Clavicle plate removal. Edit: Report

Oct 18, 09 6:30

Post #1 of 44 (17948 views)

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.

Last edited by: Chappy: Feb 24, 10 14:09

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 6:48

Post #2 of 44 (17935 views)

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

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 7:14

Post #3 of 44 (17918 views)

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

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 7:41

Post #4 of 44 (17906 views)

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.

Re: Clavicle plate removal? [Mr X] [ In reply to ]

Oct 18, 09 7:45

Post #5 of 44 (17904 views)

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.

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 11:51

Post #6 of 44 (17876 views)

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

Re: Clavicle plate removal? [Mr X] [ In reply to ]

Oct 18, 09 12:29

Post #7 of 44 (17865 views)

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.

Re: Clavicle plate removal? [jwrdds] [ In reply to ]

Oct 18, 09 13:10

Post #8 of 44 (17857 views)

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

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 13:26

Post #9 of 44 (17845 views)

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.

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 13:28

Post #10 of 44 (17843 views)

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 H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Clavicle plate removal? [johnpostmd] [ In reply to ]

Oct 18, 09 14:08

Post #11 of 44 (17828 views)

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!

Last edited by: Chappy: Oct 18, 09 14:10

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Oct 18, 09 17:23

Post #12 of 44 (17796 views)

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

Re: Clavicle plate removal? [jwrdds] [ In reply to ]

Oct 18, 09 17:56

Post #13 of 44 (17782 views)

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.

Re: Clavicle plate removal? [johnpostmd] [ In reply to ]

Nov 28, 09 13:22

Post #14 of 44 (17654 views)

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!

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Nov 28, 09 15:06

Post #15 of 44 (17632 views)

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 H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Clavicle plate removal? [johnpostmd] [ In reply to ]

Nov 28, 09 21:38

Post #16 of 44 (17593 views)

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

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Nov 29, 09 3:33

Post #17 of 44 (17570 views)

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

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Nov 29, 09 4:34

Post #18 of 44 (17565 views)

Glad you are well!

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Re: Clavicle plate removal? [Mr X] [ In reply to ]

Nov 29, 09 7:17

Post #19 of 44 (17541 views)

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.

Re: Clavicle plate removal? [nola] [ In reply to ]

Nov 29, 09 7:21

Post #20 of 44 (17540 views)

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!

Re: Clavicle plate removal? [rroof] [ In reply to ]

Nov 29, 09 7:32

Post #21 of 44 (17533 views)

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 : ).

Re: Clavicle plate removal? [rroof] [ In reply to ]

Nov 29, 09 17:49

Post #22 of 44 (17493 views)

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 H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Nov 30, 09 11:41

Post #23 of 44 (17459 views)

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! :)

Re: Clavicle plate removal? [squid] [ In reply to ]

Nov 30, 09 16:07

Post #24 of 44 (17427 views)

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.

Re: Clavicle plate removal? [nola] [ In reply to ]

Feb 24, 10 14:08

Post #25 of 44 (17226 views)

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.

Last edited by: Chappy: Feb 24, 10 14:12

Re: Clavicle plate removal? [draketriathlon] [ In reply to ]

Feb 24, 10 15:20

Post #26 of 44 (5961 views)

That sounds like a horrible injury. The sternoclavicular joint is an ugly mess of tendons and bone at the best of times. How did you do it?

Re: Clavicle plate removal? [alexZA] [ In reply to ]

Feb 24, 10 15:28

Post #27 of 44 (5959 views)

Wow old thread... I was playing hockey at Iowa State, and was backchecking full speed and checked a kid at our goal line. It was a complete accident but his feet came up and clipped my and i went shoulder first into boards.

Heres the journal article for the procedure they did with pictures of me cut open.. kinda cool. But yeah i had to go to the University of Iowa Hospital because of the rarity of the injury. Needless to say with how good of a job he did i am going back to him for my PCL surgery this year.

http://www.ncbi.nlm.nih.gov/...articles/PMC2603349/

Re: Clavicle plate removal? [draketriathlon] [ In reply to ]

Feb 24, 10 15:36

Post #28 of 44 (5951 views)

Pretty cool pics and a good scar for the ladees. Good luck with the PCL op.

