Boom King
downloaded a pic of moorey's bruised arse
Nice work. Have you got the xray transparency? You can cut it into a nifty front guard for posterity....
Fractured collarbone
- Thread starter teK--
- Start date
Z
Zaf
Guest
What would a FACEM know hey?
The arm still needs to be supported in a sling for about 4 weeks after an ORIF.
teK--
Eats Squid
Fair call. The ER people do an amazing and too often thankless job. I didn't expect them to sit down and discuss treatment options with me... That is the job of the fracture department whom they referred me to for next week.
In other news, the surgeon i saw today recommended/offered a plate rather than the other option (internal long screw) which I'm also aware of.
Has anyone here done a plate? Would u do it again and did u end up having it removed?
Thanks.
teK--
Eats Squid
Negative!
moorey
call me Mia
Slow clap.
cameron_15
Eats Squid
I had a plate in my collar bone about 10 years ago now. My fracture was different to yours in that it was comminuted (lots of small fragments) and there was some overlap causing my shoulder to be shorter and lower on one side. I waited with conservative treatment for about 8 weeks and it was clear then it wasn't getting better on it's own in a way I was happy with.
I got a second opinion (which I should have gotten right away) from a private surgeon - Dr Richard Dallalana in Melbourne- who recommended surgery right away which sorted everything once and for all. A few days after surgery everything was back in line and I could comfortably have full range of motion out of the sling for rehab purposes.
Everything is great now, I have no pain, I'm symmetrical and strong. It's held up fine through years of bike riding and many seasons of rugby as a prop.
There are lots of things to consider though.
- With a plate you will need 2 operations, one to put it in and one to take it out.
- Each surgery requires a general anaesthetic which is inherently risky - on my second operation I required some respiratory support and ended up staying the night as the morphine I was given suppressed my breathing, this is rare but it's happened to me twice now and it's more common in young males after orthopaedic procedures
- You shouldn't ride with the plate in, if you crash again and break it the fracture will occur at either end of the bone, either by your neck near some significant blood vessels or at the shoulder which can cause more grief due to the complexity of joints in the region
- after having the plate out you'll have to wait a few months for the swiss cheese that is your collar bone to fill in - so even longer off the bike
- Surgery is expensive
- I have a scar and a numb patch below my collar bone as there is inevitable nerve damage with the surgery
- I have some muscle asymmetry of the Pec which I believe to be due to the procedure, parts of the Pec muscles attach to the collar bone and I believe these were disrupted in surgery, but it could have been due to the fracture itself. This may or may not be an issue to you, I have no strength issues (Can bench 140kg's) but you can see the asymmetry.
My advice would be to get another opinion (which you have done), See the Fracture clinic and ask loads of questions then give it a couple of weeks and see how it looks. If things are going OK then maybe you can avoid a couple of Operations, If there are signs of Non-union or Mal-union you can always reconsider.
I got a second opinion (which I should have gotten right away) from a private surgeon - Dr Richard Dallalana in Melbourne- who recommended surgery right away which sorted everything once and for all. A few days after surgery everything was back in line and I could comfortably have full range of motion out of the sling for rehab purposes.
Everything is great now, I have no pain, I'm symmetrical and strong. It's held up fine through years of bike riding and many seasons of rugby as a prop.
There are lots of things to consider though.
- With a plate you will need 2 operations, one to put it in and one to take it out.
- Each surgery requires a general anaesthetic which is inherently risky - on my second operation I required some respiratory support and ended up staying the night as the morphine I was given suppressed my breathing, this is rare but it's happened to me twice now and it's more common in young males after orthopaedic procedures
- You shouldn't ride with the plate in, if you crash again and break it the fracture will occur at either end of the bone, either by your neck near some significant blood vessels or at the shoulder which can cause more grief due to the complexity of joints in the region
- after having the plate out you'll have to wait a few months for the swiss cheese that is your collar bone to fill in - so even longer off the bike
- Surgery is expensive
- I have a scar and a numb patch below my collar bone as there is inevitable nerve damage with the surgery
- I have some muscle asymmetry of the Pec which I believe to be due to the procedure, parts of the Pec muscles attach to the collar bone and I believe these were disrupted in surgery, but it could have been due to the fracture itself. This may or may not be an issue to you, I have no strength issues (Can bench 140kg's) but you can see the asymmetry.
