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Clavicle plate removal. Edit: Report

 

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Chappy

Oct 18, 09 6:30

Post #1 of 44 (10660 views)
Clavicle plate removal. Edit: Report Quote | Reply

Back on 9.06.08 I was struck and had a displaced and commuted fracture that required a bone graft and the plate. I've had two brief conversations with two different surgeons who are not big fans of having it removed. The risk for infection is the most cogent reason i have been able to extract as a reason not to have it removed. I have an appt in Nov to engage the issue and schedule the surgery if that is the decision. I am rehabbing from knee surgery this week so my activity has been greatly restricted. I will be out of the pool for 3 weeks. So I'm thinking I might as well get this thing out if I'm going to do it.

Since the accident I have been able to swim up to 2 miles. The clavicle discomfort is like a low-grade toothache that never goes away completely. I've just learned to live with it. It's a daily annoyance. The reason I would get it removed is protection from a really ugly clavicle fx down the road. I'm thinking with the plate in there if it breaks it will likely break at the weakest point ~ the ends of the plate. I'm guessing that would not be such an easy repair. Without the plate and it breaks I have a better chance for a more manageable break. When I've presented that scenario to the surgeons there is a certain pause in the room and a consideration that this could be an outcome. I respect both these guys and their opinion will wiegh heavily in the decision. I'm looking for anecdotes and better questions to engage.


(This post was edited by Chappy on Feb 24, 10 14:09)


Boudreaux

Oct 18, 09 6:48

Post #2 of 44 (10647 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

Chappy; I can't be of help here.

I can only say, I wish you the very best. As I go through my daily pains with various body parts which hurt constantly, I'm reminded by studs like you that I have it easy.

Best, Kai
"you know, aero trumps training ;-) "
R10C 10/09


Mr X

Oct 18, 09 7:14

Post #3 of 44 (10630 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

I have 7 screws in my plate on my clavicle. If you were to take the plate off, the 'screw holes' will be extremely weak for about a year given that the bone marrow in the clavicle is relatively low and hence the clavicle will be slow to heal. As such, unless your surgeon takes bone marrow (usually) from your hip and inserts it into the old screw holes, you clavicle will be extremely weak for about a year and should you fall on your clavicle it may shatter into numerour pieces resulting in a more serious issue. Thus, ensure you discuss this with your surgeon. FYI - I decided to leave my plate in until such time as I become inactive for a year (most likely never!).

ItsAGoodLifeIfYouTriIt


draketriathlon

Oct 18, 09 7:41

Post #4 of 44 (10618 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

I would be more concerned about where the plate could end up from shifting or if you had another injury. In 05 i seperated my sternoclavicular joint and the clavical dislocated posterior. They ended up just drilling and stitching it back together. (which makes me wonder about what the other poster said about the holes, i was only out 6 months). This was experimental and the old option was to put a plate in it. They said the biggest concern with the plate is that it could shift some and possible end up to close to some major arteries. If it was me i would rather not have something metal sitting that close to my neck, but good luck either way.


Chappy

Oct 18, 09 7:45

Post #5 of 44 (10616 views)
Re: Clavicle plate removal? [Mr X] [In reply to] Quote | Reply

The surgeon who did my knee mentioned the screw holes as a concern in passing. What you say about the bone marrow makes sense.


Kai, thanks for the encouragement, we're all endeavering to stay in the game. If any of us were needing excuses to opt out I suspect we each could find quite a few.


Brian in MA

Oct 18, 09 11:51

Post #6 of 44 (10588 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

My plate has been in for three years now (six screws holding it in place) and my surgeon said he would only remove it if it was either causing chronic pain/soreness or if the tissue around it became inflamed, otherwise it would stay in. I forgot what the timeframe was that he quoted for the screw holes to fill in if it did have to come out. It hasn't bothered me since getting it or hindered me from doing anything, so I don't plan on it coming out unless it has to.


"You can never win or lose if you don't run the race." - Richard Butler



jwrdds

Oct 18, 09 12:29

Post #7 of 44 (10577 views)
Re: Clavicle plate removal? [Mr X] [In reply to] Quote | Reply

I just had my right clavicle plated with 8 screws. It has been ten days. Could you give some idea as to what you were told you could and could not do? I have been out of the sling since monday, and it really does not hurt at all. Not even really limited range of motion. I live in tenn and sports medicine is a foreign term to most ortho guys here. He really does not have a very consistent answer for me. Any ifo would be great.


