MikeyBoyAz

First off, this is NOT a medical ADVICE thread.


Back Story: While riding Saturday last I collided with another rider and crashed. I broke my clavicle and although I was awake 100% I couldn't get up, so they called the PMT. Long story short I had it repaired. In my case I had a complex fracture with shards so the doc highly recommended against leaving it to set without surgery.

Question: Who else has broken their clavicle? Did you have it set and wear the brace or did you opt for surgery? For each type (surgery or not) how much time did it take to get back on the bike (following Doc's advice)? Is the general trend that the muscle PT will take longer after they cut it back to perform the surgery; or that the risk of the joint freezing is worse; or [insert justification here]?

Reasoning: The doctor said the general consensus of cyclists at the trauma center (over half) was NOT to have it repaired either because they heard it didn't matter either way or they wanted the trophy [insert justification here].

What are your non-medically sensitive [low/non-liability risk] thoughts?

gsteinb

I broke my collar bone in 2010. I needed surgery (the bone was poking the skin). I was riding within a week indoors. I was racing a couple-three weeks after surgery. All against doctor's advice..but still.

BentLink

Heal well and take your time.

Mine was broken into bits (comminuted, to be precise) with a big chunk displacing the ends, like a "Z". Surgery followed quickly, and I was back on the trainer within 2 weeks, still in a sling. I could run in 8 weeks, but lost range of motion so I couldn't reach my bars. A little PT and I was riding around week 12. This was pretty conservative, but I've had zero problems in 2 years since the crash.

Larry3x2

Mine was comminuted, three fractures, wore the brace without surgery. Have a slight offset in the bone with no problems. I preferred no metal get installed.
Larry

SteelCan

I had a similar clavicle fracture - lots of comminution with the dreaded Zed break. Occurred 7mths ago - Aug 30th. I also had a subluxation - partial dislocation at the sternum.
I did a lot of research and after talking with a couple Docs, it was IMO a no-brainer to have the Ti Plate/ORIF surgery. (best large, long term study since the new Ti Plate became available was by those crazy Canadians that agreed to enter a blind study to measure the success of ORIF vs. natural healing). Result favored the ORIF surgery. You can google it.

However my Ortho did provide the caveats:
1. potential nerve damage. To quibble -I did have some minor tingling sensations in my shoulder that reached my palm for a couple months. It has since gone away.
2. scarring and some muscle issues that could effect your neck.
3. Infection. Not likely but a potentially life-threatening side-effect. You can expect to receive 2rds of IV antibiotics over 6hrs after surgery.
My Outcome:
I had comfortable 95% ROM within 3hrs of surgery. (In addition to the short term anesthesia and propofol, I likely had a nerve block that lingered and kept the pain down). I was in agony BEFORE surgery but did not require anything for pain afterward -nor before, I just suffered :-). I left the hospital 7hrs after surgery (waiting for the second round of IV antibiotics to complete).

I rode a group ride 24hrs later - dumb (as a test to measure how pro's handle it. Doc certainly would not have been pleased).
How did I feel riding?
I could have raced. Only thing that stung was surprisingly when unclipping and touching my foot to the ground at a stop. Even though I stopped gingerly, I could feel a "sting" that traveled to the break.
I did give it another 3mths before I rode outdoors/group rides. (problem wasn't riding, it was making sure I didn't fall and re-injure the exceptional care I received)

Check out the forums on thumpertalk.com and search for Dr Mark and collarbones.
If you would consider traveling to the Philly area, I'd PM an Orthopedic Trauma Surgeon that provided absolutely OUTSTANDING care. My X-rays were reviewed by the 3 independent Ortho's. Each used the term "Gnarly". This Doc made what was a complicated repair of a HIGH ENERGY IMPACT seem easy and routine. He also understands athletes and I think fascinated (and a bit perplexed) with cyclists.

MikeyBoyAz

Very good to know (from all of you)

Good news on the surgeon.
*Rated among top 100 'orthos' in the nation [Anthony Rhorer]
*Outstanding honesty and bedside manners
*Excellent clean staples. I feel like this should be commonplace but I believe there is a pattern with surgeons: Crappy closing means crappy internal work too.

Doc recommends stationary bent to keep the guads fresh and voted 'no' for my upcoming charity ride on the 6th (only 70 miles but still)

Another question: Did anyone need a more relaxed geometry (higher bars) after surgery and healing? I am contemplating borrowing a friends cervelo with a +17deg stem to get the tops nice and high, just temporarily till the arm feels 100%.

Beaker

I had a comminuted and displaced fracture of the clavicle last year. Unless I wanted to be permanently lopsided, surgery was the only sensible path. I had an intramedullar rod implanted and it stayed put for about 3-4months. After enough calcification, I went back in for a 5-10min procedure to have it unscrewed from the back of my shoulder. I've been very happy with the results - it feels as though the fracture never happened and I've no permanent hardware. One thing that became apparent - everyone has a different kind of injury. The xray just shows you what happend with your clavicle, but not how much tissue or nerve damage you might have. What worked for me might not work for you. For instance, I went around with my busted collarbone for about a week before surgery and it never really felt painful, just uncomfortable. First few days post surgery were way more painful than the original break.

I was back on the trainer 1-2wks post surgery. GL.

dstrong 

This thread is definitely cringe-worthy.

SteelCan

Do not draw conclusion of surgery based on cosmesis/closings. My Ortho did not do the closing. It was handled by an intern so he could treat other patients in the OR. BTW, I had the synthetic form of Cat Gut as a suture. I think it is preferable to staples for scarring.
As for fit, I was complaining about the strain and absolute fatigue in my traps. I was told I was likely compensating for my subluxation, not the fracture. In any event, I tilted the nose of my saddle UP 1degree to try and remove some of the strain and I also pitched my bars up so I could rest easier on the hoods. No change in stem height.

pmt

I don't remember getting that call.


