need some advice on two treatment options. i have a broken clavicle (midway along the bone). there is some vertical displacement. i have the choice of surgery (to pin and plate it) or not. reason not to may be that there is a lot of damge on the same side to my jugular veins which needed surgery. but i’d like to do whatever will be best for making a full recovery and keeping full ROM for swim (especially) but also bike and run. thanks for any advice.
Dude, you totally need one of these: http://www.roadcycling.com/articles/Carbon_Clavicle_Implanted_in_Lance_Armstrong_002674.shtml
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I am not an orthopedist, but the trend these days IS to surgically repair in athletes - at least here in Boston.
Is it the same side as the scapular fracture? what if anything are they doing about that?
If they are repairing jugular I would think that that would be an ideal time to do clavicular repair.
broke my clavicule in a similar way as the x-ray Khai as posted. But was lucky that both peice have fuse back together in a close to normal position and range of motion wasnt affected after that… there is still some tenderness or tighness still now from it but it s mostly when running…never when swimming
but i m sure someone more qualified can chip in! take good care of yourself…we want you back in one peice and healthy!
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Join the club! Right or left? Mine was right. I broke mine pretty much in the middle and that section rotated 90 degrees and almost, they said mm’s away, punctured my lung and, lucky, didnt have enough force to break the skin. At first, I had to wear that comfortable figure 8 until they decided what to do. In the end, I found a great Air Force (I was a Senior in college and still covered under my parents Army health coverage) bone doctor (can not remember the real term) and he took a look and a couple of days later, I was scheduled for an in patient procedure. I asked him the same questions, about how he was going to mend it and through what method. He preferred to not use any pins or plates as he said that pins in bones have a habit of floating around and turning up in undesirable places. His solution was to take the fragment that broke free, cut it in half and buttress the collar bone front and rear with it. Kind of like a bone graft. The body and the bone took over from there building up a ball around the break and the pieces and rebuilding a solid collar bone. The stitches were all internal (still dont know how he did that) and now all thats left is a faint scar about an inch or so long. The result was a completely smooth right collar bone, until I rolled onto it and smushed it a little bit (the pain from my 1 cm compressed and fractured L2 caused me to forget about the collar bone) but not enough to undo the work the doc did.
As for range of motion, its not 100% and never will be. I was in a sling after the surgery for a few months and during that time, my shoulder locked up tight. Had a few months of rehab wear they slowly worked the arm and shoulder through small movements and a finger walking your hand up the wall technique. I can, however, support my own weight in aero, swim, throw, etc… without issues. The only time I have issues is when I need to scratch my back as my arm will not go as far back as my undamaged left will, or when doing weights like the bench press. Past a certain point and my shoulder hates it. It will not be comfortable and it will not be a quick journey like most bike related collarbones. With rehab though, youll be back out there like me.
Some other riders who have broken a collar bone balk at the issues I still have with my shoulder saying that theyve cracked theirs and dont have any residual problems like what I have. I then remind them that they just broke theirs whereas I f’d mine up. Stupid freeriding and that whole “go big or go home” mentality. Ill see if I can dig up my XRays and scan them in. We will compare breaks!
Im glad youre alright and coming back around. Sucks when bad things happen to good people.
Well, I’m certainly not an expert, but I’d think it depends on how bad the break is, at least in part. Or that’s what my orthopedic surgeon told me when I broke my collarbone - which was completely broken, the two parts overlapping, one half jutting upwards. So that was pretty clearcut. He said that if it’s a bad enough break, then they just don’t heal well enough without being set. So mine got a titanium plate, and I’ve had zero problems with it in terms of swim/bike/run. Nada. Wouldn’t even know it’s there.
Tasha
Just adding the picture of my broken collarbone, vertical shards and all - umm, yeah, that was never going to heal normally on its own.
Maybe that’ll help you compare it to yours, as you think about what can and should be done…
Tasha
There had been numerous threads about this in the past.
The take home message I got out of them:
If it is a clean fx and aligned well it may heal well on its own, but it may take longer.
If it is a complex fx with a lot of displacement surgery seems to be the better option and may lead to faster recovery, but you would have to “deal” with the hardware later.
Good to see you back (on ST, that is).
I’ve broken both. No surgery on either. Full ROM, but have a hard time carrying
a messenger bag to either side now.
Here is a summary of my discussions with my sports medicine guy. I will paraphrase:
“If the ends of the bones aren’t on the same side of the body then you need to have
surgery. Other than that, most surgery is being advocated, not surprisingly, by orthopedic
surgeons. If you are a professional athlete then having the surgery might be a good
idea because you can get back to work so much faster. [ed: Amusing since he
knew I was nowhere near that, but you are.] The problem with the surgery is that
if you’ve seen ortho’s work, it’s hardly delicate and there is a lot of vascular work
right behind the clavicle.”
I’ll add my own picture to the party:
I did IMAZ 12 weeks after this.