Mr X

Oct 18, 09 13:10

Post #8 of 44 (10569 views)
Re: Clavicle plate removal? [jwrdds] [In reply to] Quote | Reply

In Reply To:
I just had my right clavicle plated with 8 screws. It has been ten days. Could you give some idea as to what you were told you could and could not do? I have been out of the sling since monday, and it really does not hurt at all. Not even really limited range of motion. I live in tenn and sports medicine is a foreign term to most ortho guys here. He really does not have a very consistent answer for me. Any ifo would be great.

ItsAGoodLifeIfYouTriIt


jefferisr

Oct 18, 09 13:26

Post #9 of 44 (10557 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

I had my plate inserted in Oct. 2007. I had it removed Nov. 2008.

The main reason I had it removed was because the plate area was being irritated by my bathing suit and running bra strap. In addition, I had numbness down my arm for most of the year the plate was in. I did learn to live with it and had to put some thought into yet another surgery.

My doctor didn't see a problem with taking it out. His only warning was to not fall on it for a couple months. I actually did fall pretty hard on my right shoulder six months after the surgery and didn't hurt the clavicle.

I am glad I had it removed.


johnpostmd

Oct 18, 09 13:28

Post #10 of 44 (10555 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

Chappy - all good answers above. You can see that there's no right answer in many cases. One thing I would wonder is why you still have "toothache pain" on a daily basis? Any chance that despite being over a year post op that it's not completely healed? It is unlikely that plate removal will change that. (Your surgeon will probably x-ray your clavicle and comment on this.)

The screw holes will become what's known as stress risers and do have the potential to refracture in the first 6-12 months. That said, the potential for a "marrow graft" to the holes is pretty low in my book.

So, I'd suggest that you are armed with the appropriate questions for your surgeon who knows the particulars of your situation best and the two of you will decide what's best for you.
John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


Chappy

Oct 18, 09 14:08

Post #11 of 44 (10540 views)
Re: Clavicle plate removal? [johnpostmd] [In reply to] Quote | Reply

It was a nasty fx. Kind of hard to imagine that it would ever repair from the looks of the xray. I think I had 9 screws. The dull ache is most noted in the pool and cold-damp days. I always know that its there. If my wife lays her head on that side, ouch. It still had some healing to do on the repeat xrays 3 months post surgery. I am a bit more informed so we should have a good conversation in the coming weeks. Thanks everyone!


(This post was edited by Chappy on Oct 18, 09 14:10)


Alaric83

Oct 18, 09 17:23

Post #12 of 44 (10508 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

I had a plate w/ six screws put in in sept 08 also.

My main reasons for considering to remove it are irritation from wearing heavy backpacks (biking on a bumpy path with a pack full of groceries went from mildly irritating to very painful quite quickly). Also somewhat afraid of what the plate would do if I crashed on that shoulder again, may or may not be an unfounded fear, but its something I've thought about.

My shoulder functions and feels normal to me now, doesn't limit my swimming at all. Just feels weird when I idly count the screws with my finger (a nervous habit I've had ever since the surgery).

---------------------------------------------------------
All we have to decide is what to do with the time that is given to us. ~Gandalf


ltri

Oct 18, 09 17:56

Post #13 of 44 (10494 views)
Re: Clavicle plate removal? [jwrdds] [In reply to] Quote | Reply

   
http://forum.slowtwitch.com/...%20dubyakay;#2452986

Check out this thread. I thought orthogirl gave some great advice. i tried to write my major steps. i feel on a mtn bike w plate and 8 pins. i hope never to remove plate. i think the protruding screws look cool

Damn, that's a cold ass honkey.


Chappy

Nov 28, 09 13:22

Post #14 of 44 (10366 views)
Re: Clavicle plate removal? [johnpostmd] [In reply to] Quote | Reply

One day post op from having the plate removed and all is well. After armed with all the info and long talk with the team it still took 2 weeks to decide to have the plate removed. I felt the difference as soon as they woke me up. That chronic arthritic-like pain was gone. The surgeon said it took a bit longer than anticipated ~ much scar tissue. The clavicle itself was well healed. I worked in the yard most of the day today without a bit of discomfort. Pain fee and with good rom. I've got 4 months of winter indoor riding so hopefully that will give me good-enough healing to take it out on the road come spring. Thanks for the help!


johnpostmd

Nov 28, 09 15:06

Post #15 of 44 (10344 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

Chappy - good job. In the end, you made the right decision for you! The thoughts of indoor workouts till all's quiet are good ones. I have yet to crash riding indoors (putting my clavicle at risk) but I've heard that some do. Good luck for a successful racing season in 2010.
John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


rroof

Nov 28, 09 21:38

Post #16 of 44 (10305 views)
Re: Clavicle plate removal? [johnpostmd] [In reply to] Quote | Reply

You must be better on rollers than I am John ;)

@ Chappy - glad you are healing well. Hit the L'ville roads hard next spring (figuratively of course, kind' of a "break a leg" showbiz term) ;) I'll be down next weekend for the KY state Cross champs on the green.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


nola

Nov 29, 09 3:33

Post #17 of 44 (10282 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

I have a plate w 8 pins from Spring 2008. No issues so far, but please post updates on yours. Also, were there any issues with you insurance company? I assume it was not considered elective?


