Out with the plate
 

I know I'm not the only member of the illustrious 50+ broken collarbone club, but I couldn't find references to the joys of taking out the plate, which is what my surgeon says he wants to do, although probably not for another six months or so.

The story: I broke collar bone, elbow and wrist after a pothole-induced crash back in June, and had surgery on elbow and collarbone within a week (the wrist healed without medical intervention). But just as I feel I'm getting somewhere after a long, slow, painful recovery (doctor friend tells me helpfully that breaking two bones is more than twice as bad as breaking one), the surgeon says he says he may want to take the (steel) plate out from the clavicle next summer. The elbow plate can probably stay, although I'm never likely to be able to straighten my arm fully. I can (probably) live with that.

Has anyone had surgery to remove a plate, and how long was your recovery after that? Anything you wish you had known then that you know now? And any other advice on getting back to full strength? Both plates are steel, which surgeon says is stronger than titanium, and they didn't set off the airport x-ray machines when I took a couple of flights earlier this month.

Unfortunately I have some experience with that. I had the plate installed in '12 and removed a year later. Generally speaking there is no reason to have it removed except for discomfort, complications, range of motion limitations or sometimes cosmetic reasons. For me, the surgeon had torqued the bone up when installing it and that along with my unusually low fat for any padding was causing intense discomfort so I had it taken out. The default for the surgery is to leave the plate there, forever. It sounds strange to me the surgeon has already decided that he may want to take it out, so I'd find out why specifically. It should be your decision not his, and whatever his concerns are they're something you should know.

(maybe I'm reading that wrong and it's already been discussed in depth, but it sounds like he's making some determination and letting you know later. I think it's better when the patient is informed and involved).

On the bright side, taking it out is a minor outpatient procedure. Some pain for a few days, pretty intense at first but rapidly diminishing - I didn't even take pain meds after leaving the outpatient room. Nor the sling, nor any PT, and I was riding again after two or three days. You may prefer a different schedule, but it's nowhere near as traumatic as the initial ORIF surgery.

I have a different plate there now BTW, and I don't plan on having it removed.

The plate will come out if it's restricting the joint in any way, which I suspect it is. And I will be glad to see the back of it. I admit I was surprised he wanted to wait a full year before deciding - doctor friend had hers out within six months.

But good to know that it's a minor op. The initial surgery was day surgery, but I was on the pain meds for a while, and my arm was pretty much frozen in place when the case came off. Hence long, slow painful recovery.

No collar bone experience here, but its nice to hear from you, Boudica. its been a while since you posted here. I have some plates in my back, the Neurosurgeon offered to have everything removed now that everything is stable and the grafts are solidified, but it wouldn't do much. I am letting them stay, unless it gets to be some type of problem.

Bill

Double break of the left clavicle here, but fortunately no surgery or hardware.

Colles' fracture of the right radius, as well, but again, fortunately no surgery or hardware.

I still have a plate on the radius of my left arm from when I shattered it in a water skiing accident in 1977. Back then they left the plates in. I wish they had taken it out. Muscles and tendons rubbing over the screws over the years have caused issues and it sets off alarms in some airports.

The last time that I was in the airport I told my grandson they were going to have to hand check me because I have metal in my hip and shoulder. Sure enough - I was right. The bad part is the TSA guy checked my left shoulder and right hip. The metal is in my right shoulder and left hip. So much for the effectiveness of airport security.

I have pins and screws in my sacrum from a cycling accident in 2012. I’m uncomfortable after sitting long periods (at my job), or walking more than a couple blocks, but I can cycle fine. The orthopod cautioned against removal, too.

BTW, [MENTION=17730]Boudicca[/MENTION] I also recognize your screen name from the past; It’s the name of a British warrior queen during the Dark Ages, as I recall (I looked it up; first century AD :o).

I called myself after my first road bike, who is called Cea. (The Roman name for Boudicca was Boudicea, spelling varies). Word has it her fierce band of Iceni warriers burned London and St Albans to the ground. The Romans killed her for it.

I did some more homework on the plate-removal stuff, and it seems that as a biker it's not a bad idea to have it taken out because in the stretched-out, road-bike position you need all the room in your shoulder area that you can get. The plate hooks around the end of the collar bone, presumably to stop the bone moving as it heals, and that means there's less room for all the soft tissue to do its stuff.

May I say how boring it is to do 1-2-3 hours of shoulder/elbow/wrist exercises each day, and how totally important it is to keep doing them until I heal.

Interestingly, I did not set off the airport security alarm on my first post-surgery flights last week.

Depends on where the break is and the plate I guess - neither of my plates extended around the collarbone and I have just about 100% range of motion now.

