What's the long term like for a collarbone fracture?

[boarderline]

I broke my left clavicle/collarbone when I wrecked at the end of the video shown above during a practice/qualifying session for a race at MMP here in Utah. Pissed me off too because I qualified for pole position the lap before I went down. Clutch locked up and the rear tire skidded, tossing me over the highside and onto my shoulder at about 50 MPH. That was 8-16-08.

X-rays in the emergency room showed a rather nasty displaced (ends of bones FAR apart), comminuted (broken into 4 fragments) fracture of the clavicle. The lower displaced portion almost punctured my lung.

Met with an orthopedic surgeon on 8-18-08 to discuss treatment options. After reviewing the x-rays, he suggested I have ORIF (plate + screws) surgery on the bone as there was a very good chance it would never heal on its own correctly.

So the surgery was done on 8-20-08 and a titanium plate + 7 screws were installed to hold it together while it heals.

Flash forward past one month of recovery suckage, physical therapy started last week to help restore movement in the shoulder and to get strength back in the area.

I've been working the PT hard and stretching every time I think of it. Bone pain is gone, I can rotate the arm 360 degrees but the muscle surrounding the rotator cuff is still quite stiff. The area under the incision is numb for about 1-2" as well. Also, I have a bit of foreign object sensation where the plate and screw heads are.

Will the shoulder and the surrounding area ever feel normal again? Anyone else gone through this?

[Vinman]

since it has just been about 5 weeks or so I would say you are doing well. And you will probably get most or all of your strenght and ROM back providing there was not some other injury at the same time like a rotator cuff or labral tear, ligamanet tearing etc...

[TBS]

I broke my right clavicle in 1990 in a bicycle race. There was quite a bit of displacement (one piece came out thru the skin) but no material comminution (or however docs say it). The surgeon put it back together by drilling little holes in the bones and lacing it up with some kind of dissolving material.

It took about two months to feel OK again and three before doc cleared me to ride. No loss of range or strength.

I think you are about on track. Yep the shoulder gets real stiff because of lack of use but that will prob pass if you follow your PT. You will have the foreign object sensation because their isn't much between the plate and your fingers except a little skin.

Hang in there - it will get better. Good luck

[Elkhound Odin]

I broke my left collar bone skiing in 1997. Visually my left shoulder is lower than my right, but I had a full recovery of strength, with just a bit a rotational limitation. Particularly rotating from behind. I notice it swimming, but since i don't swim much, not really a porblem.

I think you are the right track. Depending if the hardware is causing pain, you may/may not get it removed at a later date. I had to get screws removed from a foot surgery last year. My foot feels much better.

[Sparky]

The worst should be behind you now.

I had the same operation 4 months before you. Except I had a bone graft too because my fracture was left a year to see if it would fix itself.

Now I am carefully mountain biking, sea kayaking and running mountain marathons. I am stoked that I had it fixed and wish I had it done when I first bust it. Thanks for the advice Dr M.

[Power_Sauce]

Same boat....

I just got back from the Dr., who informed me my collar bone is broken, and will require surgery, with plates and screws. Hoping to be skiing gingerly by February (optimistic?).

Here's to your (and my) speedy recovery!

And fuck typing left handed.

[boarderline]

Same boat....

I just got back from the Dr., who informed me my collar bone is broken, and will require surgery, with plates and screws. Hoping to be skiing gingerly by February (optimistic?).

Here's to your (and my) speedy recovery!

And fuck typing left handed.

Hang in there man, this is a painful injury but you'll feel better soon. You'll have a badass 6 inch scar on your shoulder and a story to tell.

How did you break it? What's the break like, is it displaced and/or in a few pieces? When's your surgery going to happen?

If you do as the Dr. tells you and work your PT hard, skiing in January isn't unreasonable. I rode my bike for the first time since the accident last weekend 5 weeks after surgery. Full bone strength comes 2-3 months after the operation.

Here's what to expect, based on my experience. Your arm is in a sling right now, the arm feels weird when it's unsupported right? My arm felt like it was gonna fall to the floor, LOL. If yours was like mine it feels like there's now an extra joint in the shoulder, and feels like there's bits of bone moving around in there. Pretty painful and learning to do stuff one-handed kinda sucks.

Once you're at the hospital, they'll put an IV in, take your blood pressure etc, to get you all prepped for the surgery. Your anesthesiologist may give you the option to get a shoulder nerve block to numb the nerve for about 12-16 hours after the operation. Take this option, it'll save you a lot of pain. They'll put you under general anesthesia and you'll go to sleep and it'll seem like no time has passed when you wake up. You'll be groggy afterward so get someone to drive you home.

You'll then sleep off the anesthesia. Make SURE you take your oral painkillers before the nerve block wears off. Also, if you get the nerve block, your arm will be paralyzed till it wears off so don't let this freak you out. The pain after the nerve block wore off was probably the worst I've ever felt, including a couple of cracked vertebrae I got in a different snowboarding accident. Hurt much worse than the initial breaking of the bone. The first 72 hours after surgery just plain suck, brutal pain so you'll be popping heavy duty oxycodone pretty often to cope. It gets MUCH better after that, the bone pain for me subsided to the point I didn't need painkillers after about 4 days post-op. You'll find that now the bone has been stabilized with hardware, it'll feel much better.