My advice would be to get another opinion (which you have done), See the Fracture clinic and ask loads of questions then give it a couple of weeks and see how it looks. If things are going OK then maybe you can avoid a couple of Operations, If there are signs of Non-union or Mal-union you can always reconsider.
cameron_15
Eats Squid
Did I have it removed? Yes, you don't want it in there long term due to the risk of a complicated fracture, hardware or skin/infection problems.
Would I do it again? Only if it was clear things were not going to improve satisfactorily conservatively.
I also had a friend go through the same procedure at the same time as me. He developed complications at the wound site, basically his wound reopened and he required another operation to tidy things up again. This meant he had 3 operations in total and an even longer period of recovery/disability. At one stage he had a drain in the wound to suck out any accumulating fluid. This posed a pretty significant infection risk and I believe he had prophylactic antibiotics for a period while that was in.
I'm not trying to dissuade you from Surgery, I just feel it is something that needs to be given serious consideration. It's not a matter of "hey I'm impatient I want surgery" there are very real (although rare) risks and consequences to the procedure.
Lastly, a private Orthopod has a pretty big conflict of interest - doing the procedure results in good gains for him ($$$) with potentially minimal gains (or even losses) to you. You might get a more honest opinion from a public sector orthopod at the fracture clinic. I'd suggest attending that review and asking lots of questions. Tell them You're happy to pursue surgery privately if they believe there'd be a benefit for you. The downside of the public system in this case is that young males are almost always bottom of the list for surgery, so while you may benefit from surgery resource constraints could mean you get shafted to conservative managament because it would be good enough but a lot cheaper to the system.
All the best with your recovery whichever path you choose!
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I have had 4 broken collarbones. 2 have healed naturally and 2 I’ve had plated. I have a plate in my left one now that I can have out at anytime now. If you go with the plate option DON’T CRASH on it. I had this drummed into me by the surgeon after last operation. Once plated it won’t break while plate is there causing next weakest link to take the impact, ie shoulder or neck.
I feel your pain and no to well the annoyance over the first 3 weeks feeling the bones move. My right side (3 brakes) was plated last time and is now as normal once plate was removed.
The plate in left side at the moment has caused some numbness (nerve) and is really uncomfortable (wearing camel back and even seatbelt aren’t good for it).
Risk is there for infection on plate insertion and removal but sometimes it is the only option. Recovery from plate removal is quick. Only uncomfortable while would heals.
I can’t recommend surgeon as I’m in another state. Wish you well with recovery.
I feel your pain and no to well the annoyance over the first 3 weeks feeling the bones move. My right side (3 brakes) was plated last time and is now as normal once plate was removed.
The plate in left side at the moment has caused some numbness (nerve) and is really uncomfortable (wearing camel back and even seatbelt aren’t good for it).
Risk is there for infection on plate insertion and removal but sometimes it is the only option. Recovery from plate removal is quick. Only uncomfortable while would heals.
I can’t recommend surgeon as I’m in another state. Wish you well with recovery.
Lazmo
Old and hopeless
The angle of the bones to each other looks pretty crap. A plate might be worthwhile. Not much cross over, which is good. I’ve broken both sides, but am old, so no plates back in the day. I did re-break the right one about 10 days into recovery, while peanut buttering a salada one handed. It flicked off to the side, and I just instinctively caught it, with my brummy arm. Honestly, THE most pain I’ve ever felt.
Good luck.
Good luck.
Yeh, mine was in 3 pieces and the ER doc said to treat it conservatively. Ortho shook his head when I told him. His words to me were that more often than not, collarbone fractures are plated these days. It'll still be 6 weeks or more till you can (should) ride but within a few days of surgery life is pretty much back to normal.
teK--
Eats Squid
Just a quick update; first surgeon said it was a decent break and suggested I get plate/screws if I am concerned about symmetry or function. They were able to operate 2 days later but I needed thinking time...
After much more reading I decided if I was going to get surgery I wanted the internal screw fixation method. The idea of having a metal plate under the skin causing discomfort, and a swiss cheese collarbone with a second round of recovery after removal, didn't really appeal to me.
I went and saw a second surgeon who I read offered the alternative options. Unfortunately they said they didn't offer those procedures anymore, but also the recommended I wait another 2-4 weeks to see if it starts healing by itself, before deciding to get surgery.
Not to be discouraged. With my upper back pain getting worse, and working with only one hand at work for over a week driving me bonkers, I continued reading and asking around with other people who had a similar injury. I decided I definitely wanted to get surgery to correct my shoulder alignment. It was just about finding someone who did the procedure I wanted.