Re: Clavicle plate removal? [draketriathlon] [ In reply to ]

Feb 24, 10 15:50

Post #29 of 44 (5945 views)

Cool pics, thanks for posting the link. Eventhough I have pre- and post-op x-rays of mine, I've always been curious what it looked like once they went in there to insert the plate/screws as mine was a double-displaced fracture with the clavicle in three separate pieces. Now I have a relative idea. : )

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

Re: Clavicle plate removal. Edit: Report [Chappy] [ In reply to ]

Feb 24, 10 15:57

Post #30 of 44 (5942 views)

Interesting to read about this -

I had my plate put in October 2007. Pre-op I was told 3 screws, post-op I found out surgery went long and I had six screws. Long and short is while it was obvious that one end of the break was tenting the skin (hadn't popped out though) what wasn't obvious was that the other end was pretty severly impacting into my trap.

I don't have any pain but sometimes I get a dull ache like I've had all day today. When I asked my doc about taking it out (2 months after I got it) he said that pain or if the screws were backing out was really the only reason to take it out. I personally don't know why but I don't like showing the scar. My fear with taking it out is I'm still playing rugby and if I remove the plate that will end that. Also with cycling I would like to keep it strong assuming like (almost) all cyclists I'll be in a bad wreck at some point.

This thread has made me wonder about it again though.

Re: Clavicle plate removal? [Brian in MA] [ In reply to ]

Feb 24, 10 15:58

Post #31 of 44 (5942 views)

Heres the CT scan images... well a picture of the ct scan held up to a light haha.

Re: Clavicle plate removal? [jefferisr] [ In reply to ]

Sep 4, 12 23:54

Post #32 of 44 (5102 views)

I'm having same issues w/ plate and screws, irritated by swimsuit/jogbra/seatbelt, and have scheduled surgery to have the hardware removed.

I'm wondering about recovery time/resuming activities the second time around though?

Also wondering if the feeling came back in your arm after the plate/screws were removed? (Mine has been numb since first surgery, 18 months ago...).

Thank you!

Re: Clavicle plate removal? [groovychicSF] [ In reply to ]

Sep 5, 12 5:38

Post #33 of 44 (5037 views)

I had my plate and 11 screws out on Dec 20, 2011 and was on the trainer by Dec 24, though it was only for an hour. Assuming the bone has healed the only thing holding you back from swimming is the wound fully healing, which should take about 4 weeks. YMMV.

Regarding the numbness, that's a surgical issue. They probably did not take the time or care to fully dissect the platysma muscle in the neck region and cut a brachial nerve which could lead to the numbness.

Bob

Re: Clavicle plate removal? [groovychicSF] [ In reply to ]

Sep 5, 12 5:46

Post #34 of 44 (5032 views)

The removal surgery actually hurt more than expected. If I remember correctly, I took a week off and was out and running again after 7 days and swimming in two weeks. You have to be careful not to fall for about six months.
Numbness went away in about six months.

I have no regrets about having the plate removed. Scar doesn�t really bother me and nobody seems to notice it.
I did purchase an expensive scar fading cream and used it for about six months. Unfortunately, I can�t recall the brand.
Also, be sure to use good sunscreen on the scar...forever!

Good luck.

Re: Clavicle plate removal? [jefferisr] [ In reply to ]

Sep 5, 12 7:35

Post #35 of 44 (4992 views)

jefferisr wrote:

The removal surgery actually hurt more than expected. If I remember correctly, I took a week off and was out and running again after 7 days and swimming in two weeks. You have to be careful not to fall for about six months.
Numbness went away in about six months.

I have no regrets about having the plate removed. Scar doesn�t really bother me and nobody seems to notice it.
I did purchase an expensive scar fading cream and used it for about six months. Unfortunately, I can�t recall the brand.
Also, be sure to use good sunscreen on the scar...forever!

Good luck.

Are you saying that the numbness that was present with the plate was no longer present with the plate removed? I thought the numbness was a function of the operation, not the hardware.