There are some brand-new clavicle brackets available that have just been approved, so surgery is now a much better option than before.

motorthings

i wish i had gotten my first break plated, since the resulting muscle/skeletal imbalance from the offset healing has caused me drastically increased migraines and other aches/pains over the years. luckily the second break kinda evened it out, and things are a bit better, but still not great.

Looigi

Broke mine last year in two places. Saw/consulted three different orthopedic surgeons. One said we don't usually operate on fractures like that, and the the other two were ambivalent about surgery vs not, partly because of the location (toward the distal end). I opted for no surgery and was back on the bike after 10 days. It works fine now, mostly. The only issue is some pain/discomfort when I lie with my arm extending upward under my head. Overall, I'm happy and satisfied with the decision. As background, I've had three previous significant orthopedic surgeries, which all turned out well too.

bogdan912

Get the surgery, I've broken both sides first break wasn't as bad and I did the torture device that is known as the figure 8 brace. It took almost 6 weeks to feel strong enough to begin rehabbing it, in the 2-3 weeks after everytime I moved my arm wrong it felt like I re-broke the healing bone.. On my second which looked remarkably similar to the Z break shown above I had it plated as the offset was nearly an inch, it probably wouldn't have healed. After 1 week I felt like I was ready to get back to normal life, no pain and little weakness. I followed my doctors orders mostly, and was doing physical therapy after the first week. He told me no running as a fall could re-injure, but at the time I was training for the amateur national mx championships and didn't want to lose my base so after 1 1/2 weeks I was running and doing core workouts. From the get-go I felt like I could go right back to normal life, I began cycling after 6 weeks and didn't notice any real issues related to the break. I was in the gym lifting (light) weights after 6 weeks and back to normal life, motocross, and heavy weight at week 12.

My cut was stitched, not sure if it was the cat gut or not but it was mostly internal except for both ends of the vertical cut. My scar is like a pencil mark, whereas others who had a horizontal cut and staples have a large scar that looks like train tracks

I'm also in So Jersey maybe SteelCan and I had the same surgeon? Dr Austin, at the Rothman Institute.

eippo1

I also say get the surgery. I shattered mine in 5 pieces, but everything more or less lined up, so they told me to let it heal on its own. The bones did not heal well and I have a couple weak spots there. The other thing is that before surgery, they would have done an MRI, which would have picked up the fact that I also had a torn labrum, which requires surgery as well. I did end up having to get the surgery for the labrum years later.

MikeyBoyAz

Beaker: I watched a Y0UTUB3 video of the rod style repair. I wonder if the hollowing does anything to the bone long term?

Steelcan: I suppose I am not really saying he's good because he closes clean/has a clean closer, but I have had the negation where there was a crappy closing (for my feeding tube after brain surgery) and everything about that doctor was disappointing and needed correction later.

Bogdan912: I had the surgery Sunday. I think the railroad track scar is going to be by badge of honor

Ricanfred

Yup; and I thought my concussion last year was badass....

Beaker

There's not much "hollowing" here - the rod inserts into a cavity in the bone that contains marrow, your clavicle is not a solid mass of bone. My ortho was of the opinion that the healed bone with additional calcification at the union would likely be at least as strong if not stronger than prefracture. I've full range of motion, and strength in that shoulder now; I've no reason to doubt him.

gadabout007

I had the pin same as Beaker, however they opted not to remove the pin. It was about three months before I could comfortably sleep on my side. Recovery was very fast with no lasting problems nine months later.

Beaker

Interesting - did you have the same compression nut at the shoulder end (as opposed to the "nail" version)? For me that thing was the only irritation during the bone healing - I could feel the end of it moving underneath the skin of my shoulder when I moved my arm or neck in a certain way. I was kind of glad to get rid of that.

gadabout007

I have the ASDM clavicle pin, which is nothing like the rockwood pin. It's installed flush to the bone. The way the surgeon explained it to me is they prefer to leave it in unless the patient is having problems or their bones are still growing.

Beaker

Yeah, that looks a lot more comfortable than mine:

lennyk

Stupid question, if one does not opt for surgery to fasten the bones,
How do the bones heal together if only in a sling ?

Juan Foote

Where I have not broken a clavicle (one of the few bones I haven't {looks for wood**) I have gone both ways where it came to having surgery or not. I found, years down the road, that every break I allowed to be operated on and that I waited the proper time for healing and recovery healed better and hurt less in later years than ones I tried to rush or cut corners on. Where it may seem like a big deal to be loosing months of fit and training opportunity it really makes much more difference when you have to live with the pain or possible dysfunction for the rest of your life. Adding insult to injury is when you have to have it re-broken and set again years later....

bianchi10

I have broken mine in the same place 4 times. First time hurt like hell (first bone I ever broke) and I think it scared me out of my mind also. I was playing college soccer at the time. First 6 weeks were BRUTAL. Never realized how much my body movement would effect my shoulder. 2 and half months later I was given clearance to play soccer again (competitively, I could practice lightly after 5 weeks). First game out I was tackled from behind and felt it brake again. Still hurt, but not as bad. went to dr. and he put me back in sling and off field for another 2 months. 4 months later, broke it again. Didn't go to dr. this time, just put it in sling and rested. Last I broke it was soccer again but indoor. was tripped and shoulder went into wall. didnt' faze me. got up walked off field and went home to get sling.

moral of the story, dont break your collar bone, it hurts and takes you out of everythign!

Beaker

Recently fractured ends of the bones "want" to heal and new bone growth is stimulated at the fractured end. So long as the shoulder is held relatively immobile then the bones can fuse again on their own. If the fracture is displaced it becomes more difficult and the chances of a non union are higher.