Was out on a training ride Friday week ago and crashed heavily after the front wheel slid out landing heavily on my right shoulder. Needless to say the x-rays confirmed a broken clavicle. Saw the specialist end of last week who said it’s displaced 1.7cm (x-ray attached) and he’d be happy to leave it to heal on it’s own, or if I have any concerns then to get it operated on. Not exactly a clear cut response from a specialist. As for a second opinion he said some of the other shoulder specialist tend to probably treat this more aggressively and would probably go with surgery, but they also have bigger mortgages then me!
So hasn’t really left me knowing what I should do. Has anyone had any similar experiences with the amount displaced and whether they had surgery or not? Keen to hear some thoughts, I’m 38 now so not exactly breaking any more records but not keen to slow down and be limited by anything later.
In general… if it will heal (correctly) on it’s own, I’d leave it alone.
I broke mine ~10 years ago and it was in multiple pieces, leaving not much choice but surgery. The good with surgery - it goes back with a plate, so it’s solid and you can resume activity pretty fast (more to do with pain and the incision wound than the clavicle itself) the bad of course, is you have a plate in your shoulder either forever or until you have it removed… also you are having surgery and at the end of the day no surgery is risk free.
I would like to leave it to heal naturally but just got doubts in my mind incase it doesn’t heal properly or gives me issues later and I’d regret not getting the surgery done. Have you any issues with having the plate in? Has it stopped you from doing anything?
I’d speak and quiz the shit out of the doctor on what he expects if you let it heal naturally… a second opinion is always a good thing as well.
I was lucky, they expected rehab to get range of motion back, but I had full rom as soon as the staples came out.
The big issues with the plate are adjusting to it in the beginning (when sleeping it feels like someone is stepping on you until you get used to it) - issues 10 years later are pretty minor, some stiff/soreness in the cold, some fabrics and the seatbelt in the car can rub it and irritate it. In general it’s just skin, metal so anything abrasive (bibs, tight cut off tops) can irritate it. I’ve crashed on mine a few times since and now it sticks up a little more than it used to (everything held together though!)
*pretty random, but I used to love riding rollercoasters… any of them with the over the top securing are out of the question now
Sample of 1, and I’m an engineer not a doc. But I am an engineer !
My best buddy did his, prob circa 14 years ago. About your age at the time.
Similarly gapped from memory, tho his was displaced is ‘2 planes’ (ie not just a straight perfectly aligned 2 bones with a direct gap between - his was gapped with an offset so after healing the bone would have a left then right S shape joggle in it).
Both 1st hospital when it happened and a then a 2nd back home (so 1x ER and 1x different specialist) said to let it heal onots own.
6-8 months later at the final sign off by the top man that department… decided the healing was shiite.aftwr all and shoulder not aligned etc.
Had to have it re-broken and reset + plated.and screwed together. As it was so long after the initial break he had to have a bone graft to get it to heal again.
Pissed away over a year before he was right from end to end.
I’ve had both break, first was broken in line and took a bit to heal but eventually regained full rom and you’d never know it broke. Second one happened in April of this year and was a “Z†fracture and was pushing up the skin, dr said I could let it heal but I’d have a huge protrusion so opted for surgery. Once the plate was in I had almost no pain the next day and two days later I basically ditched the sling and slowly over the next week started moving it. I’d say after three weeks I had full rom and started doing light weights workouts (had been doing band resistance rom exercises after the first week).
I’d pick which ever option let’s you recovery as fully as possible. I’ve had a lot of injuries over the years and I know they’ll add up when I’m older so if I can get them fixed properly to minimize their effects on me as I age that’s the way to go.
I am going to be contrary to others and say “get the surgery”.
I had a similar fracture almost 20 years ago.
Doc said it would heal just fine.
It did heal- But now almost 20 years later I can tell that the architecture of my AC joint is jacked- The fracture didn’t heal quite as straight as it should. For a few years I did not notice- Now I do.
with surgery you risk infection, but you are likely going to make a full recover faster.
without surgery, you risk poor union, thus altering shoulder and neck mobility, and even if the union is proper, it is still longer for a full recover.
p.s.- my buddy just crashed at imchoo and had a 2.5cm displaced fracture. his ortho said no surgery… i saw the image and was like… wtf no way. sent it to two of my ortho buddies, and my 2 cousins (ortho, and er chief), and all 4 were like ummm, wtf? he had surgery this past friday.
Yeah definitely leaning down the surgical option. Not the most patient person going around and don’t want to run the risk of a delayed union. Plus got 2 little girls at home so the sooner I can pick up my little one the better.
Have made an appointment with another specialist for tomorrow to get a second opinion and go from there.
Risks and benefits both ways. Which is better for you, IDK. You need to find someone who will explain the situation as clearly as possible and then you can collectively decide.
I’ve personally broken both of my shoulders-neither required surgery. First proximal break on the right side-gave it some time and it healed up just fine. Second was distal third (furthest away from the body), on the left side, with multiple rib fractures and a T1compression fracture. This shoulder fracture is the kind that almost always needs surgery. I pushed it close together (reduced it, painfully) each day after the accident and the f/u ct scan a week later was close enough. No surgery again. Not the smartest thing in the world to do.