Ironman Certified Coach

Currently accepting limited number of new athletes

Re: Clavicle plate removal? [bufit323] [ In reply to ]

Sep 5, 12 9:16

Post #36 of 44 (4968 views)

I believe the numbness is from the surgery. I have had a couple surgeries that resulted in numbness. The numbness usually goes away in about six months.

Re: Clavicle plate removal? [jefferisr] [ In reply to ]

Sep 5, 12 11:42

Post #37 of 44 (4942 views)

jefferisr wrote:

I believe the numbness is from the surgery. I have had a couple surgeries that resulted in numbness. The numbness usually goes away in about six months.

I'm five months out. The numbess has improved but still encompasses a larger are than I had hoped at this point.

Other than that, the only issue remaining is discomfort when I put a school bag or shoulder strap on.

I won't be removing my plate unless something changes a good amount.

Ironman Certified Coach

Currently accepting limited number of new athletes

Re: Clavicle plate removal? [bufit323] [ In reply to ]

Sep 5, 12 14:36

Post #38 of 44 (4903 views)

broke mine 5/1/12. 9 screws and plate Dr. told me the plate comes out in a year cause it can become like an arrow if i go down again and possibly puncture a lung or other organ like heart.

Re: Clavicle plate removal? [Macho Grande] [ In reply to ]

Sep 5, 12 15:44

Post #39 of 44 (4875 views)

Thanks Bob! Sounds like a much speedier recovery than after the first surgery (which makes sense, since the bone is healed).

And will talk to my surgeon about taking better care of my nerves the second time around. ;)

Thanks again!

Re: Clavicle plate removal? [jefferisr] [ In reply to ]

Sep 5, 12 15:56

Post #40 of 44 (4869 views)

Thank you! Again, sounds like it's easier to get back into training much faster after the second surgery. Also, great to hear that you're still happy you had the plate removed! I think I'll feel much more agile and "free" when it's out.

Wasn't too worried about the scar - although I've received conflicting info about whether they can cut along the original incision or have to create a new one/second scar (?) ... either way, figure it just makes me look like a tough chic. ;) (Although not quite as tough as with current visible plate and screws, lol.)

Re: Clavicle plate removal? [groovychicSF] [ In reply to ]

Sep 5, 12 16:10

Post #41 of 44 (4855 views)

I visited ST for a look-see and saw this thread and thought I would follow-up. I'm about 33 months out from the removal. I think if I had it do over I still would do it. On a 10 pt scale before the removal I'd say I was a 5. After the removal I'm up to a 7 with occasional days at 8. It may have something to do with being 55. It can still ache and limit the swimming. I nearly always feel it. Back in March I was seeing a new ortho for a Synvisc injection through the VA. He was reading my history and asked if I was the counselor-guy on a bike hit by a truck and ended up with a clavicle fracture. After I confirmed, he says, "I don't remember you but I do remember that clavicle. That was a nasty break. I was in the O.R. that day as a resident." It nice to be remembered, I think : )!

Re: Clavicle plate removal? [Chappy] [ In reply to ]

Sep 5, 12 16:38

Post #42 of 44 (4843 views)

Ha, yes, always nice to be remembered one way or the other!

Glad to hear that things are better and that you're still swimming, despite aches and pains. (And super to thrive after being hit by a truck, oy!)

Ok, so, survey says: 9 out of 10 folks still happier they had plates & screws removed! (Or something like this...)

Sept. 13th, here I come!

P.s. Perhaps a virtual 'say goodbye to the plate' party on the 12th? Ha!

Re: Clavicle plate removal? [groovychicSF] [ In reply to ]

Sep 5, 12 18:02

Post #43 of 44 (4812 views)

The surgeon who did the removal used the old incision. He was a late 30 something with plenty of experience so it turned out looking much cleaner and smaller. The repair surgery was probably closed by a 1st-2nd year resident. Experience matters.

Re: Clavicle plate removal? [cjb3] [ In reply to ]

Sep 6, 12 6:26

Post #44 of 44 (4783 views)

Well, not exactly true since it would take a one in a billion, play the lottery now shot to dislodge the plate and 9 screws so that the thing could become a "arrow."

However, if you crashed the plate can cause more damage to the bone and shoulder joint if it is in there.

Bob

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