-Jot
Hi Jordan, Lauren here, stealing Adam’s ST account. My gosh, I am SO sorry to hear about the crash… we are just so relieved to hear you are going to be OK.
I thought I’d share my clavicle experiences. I had a mid-shaft fracture with about 0.5cm displacement and minimal overlap. The break was fairly clean as there were no loose fragments, but the two ends of the bones sure did have some pointy shards! It looked rather dramatic on the x-ray and I thought there would be no way for it to heal without surgery. But, I was told that with less than 2cm displacement (vertical) and significant overlap, a mid-shaft fracture has a great chance of healing on it’s own. Over the past two months I have had far too much time on my hands to scour the internet and read clavicle messageboards and personal experiences and from what I’ve read, those who have had surgery heal quicker and have fewer long-term complications. But, obviously with surgery there are risks involved so I was told for clavicles this is usually a last resort, unless the fracture is the distal or proximal thirds or falls into the displacement range.
My healing experiences in terms of pain have been fairly decent. I was out of the sling within a couple of weeks, starting range of motion. I was in the pool at 3 weeks kicking and swimming single arm. Around 6 weeks I started sculling with my arm out in front of me and at 8 weeks began to try both arms. I am now at 10 weeks and am still in a lot of pain to swim with both arms but the strength is slowly showing signs of coming back. I had an x-ray yesterday that showed minimal callus between the bones so it is definitely a slow healer. I think having displacement really slows things down in terms of healing. Bones need that contact! As for riding, it really hasn’t been a major issue and running was tolerable around 3 or 4 weeks, but about 6 weeks before I could swing both arms normally. Chiro and ART has been integral in the healing, right from the very start, and at least twice a week.
I hope this helps… please drop us a line when you get a chance.
Heal up!!!
chef L
Do you have Joanna’s email? She went through these questions in NOV. Let me know if you need it. Good to have you back and kicking. 
My two cents…get the surgery. I broke my right clavicle into three pieces while snowboarding. Displacement was significant but the surgeon sent me home for one week with the figure-8 brace and lots of drugs in the hope that things might return to correct position. The bone fragments didn’t move during that time so he opened me up and inserted 8 screws and plates. Recovery time was around 8-10 weeks but with good physiotherapy I have full ROM and no issues whatsoever with activity. I had the screws and plates removed one year later because carrying any type of bag on that shoulder was uncomfortable but that surgery may not be necessary in your case.
Hi Jordan. I am so sorry to hear about what happened. Glad to see you are well enough to post on slowtwitch!
I am an orthopaedic surgeon, subspecialty-trained in orthopaedic trauma and hand/upper extremity surgery and I have a lot of familiarity with clavicle/scapula fractures.
Some thoughts:
Sounds like you fractured both the scapula and clavicle, no? If you have an injury to the superior shoulder suspensory complex then surgery is essentially mandatory. (fracture of certain part of the scapula along with midshaft clavicle fx)
If they are “in there anyway” doing a vascular repair then that lessens the question of “surgical risk” since they’ll already be in there. Yes, the drills and retractors could injure the brachial plexus (nerves) or the major blood vessels which are very close, but that is extremely rare in competent hands. Question then becomes if you are up for a 10-15% chance of needing hardware removal surgery in a year (and the associated down time from racing/training to let the screw holes fill in). After removal there is a risk of re-fracture thru a stress-riser (screw hole) just like if you drilled a hole in your bike’s frame - it’d break thru the hole if twisted hard enough. Luckily the body fills bone holes in time, but it takes a while.
Level 1 evidence from a few studies shows strength benefit of ORIF for clavicle fractures. The bone with surgery is brought back out to the right length and the shoulder girdle to the right position in space, making the muscles (principally the lats, traps, and pectoralis) that span chest to shoulder stronger. Conversely, if the bone heals short (as it may without surgery – there is NO WAY to “set” the bone or hold it in place without internal fixation like plates/screws) then the muscles are shorter at rest and, like rubber bands, they need pre-stretch to contract maximally. Thus - you WILL have a strength deficit that is worse without surgery but may not be detectable (may only be 2-3% and you could compensate by long-term rehab)
Contrary to what some have posted, the recovery is NOT faster with surgery on isolated clavicle fractures. Although with BOTH a clavicle and scapula Fx it may be. Approximate time until “full” use 3 months either way, maybe shorter without surgery - but that doesn’t take into account your vascular injury or scapular injury.
Long-term you’d notice the very subtle strength deficit in the swim. It’d make just about zero difference in biking or running. My guess is it’d be an obstacle that could be overcome. I don’t think a slightly short clavicle (despite the muscle changes mentioned above) would drastically affect swim strength.
The big question is - what is your scapular injury pattern?
