Thread: broken clavicle recovery

took a header off the bike Sunday. right clavicle now in at least four pieces. orthopod says to just let it heal, i'm working on getting a second opinion.

I'mon norco for pain, ibuprofen for swelling. Starting to think about recovery, although I'm still in pain management at the moment. I've eating whatever tastes good, which means junk food, because between the pills and the pain the stomach isn't doing so great. But in a few days I want to get serious about recovery, and am wondering if there are dietary choices for which there is actual clinical data showing they will support/speed/maximize bone fracture healing.

A clavicle fracture will almost invariably heal despite what you eat rather than because of what you eat, but taking calcium and vitamin D is not a bad idea with a fracture.

As far as your ortho's opinion, we've gone from almost never operating on clavicle fractures to more frequently operating, but the pendulum may have swung slightly too far in the direction of intervening. Obviously every fracture is different, but the vast majority tend to heal fine without surgery (there are a couple exceptions, but not common).

Best of luck and heal up in time for winter. As you've probably already learned, sleeping in an arm chair for the next week is probably more comfortable.

Originally Posted by Orthoski

the vast majority tend to heal fine without surgery (there are a couple exceptions, but not common).

I'd be curious to hear more of your opinion on the exceptions. My wife had what sounds like a similar break last spring (4 pieces, one rotated 90* out of normal alignment) and her doc's opinion was that surgery was mandatory. Without surgery he thought she was looking at a long painful recovery with a high probability of non-union. I'm not any kind of medical professional, but for complex breaks like these in active people surgery seems like a no-brainer.

James, I would absolutely get a second opinion and go for surgery if you have insurance and/or can afford it. Altachic's recovery was remarkable. She went from barely able to move (said the pain coming down in the patrol sled was worse than childbirth) to zero sling use in less than 3 days.

I asked my family doc to look at the x-ray and give me a call. He did so, and basically I told him what the orthopedist said, and he agreed wholeheartedly. I like my regular doc because he is aggressive about the same things I am when it comes to health (preventive care, taking the long view and planning for being healthy in old age, valuing natural methods over medications, e.g., a few years back he told me if I coiuld drop 15 lbs. my BP would move from high into acceptable range and that would be a lot better than putting me on a lifetime prescription, it worked), but he also has enough humility to know that when it comes to aggressive interventions it is remarkably easy to do more harm than good.

ANyway, he paddles kayaks, hunts, bikes, skis, and he said that if it was his clavicle he would do exactly what the orthopedist is telling me to do. That was pretty reassuring.

[QUOTE=Dantheman;3701832]I'd be curious to hear more of your opinion on the exceptions. My wife had what sounds like a similar break last spring (4 pieces, one rotated 90* out of normal alignment) and her doc's opinion was that surgery was mandatory. Without surgery he thought she was looking at a long painful recovery with a high probability of non-union. I'm not any kind of medical professional, but for complex breaks like these in active people surgery seems like a no-brainer.

There's always a judgement call in any operative indication, and therefore in any given single case I would always defer to the treating surgeon. More broadly, immediate surgical indications include severe tenting, and therefore threatening, of the overlying skin or nerve/blood vessel injury. Buttoning of the bone ends through muscle may also require surgery as do some fractures in the very far end of the clavicle (near the shoulder) which may cause the shoulder to sag due to the attachment points of certain ligaments. In the more common scenario involving the middle of the clavicle, there was an often quoted study that active people with more than 2cm of bone shortening noted more fatiguability in the affected shoulder, but tough to tell what this means in action - more likely to be significant in active overhead laborers than in most other people. A more recent Canadian trauma study found that those treated non-operatively took longer to heal (28 vs. 16 weeks) and were more likely to not heal (7/49 patients) but operative patients had their own set of complications including wound infection and symptomatically prominent hardware (9/62). The scary part is that older studies had much higher complication rates with surgery, but hardware has come a long way. I've had discussion with upper extremity surgeons about what to make of this, and some argue that they would let the vast majority heal non-op because there are more things you can do if it goes on to not heal (though easier to fix fresh).

Again, every surgeon has their take, and every case is a little different...sounds like your wife had the right treatment for her.

If your clavicle is in that many peices get it plated. It's gonna look all screwed up if they don't.

Originally Posted by Crass3000

If your clavicle is in that many peices get it plated. It's gonna look all screwed up if they don't.

I think the best thing you're doing, James, is getting a second opinion. Decision making is rarely black and white, and while there are definitely pros to operating, nothing is without risk, so getting a fresh pair of eyes is often helpful (and surgeons are not offended by this - they would do the same for their family).

Keep us posted!

Originally Posted by Orthoski

but hardware has come a long way.