Finally I found Dr Martin Richardson who is a surgeon with a lot of experience with the internal screw fixation method. It is a lot less invasive and risky than the traditional plate and screw method, and also for vast majority of patients they can leave the screw in for life, thus avoiding a second round of recovery.
He seemed to be the one who most understood the demands of needing a strong and balanced shoulder for the type of sport we do. I am booked in for surgery tomorrow and will report back after my initial recovery!
Thanks all for your advice and helping me through this.
After much more reading I decided if I was going to get surgery I wanted the internal screw fixation method. The idea of having a metal plate under the skin causing discomfort, and a swiss cheese collarbone with a second round of recovery after removal, didn't really appeal to me.
I went and saw a second surgeon who I read offered the alternative options. Unfortunately they said they didn't offer those procedures anymore, but also the recommended I wait another 2-4 weeks to see if it starts healing by itself, before deciding to get surgery.
Not to be discouraged. With my upper back pain getting worse, and working with only one hand at work for over a week driving me bonkers, I continued reading and asking around with other people who had a similar injury. I decided I definitely wanted to get surgery to correct my shoulder alignment. It was just about finding someone who did the procedure I wanted.
Finally I found Dr Martin Richardson who is a surgeon with a lot of experience with the internal screw fixation method. It is a lot less invasive and risky than the traditional plate and screw method, and also for vast majority of patients they can leave the screw in for life, thus avoiding a second round of recovery.
He seemed to be the one who most understood the demands of needing a strong and balanced shoulder for the type of sport we do. I am booked in for surgery tomorrow and will report back after my initial recovery!
Thanks all for your advice and helping me through this.
teK--
Eats Squid
Update; Surgery went well I was in and out in the space of half a day.
Collarbone is now back in one piece!
Before:
After:
First day post-op was fairly horrendous with pain. The pills were pretty good but had to eat a lot of prunes, if you know what I mean. One noticeable improvement was the tension in the upper back disappeared as now the shoulder was in the right place.
Second day was not too bad and no longer had to rely on the pills.
By third day I felt good and was back to work, had arm out of sling whilst at the computer etc. Also started some mobility exercises.
By day 5 I think I pushed a bit too hard and the shoulder was getting sore. The muscles were all crapping out and seizing up. Back in a sling for most of the day hereon to provide more support.
Just got back from Physio yesterday and nearly fell off his chair when he saw how much my upper back muscles had wasted away during the 3 weeks of being in a sling. Every other muscle I had remaining on that side was over stressed from compensating for the broken collarbone, and were giving off crazy spasms after now being stretched back in the opposite (correct) direction after surgery. Shoulder joint was stiff and can't lift my arm higher than about chest height.
So doing some more mobility work now until post-op appointment with the surgeon whereby he might clear some light stability work.
So the moral here is... If you think you need surgery then decide early and get it done asap. Every day you keep the arm immobilised is going to stiffen up the joints and waste away your muscles. There are exercises you can do with your wrist, elbow and fingers etc which don't put any stress on a broken collarbone and these should be commenced pretty much within a day or two of the accident.
More to come..
Collarbone is now back in one piece!
Before:
After:
First day post-op was fairly horrendous with pain. The pills were pretty good but had to eat a lot of prunes, if you know what I mean. One noticeable improvement was the tension in the upper back disappeared as now the shoulder was in the right place.
Second day was not too bad and no longer had to rely on the pills.
By third day I felt good and was back to work, had arm out of sling whilst at the computer etc. Also started some mobility exercises.
By day 5 I think I pushed a bit too hard and the shoulder was getting sore. The muscles were all crapping out and seizing up. Back in a sling for most of the day hereon to provide more support.
Just got back from Physio yesterday and nearly fell off his chair when he saw how much my upper back muscles had wasted away during the 3 weeks of being in a sling. Every other muscle I had remaining on that side was over stressed from compensating for the broken collarbone, and were giving off crazy spasms after now being stretched back in the opposite (correct) direction after surgery. Shoulder joint was stiff and can't lift my arm higher than about chest height.
So doing some more mobility work now until post-op appointment with the surgeon whereby he might clear some light stability work.