"You can't always do what's right; but you can always do what's left." Them Crooked Vultures


tigerchik

Nov 29, 09 4:34

Post #18 of 44 (10277 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

Glad you are well!
_________________________________________
Proud member of Fishtwitch and the ST Grammar Police
send a PM for blog accesshttp://www.tigerchik2.wordpress.com"]


tribike

Nov 29, 09 7:17

Post #19 of 44 (10253 views)
Re: Clavicle plate removal? [Mr X] [In reply to] Quote | Reply

Due to the body's remarkable ability to heal, the body remodels the empty screw holes relatively rapidly. Weakness in these areas may persist for 12-18 mos but significant weakness is resolved by around 3 mos. The healing capacity of the clavicle is independent of its marrow content and there is no evidence that adding bone marrow to the screw holes enhances healing.

Not everyone needs their plate removed. It is a personal decision.


Chappy

Nov 29, 09 7:21

Post #20 of 44 (10252 views)
Re: Clavicle plate removal? [nola] [In reply to] Quote | Reply

I'm not anticipating problems with insurance because the ultimate decision to take it out was based on the chronic discomfort I was having. In fact were it not for the discomfort I would have likely made a different decision. Granted I was concerned about a future event, another fracture, but in talking it through with various parties to make a surgical decision based on what might happen in an unknown future was questionable reasoning. That's good you are not having any issues with your post-op recovery. Hope it continues!


Chappy

Nov 29, 09 7:32

Post #21 of 44 (10245 views)
Re: Clavicle plate removal? [rroof] [In reply to] Quote | Reply

Weather is looking decent for next weekend. We took in the Nationals last month. Do you know when you will be racing?

On indoor trainer accidents. Anyone remember Bob Mina's, aka Hurricane Bob, story about his first spin class experience? Priceless, think tri geek-roady hammering in his first spin class and then "sitting up." I've got my man space ready to go with two old Lazy Boys on either side on the trianer. Hopefully I'll land softly : ).


johnpostmd

Nov 29, 09 17:49

Post #22 of 44 (10205 views)
Re: Clavicle plate removal? [rroof] [In reply to] Quote | Reply

Aw geez- and just when I thought it was safe to walk by the emergency room and not have to take care of another triathlete....now I have to worry about the likes of you guys getting excited watching 2007 TdF videos - wondering who'll win this time - and then falling off your Blackburn Trackstand in your living room. We must be getting old.
John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


squid

Nov 30, 09 11:41

Post #23 of 44 (10171 views)
Re: Clavicle plate removal? [Chappy] [In reply to] Quote | Reply

One day post op from having the plate removed and all is well ...That chronic arthritic-like pain was gone....Pain fee.....

That's great news. NOW GET YOUR ASS INTO THE POOL! I expect to see you at MTM first thing in the morning! :)



Chappy

Nov 30, 09 16:07

Post #24 of 44 (10139 views)
Re: Clavicle plate removal? [squid] [In reply to] Quote | Reply

My ass can get in the pool just not the shoulder : ). Sutures come out in 10 days and then it will be time to play.


Chappy

Feb 24, 10 14:08

Post #25 of 44 (9938 views)
Re: Clavicle plate removal? [nola] [In reply to] Quote | Reply

I had the plate removed the day after Thanksgving. I woke up in recovery and felt the difference. The surgeon said there was a lot of scar tissue he had to cut through. Not sure what that means or its significance. Last week I went 3x 1hr in the pool. The discomfort is 90% gone. There is a lingering soreness after a long swim. It was the right decision to get the thing out. Now if the microfracturing and mensicus repair would heal up humpty-dumpty would be about put back together.


(This post was edited by Chappy on Feb 24, 10 14:12)

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Current-aided swims
Do swims aided by a current, such as the NYC Tri and the past weekend's IM Chattanooga, diminish the achievement? Or are they just a local geographic expression of multisport?
Diminish the achievement
Just the local geography