Yeah, her surgeon said the plates he uses now are not remotely comparable to the early ones.

orthoski, "symptomatically prominent hardware" is one of those terms I love. Describes perfectly one of the things I was worried about. I wear a backpack quite frequently. Not for a living, or anything (I'm a lawyer), but for nearly all of my leisure activities: mountain biking, hiking, fishing, backpacking, even travelling I'm mor elikely to use a pack than a piece of luggage. The ortho I saw pointged out that he has had to remove a fair number of old plates that were causing problems for patients. We talked about the possibility of inserting hardware into the bone (forget what that's called), and the surgeon basically told me if it doesn't heal, or doesn't heal well enough, those would still be options later, so no good reason to rush anything.

My GP was of the same opinion, and I really like and trust my GP since he has taken very good care of me and my whole family for well over a decade now.

Today, I am finding balance betwen suppressing the pain and being able to think straight. Still not comfortable in anything but a seated position, but making progress. I'm at least starting to think in terms of finding modes of exercise that I will be able to handle without hurting the shoulder/clavicle. Injuries like this have, in my past, led to long periods of slothfulness, weight gain, and atrophy which, at 45 years old I can no longer afford.

Can I join the party?



Did it mountain biking. I'm supposed to go to Edmonton sometime next week to see the surgeon. The idea is that he will take a look at how it has come along and make a decision on surgery. I was pretty opposed to surgery, but I'm not sure how it could heal all straight without it. They had me in a figure 8 brace, but they called me back to the local hospital to get it changed for a simple sling after talking to the ortho.

The change to a sling makes me think they are just trying to keep me comfortable till the ortho can see me, and they don't expect it to heal in the meantime. Does that sound accurate or cynical? I've jammed a towel into my armit to maybe get a bit of extra space for that extra bone to come into place. It doesn't hurt it so I figure I must not be doing any harm at least.

At any rate, my mom is good friends with an ortho in Ontario, he did all my post op checkups after my last bone breaks. My mom's going to send him the pics so I'll get his opinion too.

Just so you know what to expect, you will hurt like hell for two weeks, then significant hurt, but manageable for two weeks, then hurts but no big deal for two weeks.

Fun times when I broke mine since I had to work the next day. I couldn't do any surgery for two weeks and had to dictate my records. The pain meds made me feel like shit, so I dropped them on the third day, it hurt like hell, but it was better then being nauseous.

sasquatch, that looks like a really serious shortening of the bone if no surgery is done. That was one of the things both my ortho and GP talked about. When the break overlaps itself like that (and like mine does), you're going to end up with a shorter collarbone when it heals. In my case it's a few milimeters, and everyone seems to think it's no big deal. Yours looks like a lot more than that, but I'm no radiologist.

hutash, my stomach handles the painkillers just fine (although I'm starting to wonder when constipation goes from being an inconvenience to being a significant health risk). I worry about my liver a bit from the tylenol, especially since I'd really like to have a few drinks. And, fortunately, work was slow this week, so I've managed to handle everything that needed handlign from the couch at home. And the narcotic fog is an okay way to pass the time while healing takes place.

I'm lucky on the pain front, haven't needed any more than 2 T3's. Think I might get a bunch of beer so I can sleep better.

I'm going tuesday to see the specialist, hopefully what ever contraption he puts me in still lets me reach over to the stick on my car. so I can get up to work.

Just got back from surgery on mine. The second set of xrays showed that it had settled too far apart for any healing. It appeared to me to be like two inches apart. Feeling great now on pain pills!

Just had easily the most agonizing shower ever. Now I'm rockin a dress shirt and pyjama bottoms, the thought of putting a t-shirt back on doesn't sound fun.

Going to the city on tuesday to see the ortho. The guy specializes in custom upper body braces and such, wonder if I can still drive with whatever he's gonna put on me...

Just wanted to mention that I had surgery on mine and was skiing exactly one month later. Easiest recovery I've ever experienced, didn't even go to PT afterwards. Granted, I was a young teen at the time so I healed at an amazing rate, but I'm positive surgery was the way to go (for me). For some reason, the hardware at the time didn't include countersunk screws (apparently they were stripping the flathead screws available at the time? WTF?). But even with the slight protrusions, it never gave me problems backpacking or anything—the only time I experienced any kind of pain was if someone grabbed right on the plate from behind while playing soccer (not true pain, just the nerves going crazy).

YMMV and all that, but I'm very glad I went for the surgery.

Jamespio: start taking oral laxatives and stool softeners immediately. I always make sure to take them religiously with any kind of painkillers.

Originally Posted by angrysasquatch

Can I join the party?

Looks a lot like altachic's break. I'm not an ortho, but I can't see how that could heal acceptably without surgical repair.

Originally Posted by Jamespio

In my case it's a few milimeters, and everyone seems to think it's no big deal.

You broke it into 4 pieces and only have a few mm of shortenting? That's impressive, you should post the films.