Big defect left with a large callus and chronic pain/weakness and a lifetime of shoulder woes on both sides. Right decisions? Who knows.
I didn’t have to incur the risks of the operation and all that entails though.
I had a 2cm displacement many years ago. Was displaced forward and upward. And bad splintering.
I’ll spare you all the details, but I’d recommend surgery. Then you’ll be sure everything is aligned properly and the recovery is fairly simple. No lingering issues for me. I still have the plate and screws in 10 years later.
I recommend two surgeries. One to put the clavicle in it’s place with a metal plate, and another in about a year to remove the plate.
You will heal better, heck you can start on the home trainer ( with out hands on handlebars) a few days after surgery because the bone is well held together.
My experience: I broke my collar bone in 2010, the doctors couldn’t align both ends properly so they decided to opt for surgery. I’m glad they did. I was rapidly on the home trainer and it didn’t hurt as much as before, with the clavicle brace. A friend physiotherapist suggested to have the plate removed, because the doctors usually leave it in place if the patient doesn’t mind. After more than a year the bone forms calcification around the plate and it’s not easy to remove it, movements are not as complete with this “structure” in the body.
Unfortunaltely, I had a bad fall in a criterium the spring after. The next morning my shoulder was hurting a lot ( I still had the metal plate on), and the clavicle looked like it had a deviation. I decided to have it “X” rayed. The collar bone broke right where the screws were, and the plate bent on the impact. I had to keep the plate another 9 months before having it removed. NOw my right clavicle is shaped like an “n” while the left one is straight.
Had a hard crash this Friday while going 29mph in the tt, broken collarbone in 5 pieces. Got the surgery done yesterday and feeling good right now and practically no pain (I’m still on heavy meds), let’s see how’s the transition to normal painkillers. I can move my shoulder and could probably make it without the sling, but doc told me to wear the sling when not lying in bed or sitting in a position where I can support my arm at least for a few days since we don’t want to over stress the plate. After being in the fitness of my life I will miss 70.3 cabos but hoping to be back running for my first full marathon December 8.
I can only comment on mine which was 4.5 cm and the (teaching) hospital i was in for a week said “it’ll be fine.†Went to the ortho specialist who asked “why didn’t they fix this?â€
So 1.7 to me does not sound like a lot.
However my break was the site of a non union from a break when I was 18, was not really bone. So getting the plate to match the fucked up geometry required some hammering of the plate (I’m told, I was out). So a non union isn’t great either (always had a bump there )
I am going to be contrary to others and say “get the surgery”.
I had a similar fracture almost 20 years ago.
Doc said it would heal just fine.
It did heal- But now almost 20 years later I can tell that the architecture of my AC joint is jacked- The fracture didn’t heal quite as straight as it should. For a few years I did not notice- Now I do.
Good point made here. A related point I’d consider OP is you’ll heal faster now from surgery than you could ever remotely heal 20 years from now (if at all) if and when other ailments (and possible treatments) come up from not having the surgery done. It’s also true things are never the same after surgery, so you have to decide how much of “not the same” you want to deal with now and later.
As a general truism, each person and break is different and best to get several opinions of clavicle specialists for your own break.
That said, today vs. 10 years ago, surgery is more often the answer. The principal reason is the evolution of the fixing plates and the success that comes using them is much higher today.
My son broke his on 7/27 at IM Santa Rosa 70.3. 2cm displacement. We saw Dr. Modaber in Santa Monica the next day and he had surgery two days after the crash. We consulted with several orthos and they all agreed.
Surgery was uneventful and two nights after it he had a rough night but after that was on Advil for a week and then pain was manageable.
He was targeting IM Barcelona (10/6) but switched to IMAZ (11/24). On trainer/Zwift riding up to 5 hours the second week. More upright and limited pressure on break side.
Running week 3, holding arm against chest. Awkward but doable. On a treadie.
Full on running outside week 4 on. Zwift for next month and better shape than in July. Swimming starting week 8 and now after 2 weeks hitting good 100 yard splits 1:16 or so. Generally in better shape then before break. Hoping to KQ in Arizona.
Dr. was concerned about geometry of naturally healed shoulder. He’ll get full mobility and functionality this way. He may elect for second surgery a few years down road to remove plates. It doesn’t bother him now but it could when he climbs with a loaded backpack. He is a high altitude mountaineer.
Clearly right decision for him. Doc indicated surgery right call 75%+ of the time…
Again, your situation might be different.
Good luck. Sorry about the crash. (If it’s any consolation, it’s better than a grade 3 separation, which I had to endure). Heal well!
I had this, almost same displacement… It is pain free quite fast (5 or 6 weeks) so you can swim/weight bear on it, but it still clicked a few months after.
Clacicle is the crumplezone of your arm, its designed to break first so your arms (and nerves and vessels around them) stay safe. So while it clicks it can do that.
And definately dont immobilise shoulder while waiting (sling etc) … Frozen shoulder happens fast and takes a lot of pain and time to remobilise.
Only take painkillers for aches that stop you sleepi g and use pain to guide how much to move and yrst in all directiins after the inflamnation period is over (initial 48 to 78hrs)
(everything held together though!)