So the moral here is... If you think you need surgery then decide early and get it done asap. Every day you keep the arm immobilised is going to stiffen up the joints and waste away your muscles. There are exercises you can do with your wrist, elbow and fingers etc which don't put any stress on a broken collarbone and these should be commenced pretty much within a day or two of the accident.
More to come..
Ultra Lord
Hurts. Requires Money. And is nerdy.
Good luck with rehab mate. It’s a bitch but the alternatives definately worse.
Glad surgery went well.
Glad surgery went well.
teK--
Eats Squid
Hey all just an update which will hopefully be the last...
1 week post op I was doing some very light mobility exercises under physio guidance. Shoulder was stiff af and I could hardly raise my arm higher than my belly.
At 2 weeks I was cleared to push range of motion and do any thing up to 1kg resistance. I also started riding on an indoor trainer which helped immensely both physically and mentally. It was tiring for the first week to support my arm on the bars but it got better..
Stuck to the physios program which was expanded with new exercises and additional weight added when I saw him every 2 weeks.
At about the 5 week mark I noticed range of motion was fairly good and strength was building up very quickly from this point in.
At the 6.5 week mark ROM was measured at 88% and I was comfortably pushing around 4kg weights even though the surgeon gave me a conservative limit earlier.
At 7.5 weeks (yesterday) I got x-rays which showed good bone union and surgeon cleared me for return to full activities. Bone is not quite 100% until maybe 6 more weeks so I just gotta be extra careful when riding.
I don't have any pain and the scar is pretty neat. Ive been using this silicon scar removal ointment every night, which I'm not sure if it made a difference other than the scar is fairly flat now and looks less gnarly than at first.
There was a small numb patch where they cut under the collarbone but the feeling has been coming back progressively . Just need to keep working on getting that last 10% range back and continue rebuilding muscle.
I can't help but wonder if the recovery would have been quicker if i got surgery immediately versus waiting 3 weeks. All signs seem to point to yes.
Having met some more people lately who didn't have surgery and regretted it, I would definitely suggest any injured to carefully consider their options to have a good long term outcome. Cheers and thanks for reading.
1 week post op I was doing some very light mobility exercises under physio guidance. Shoulder was stiff af and I could hardly raise my arm higher than my belly.
At 2 weeks I was cleared to push range of motion and do any thing up to 1kg resistance. I also started riding on an indoor trainer which helped immensely both physically and mentally. It was tiring for the first week to support my arm on the bars but it got better..
Stuck to the physios program which was expanded with new exercises and additional weight added when I saw him every 2 weeks.
At about the 5 week mark I noticed range of motion was fairly good and strength was building up very quickly from this point in.
At the 6.5 week mark ROM was measured at 88% and I was comfortably pushing around 4kg weights even though the surgeon gave me a conservative limit earlier.
At 7.5 weeks (yesterday) I got x-rays which showed good bone union and surgeon cleared me for return to full activities. Bone is not quite 100% until maybe 6 more weeks so I just gotta be extra careful when riding.
I don't have any pain and the scar is pretty neat. Ive been using this silicon scar removal ointment every night, which I'm not sure if it made a difference other than the scar is fairly flat now and looks less gnarly than at first.
There was a small numb patch where they cut under the collarbone but the feeling has been coming back progressively . Just need to keep working on getting that last 10% range back and continue rebuilding muscle.
I can't help but wonder if the recovery would have been quicker if i got surgery immediately versus waiting 3 weeks. All signs seem to point to yes.
Having met some more people lately who didn't have surgery and regretted it, I would definitely suggest any injured to carefully consider their options to have a good long term outcome. Cheers and thanks for reading.
Thanks for the post
Broke mine too last week my X-ray looks nearly identical to yours. Been struggling to get good advise what to do, but have also decided to pull the trigger and get surgery. I feel the end result if I don’t will probably lead to further issues.
Surgeon says without op there’s chance of reduced shoulder movement and problems due to having collarbone sticking up so high - using back packs, Carrying things on shoulder - I work in construction. I think I’ll probBly regret not getting it straightened out.
Do you need to get the screw removed later?
Broke mine too last week my X-ray looks nearly identical to yours. Been struggling to get good advise what to do, but have also decided to pull the trigger and get surgery. I feel the end result if I don’t will probably lead to further issues.
Surgeon says without op there’s chance of reduced shoulder movement and problems due to having collarbone sticking up so high - using back packs, Carrying things on shoulder - I work in construction. I think I’ll probBly regret not getting it straightened out.
Do you need to get the screw removed later?