I don't actually have copies of the images, I suppose my doc would send them to me. THey're digital, and pretty much every doc in this town has access to the database at the largest local hospital, which is where I went to the ER and they took pics. Everyone has just logged on and looked them up so far.

[QUOTE=Orthoski;3702286]

Originally Posted by Dantheman

I'd be curious to hear more of your opinion on the exceptions. My wife had what sounds like a similar break last spring (4 pieces, one rotated 90* out of normal alignment) and her doc's opinion was that surgery was mandatory. Without surgery he thought she was looking at a long painful recovery with a high probability of non-union. I'm not any kind of medical professional, but for complex breaks like these in active people surgery seems like a no-brainer.

There's always a judgement call in any operative indication, and therefore in any given single case I would always defer to the treating surgeon. More broadly, immediate surgical indications include severe tenting, and therefore threatening, of the overlying skin or nerve/blood vessel injury. Buttoning of the bone ends through muscle may also require surgery as do some fractures in the very far end of the clavicle (near the shoulder) which may cause the shoulder to sag due to the attachment points of certain ligaments. In the more common scenario involving the middle of the clavicle, there was an often quoted study that active people with more than 2cm of bone shortening noted more fatiguability in the affected shoulder, but tough to tell what this means in action - more likely to be significant in active overhead laborers than in most other people. A more recent Canadian trauma study found that those treated non-operatively took longer to heal (28 vs. 16 weeks) and were more likely to not heal (7/49 patients) but operative patients had their own set of complications including wound infection and symptomatically prominent hardware (9/62). The scary part is that older studies had much higher complication rates with surgery, but hardware has come a long way. I've had discussion with upper extremity surgeons about what to make of this, and some argue that they would let the vast majority heal non-op because there are more things you can do if it goes on to not heal (though easier to fix fresh).

Again, every surgeon has their take, and every case is a little different...sounds like your wife had the right treatment for her.

Would an ice climber be an "active overhead laborer."

In the hospital now for a big ol' plate. I haven't felt that third chunk of bone for a while, hoping they aren't gonna have to pry it off one of the other two...

good luck, sasquatch.

Week 2 post-injury was the week from hell for me. Felt okay Mon and Tue, went to the office, got some work done. Weds decided to work at home, was okay till about noon, when the pain returned full force. I had been tapering off the painkillers so I could work, but by Thurs afternoon I was back up to maximum dosage. Thurs night, suddenly my bicep and inner elbow started hurting (was right after I tried to use the right arm for something or other). Eventually realized that I shouldn't be surprised, the arm had spent 11 days in exactly one position, and some cramping, disuse pain should be expected, but it still hurt like hell. Switched to the figure-eight brace, got a crappy night's sleep and spent Friday trying to work via phone while swimming through the hydrocodone fog.

On the upside, it is looking like I might have unrestricted access to a house in Big Sky this winter, so I am refocused on (1) short-term healing so that (2) I can start training for winter sports.

Damn that's rough James. I've been coming along pretty good, got all screwed together on saturday and for all of today I've been puttering around the apartment without my sling, feels great. The only pain I get is from the incision, and only when my skin is in some unnatural position from the sling. When I head out I put it back on just to keep it in mind, as I know that it's pretty much just the plate doing the work. Don't want to bend any hardware and make the surgery pointless. But on the other hand, I know that disuse just plain changes the way it all works, my knee has never worked quite the same.

Saw my doc yesterday. The x-rays look exactly the same as the x-rays 2-1/2 weeks ago, but he says that is the way it should be. Too soon for any noticeable healing to have occurred. He finally admitted that using either the figure-8 brace or the sling is solely for my comfort, not medically necessary or even helpful. Basically, his advice is don't do anything risky, no heavy lifting, ice when I want to, and work with PT to start stretching and rebuilding range of motion, then follow up with strengthening.

I like this guy and am quite pleased to have his reassurance, but sometimes I feel like I'm paying big bucks for him to say "do nothing."

Originally Posted by Jamespio

Saw my doc yesterday. The x-rays look exactly the same as the x-rays 2-1/2 weeks ago, but he says that is the way it should be. Too soon for any noticeable healing to have occurred. He finally admitted that using either the figure-8 brace or the sling is solely for my comfort, not medically necessary or even helpful. Basically, his advice is don't do anything risky, no heavy lifting, ice when I want to, and work with PT to start stretching and rebuilding range of motion, then follow up with strengthening.

I like this guy and am quite pleased to have his reassurance, but sometimes I feel like I'm paying big bucks for him to say "do nothing."

Much better than paying the bigger bucks to have an operation you don't need.

Saw my doc yesterday, and like you, no real healing. No heavy or awkward lifting, and biking is OK as long as I promise not to fall. Next appointment is in 4 weeks.

I've been out of the sling for just over a week now, full time. Did kayaking with no pain, but mowing the lawn didn't feel too good afterwards. It feels pretty much normal for most activities.