask because I was rushed out of the office.

If you can shed some clarification on this subject I'll bet a lot of others other than me would like to hear it.

Thanks

alienator

I think you should call your orthopod for the answers for your case. However, the plate and screws are not necessarily load bearing members as good as bone. They've been known to break in cases where loading was too great. Also, one of their major purposes is to approximate the position of the bone ends for good healing.

As for the bone growing back, bone has an amazing ability to fill in voids in its structure. After a nasty leg fracture, I was left with a fibula in many pieces and many large voids between those pieces. Surgery to repair would have caused more damage, and other injuries in the leg had priority. After a year, there were still portions of the bone you could see through. After 2.5 years, the bone had completely healed. So be patient. 7 weeks is not that long when you're talking about bone with significant bits missing.

Again, the best thing to do is to talk with and ask question of your orthopod. He/she is the one that knows your case best. As feetorfish said, a second opinion can also be good.

Curb

Thanks again Alien and Feetorfish. I will schedule and appointment once agan and ask somemore question and get a second opinion.

It's good to have you guys in this forum looking after us newbies. And No Doubt, we damn sure appreciate your responses.
Regards!

logicdevice

Thanx for you all out here , I hav appointment to Doc tomarrow and i will sure ask so many questions about surgery and natural healing process.
But i m still confused why most of the Surgeons do not refer clavical fracture for surgery , what are the side effect / infections . Anyone knows here ?

feetorfish

I agree with alienator that the hardware is not there to take the load. Rigid fixation is there to allow the very delicate new bone formation and blood vessels to grow across the fracture site. The less motion early on, the faster the healing. But understand that surgery disrupts all the soft tissue structures around the fracture site that may not have been disrupted during your fall. Remember the clavicle breaks even though you may have landed on your outstretched hand, so the soft tissues around the clavicle are intact. So if the ends of the bone look close enough thats why a surgeon may elect not to operate.
Starting to do range of motion exercises is a good idea. Its an art deciding when to stop immobilization and start motion. Wait too long and you have a frozen shoulder or a tight elbow. Your orthopedist is the one to tell you when to start range of motion.. They will look at the films and decide how happy they are with position,alignment and apposition, and most importantly signs of healing. This varys from case to case for a lot of reasons. So there is no cookbook answer as to when to start. As far as worrying if the bone will grow back, the clavicle has a very high rate of healing, unlike other parts of other bones.

Curb

Ok, I have no more questions. My questions have been thoroughly answered by Alienator and Feetorfish!

Everyone in this forum please take notice of the posts and answers I received from these two individuals. They took the time out to share their personal experience and opinions with me and the rest of us. I am extra very please with the detailed information I received from them about my broken and plated clavicle.

Hell, I might as well cut you two guys a check, you certainly earn it!

Why can’t our physicians provide information like this? I know they are busy but we pay them and the insurance to correct and maintain our health. I guess it all depends on who you get I suppose.



I hope you all get the answers to your questions like I have received.

I will try and help out and answer some of your questions if I recognize some of the same symptoms that I am having.



BUT THANK YOU AGAIN ALIENATOR AND FEETORFISH.

ocean123

Hi Joe,
So, what did you decide? How's the recovery going?
ocean123

AGHealing

Thanks to this Thread and Forum.

The only bone I've broken is my left clavicle, twice. I broke it when I was 12 years old and, just recently, two weeks ago. When I 12, the fracture was right in the middle of the bone. (I broke it playing "barnyard football", but did get the touchdown.") I was simply given a figure-8 foam brace on my way home from the hospital.
I'm 28 years old now. I was hit by a vehicle traveling ~35mph while I was crossing the street on my newly repaired track bike. No head, neck, back, or leg injuries but ....a clavicle in 4 pieces. (I am very lucky...thank God I only broke my clavicle!)

The Dr. gave me three options.

1. I could let it heal on its own and I would have a huge bump that would grow irritated if I wanted to hike or ride with a back pack around my shoulders.
2. I could get the plate and screws, but since I was such a thin dude it would probably look frankenstein-ish seeing that hardware popping out of the skin like no bodies business. Not to mention the other factors like the risk of the screws not holding their own and a shiner of a scar later on.
3. I could get a pin drilled through the center of the clavicle threading the the pieces of bone like a necklace. Not siked about the thought of a 3 to 4 inch metal rod being drilled in me for 3 to 4 months and then having it backed out in another surgery.

I opted for the "pin" surgery based on the recommendation of the Orthopedic Dr. I saw. (This thread helped a bunch in my decision as well.) I could definitely see the obtuse bone sticking through my skin. Non-union was a chance with the all the options. The doctor I was am seeing recieved his training is the army...which after some research on my own and through this thread is where this type of surgery was first used. The Dr. drilled a pin through the clavicle this week. I'm in the third day of recovery and the pain is subsiding. The 28th of this month I get a follow-up to the surgery. Thank you to all for your two cents!

alienator

Cool! Implanted hardware is always worth bonus points. If you get the hardware removed, make sure the doc gives it to you as a keepsake.

What's even better is getting another scar. Scars are just memories that never fade.