I sympathize with the PT. I never kept the sling on for more than 3 days, and I was shocked at the joint pain from even that short period. After several months, that's got to hurt.

I'd agree with your doctor about having the clavicle plate removed, for the slight amount that opinion is worth. ($0.00) This was a big topic in the dirt bike/motocross world back when I was racing regularly. Seems that some feel there is a bigger chance of breaking the clavicle at the plate's edges, than if it was removed. Not sure about the physiology of the bone structure and its strength v. the plate being a fulcrum, to break it that easily. Maybe someone has experience in the area, since that is the actual reason for your OP, I take it.

The hardware in my spine (L4-L5 and L5-S1, 2 plates, 4 screws, and 2 cages) is a titanium alloy that is totally non-ferrous, so it won't set of any metal detector alarms. And, it has had numerous chances to do so. Thankfully the strip search:eek: and orifice exam:notamused: hasn't been necessary. Since it isn't any real problem with weakening the vertebrae, I elected to leave well enough alone, as 16 major surgeries, in 10 years, was quite enough, thank you very much.

Good luck with which ever course you decide on, and its good to see you posting here, again.

Bill

Being a bit of a history fan, I've come across the name of that Celtic queen several times. Celtic warriors going into battle would sometimes strip naked which I've read had some sort of spiritual significance for them. Sometimes Celtic women would join the fray, also stripped naked.

Broke my clavicle into a few pieces a little more than a year ago. Titanium plate and 11 screws.

My doctor never mentioned that option. I'm not planning on taking the plate out.

As far as motion... physical therapy might really help with that.

However, as soon as I was cleared to ride I went out on my mountain bike and clipped a branch. Clavicle break was fine, but ended up with a partial rotator cuff tear. I should have strengthen my shoulder after months on inactivity before putting myself in harms way.

John

Update, and the surgeon is giving me a probable June date to remove the plate, which is a little later than I would have liked. I want it out -- I am still in pain when I lift the arm too far or too fast, and I can only move the arm up on the diagonal rather than straight up. But most things are getting easier, and managed a 27km bike ride yesterday, when Toronto temperatures jumped to 16C (60F) -- totally unprecedented for February. It is a hook plate that curves round the clavicle. Apparently these are more prone to cause problems, although they are better with the somewhat dramatic sort of break I had. Or something like that.

Now I have to decide whether to have the plate taken out of the elbow at the same time. My feeling is to let that one be -- surely it would be easier to recover from a single operation, and why do more slicing than you have to?

I have one in my wrist, roller hockey at 55, clavicle road bike at 62. Thankfully neither one is going anywhere.

John

Thing that surprised me about all this is that I did NOT beep as I went through the Airport XRay machine, despite two plates and an awful lot of vicious looking screws. Not even at Washington National (DCA) where you would expect XRay machines to be set at the lowest possible level.

I'm a veteran, four decades plus business road warrior and that would have really surprised me as well.

The metal detectors aren't x-rays, and its not the size of the device that sets off the detectors, its the alloy they are made from that causes an alarm by the metal detectors. The iron content is the magnetic trigger, any alloy with a high enough Fe content will set it off. Any non-ferrous metal is safe for this kind of thing, your plates and screws are most likely either titanium, or stainless steel, they both get used in medical appliances a good bit. My spinal appliances are titanium alloy, so I don't set off the TSA detectors, nor the courthouse security units. I asked about getting the medical ID cards that have your x-ray in a miniaturized picture on the card, the tech, and my surgeon told me it wasn't necessary with the plates and screws that were used in me.

Bill

Update: both plates -- the hook one on the clavicle, and the non-hook one on the (now no longer) broken elbow -- are coming out tomorrow.

Send warm thoughts up to the frozen north, please.

Good luck. You're going to like how it feels without the plates. After the surgery pain subsides.

Good luck and remember that pain pills when used appropriately can be a good thing.
Report back on how long your riding is interrupted, if any.

Good luck to ya. :) I have hardware in one knee and one elbow, and don't think I'd have them removed, at this point. It took way too long getting used to it, the first time around. :(

Both collarbones broken in the past - no plates, no problems.

Hope it all works out for the best for you.

So the plates are gone, and my shoulder feel like it's in a vise, while the freezing hasn't worn off in the elbow area yet. Disconcertingly, I was awake right through, although a little spaced out. No pain, just st aware of conversations that I couldn't quite follow. Sending the spouse out for the pain meds, and hoping he'll get back before the elbow joins the shoulder in the vise.

Forgot to mention, it hurts about as much as putting the plate in in the first place. But goes away quicker.

My unqualified non-medical advice, don't keep the arm and shoulder absolutely still all the time. Even if it hurts a little, move it a little bit now and again. Cuts down on rehab.