I offer surgery to almost every patient with a >2cm displaced clavicle fracture and lay out the above points and let folks decide. probably 2/3 of patients choose surgery. I place the plate in what is called the “antero-inferior” position where it is not noticeable (or barely noticeable) and have not yet had to remove any plates that i put in this way (as opposed to directly “on top” of the bone, under the skin where, amazingly, you can almost see the screw heads thru the skin in thin folks.
Hope that helps!
Best of luck for a speedy recovery.
-Jeff
broke mine 6weeks ago, and had it pinned and plated: indoor trainer 3 days after, running 12 days after, full ROM after a couple of weeks, back in the pool after 3 weeks (when the scar closed to avoid infection)
you can see pics in my website
good luck,
alvaro
www.planetaTri.com
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Hi Rappstar, glad to hear you are ok. Seems like you have a good fracture for a surgical option. The only issue is comfort in the long term as plates can irritate the area. I had a good result without surgery and the docs in Australia would rather let it heal naturally. Given the time to heal from your other injuries, it might be worth going the non-surgical option.
need some advice on two treatment options. i have a broken clavicle (midway along the bone). there is some vertical displacement. i have the choice of surgery (to pin and plate it) or not. reason not to may be that there is a lot of damge on the same side to my jugular veins which needed surgery. but i’d like to do whatever will be best for making a full recovery and keeping full ROM for swim (especially) but also bike and run. thanks for any advice.
Aren’t you in a hospital? Ask one of the ortho residents what they recommend in a high level athlete. They’ll shoot you straight. If you have a broken scapula and clavicle, depending on the fracture patterns, you might have to have at least one of the fractures fixed. Google floating shoulder.
Jordon
Real glad to “hear” you talking. Lots of people pulling for you.
As for your question, lots of people here have broken a clavicle. Mine was the left side in '05. When I get back from work on Thursday, will find the best article I used for my research. Can’t find it now and have to leave for the airport soon. Do as we all did. Research. Be like what Lance did. More research.
But in a nutshell, of the three types of breaks, a mid clavicle break is the best. That is what I had also. I also had some splintering. Non-surgical. Used a sling in addition to a figure 8 brace. Had been training hard for Full course when I broke mine and the dramatic change from hard training to sedentary was very difficult. Legs would completely cramp up in the middle of the night.
But since I couldn’t work (off for 6 weeks), decided to do what pro cyclists do in such cases. Was walking a few days after my crash. Week two had me on the trainer. By week three was riding around 200 miles a week, slinged up on the trainer and power walking maybe 20 miles a week. Maintained fitness pretty well. Eventually did that Vineman race, albeit very slowly.
The swimming took time though. Had lots of rash that had to heal first.
But now years later, my swimming is the best ever. And thanks to you for mentioning having to deal with “crossoveritis”. That is what got me really on track.
As a side note. 5% of clavicle breaks eventually result in some nerve impingement. Brachial plexus compression. I was one of those unlucky ones. Got to the point, about 12 weeks after the crash, and 3 weeks after Vineman, that I could not even do one pushup! Even if you offered me a million dollars! The fool doctor wanted to re-break the bone. Researched again the subject. And the result was that swimming opened it back up.
best of luck.
you’ll be back
Conrad
If you have a choice on the repair, ask them to do an IM wire instead of a plate. It’s what our orthopods have started to do. (I work in a hospital in the Lake Tahoe area where we see a LOT of ski and snowboard injuries. Our 'Pods get a lot of experience.) The IM wire has less potential for brachial plexus injuries than the plate did.
Jordan, glad you’re debating whether to have clavicle surgery or not…that means you’re well down the road to recovery. I hope you continue to improve and can get back to training soon!
Anyway, I say go for the surgery.
When I broke mine in a race two years ago, every MD I saw was 50-50 on whether I would need surgery or not. The displacement of my fracture was borderline to whether the bones would “see” each other and heal correctly. It took me 2 weeks to get in to see a good shoulder/arm/guy. During that time I was a in a ton of pain and my collarbone was driving me crazy. I got lucky since my surgeon also raced bikes. He left the decision up to me, but said that the surgery would guarantee that my position on the bike wouldn’t change and my recovery would be quicker. Thankfully, I had surgery 2 days later. In fact, I felt better the day after surgery than I did during the 2 weeks of waiting. I had a titanium plate inserted with 8 screws. I was able to ride aerobars without pain about 4 weeks later (indoors). I don’t swim so I can’t comment there, but my ROM is normal today. One of my teammates did have ROM problems (he dives) and found that regular acupuncture treatments helped him get back to normal.
Good luck!
BTW, here are before and after shots (love how they can give you JPEGs of your x-rays nowadays)
Broke my clavicle as well back in 07 and had surgery. I had a “nail”/pin put in and then had it removed 6 months later. The pin option I was told was less invasive than the plate option. Went to a surgeon, Dr. Andy Pearle at the Hospital for Special Surgery in NYC. I had my surgery about 12 days after the accident. I would ask your doctor whether or not surgery would allow for a more accurate fix to the bone than natural healing of non-surgery. Good luck!!