Sling for me came off at about 2.5 weeks. My doc wanted me to start using the arm again to get flexibility back in the shoulder but not raise it above 90 degrees. One month post-op x-rays showed good bone growth and healing so PT started. The muscles around the shoulder were pretty stiff but a steady program of stretching/exercise has helped this tremendously. I can go 360 degrees with my arm now and the stiffness is going away day by day as everything heals.

Good luck!

[Power_Sauce]

Thanks man, and thanks for the insightful response.

So the story:

Got drunk at the UW tailgate last weekend. At halftime, got in a pickup game of football with some random 12 y/o kids, didn't want to give up a TD, so i dove at a pass to break it up, and went down hard on pavement. Thought I had knocked the wind out of me, but wasn't so lucky. kids definitely yelled "the old man is down! the old man is down!" They were right.

About the break: pretty much exploded the bone. one piece about an inch long is sticking up vertically to the point you ca visibly see it. the bone is broken in at least five spots, but not a horrible amount of separation. more of a cluster.

thanks for the surgery advice. do you think i should seek a second opinion? im leaning towards no.

glad to hear you think skiing by january is feasible. im stoked to get back on the hill.

[Huckwheat]

Broke mine in Lacrosse in HS....92. No surgery or plate, so dont know the relevance, but my two cents. They let mine grow back together overlapping by about an inch. So my right shoulder is both more narrow and slightly lower.

The above said, it doesnt really have any problems. I bike a ton, lift pretty hard, etc. The only time I feel it is on long runs, sometimes I feel a bit like what I imagine arthritis to feel like and have to hold my arm against my body so it doesnt move (and therefore hurt).

Good luck with recovery to you both!

[boarderline]

thanks for the surgery advice. do you think i should seek a second opinion? im leaning towards no.

glad to hear you think skiing by january is feasible. im stoked to get back on the hill.

Yeah man, let skiing be your motivator for the recovery.

A second opinion can never hurt. Does your ortho have a good reputation and specialize in shoulders? Do you feel comfortable with them? If not, another opinion might be wise.

If you do, you might find that another doctor may not want to operate and let it heal on its own with your arm in a sling.

I'm no MD so take this for what it's worth. After a lot of Googling, I found out that for bad clavicle fractures plating/screws has a better chance for a full recovery that's also faster and less painful than letting the bone heal on its own. The chance of non-union is far less.

[Buzzworthy]

Jebus Paul!!!

That sounded, well, not fun at all.


AND GET THE NERVE BLOCK, had it with my knee and it was the bees knees.

[Sparky]

Full bone strength comes 2-3 months after the operation.
Good luck!

I was told longer, my Orthpod said 6 months to full bone strength, I am 37, I think healing takes a bit longer as you get older. I would go really carefully if you want to ski in Jan.

Yeah man, let skiing be your motivator for the recovery.

A second opinion can never hurt. Does your ortho have a good reputation and specialize in shoulders? Do you feel comfortable with them? If not, another opinion might be wise.

I'm no MD so take this for what it's worth. I found out that for bad clavicle fractures plating/screws has a better chance for a full recovery that's also faster. The chance of non-union is far less.

I would fully agree with this. Also if the bone is in bits I would personally be keen to get a plate on.

I never had the nerve block and didn't think the pain was too bad. I did have a good gas man though.

[telepariah]

I have broken both. The left one was far worse. In a 1000 foot ragdoll off a glacier and over a cliff, I broke the clavicle and scapula each into 7 pieces and shattered all the ribs on my left side, one of which lacerated my heart. This was in 1986.

A week after the wreck I had an appointment with an orthopedic surgeon. He said he would just leave me in a figure 8 and sling because if you put two pieces of bone in the same room they would find each other. I told him I wouldn't accept that because as a guide I needed to climb and carry a pack for a living. I said I needed to stabilize the side of my body as soon as possible and heal with no giant lumps. So he said ok, he would pin it. He made an incision the length of the clavicle, lined the fragments up, and threaded a pin through the marrow. It is straighter than a normal clavicle and I have better ROM than in my right shoulder, which I fractured out at the distal end a couple of years later.

Nobody knew about the laceration in my heart at the time. If they had he never would have performed surgery. I am glad and lucky that everything worked out ok. I had the pin in for 10 weeks and on the day it was removed, I climbed the First Flatiron. I couldn't lift my arm over my head yet, but I could climb an easy 5.4 face. Since then never looked back. Now they use plates and screws, which is probably less risky in terms of stability during the knitting of the bones.

You'll be fine.

[Power_Sauce]

So I had surgery a little over two weeks ago. The collarbone seems to be healing up nicely. No pain, able to use my right arm to do most things that don't involve lifting weight. I wound up with a plate and ten screws (check the picture). I'm hoping to be skiing by January, although my doctor has said he won't clear me until March.

Anyone else that's had the plate/screw procedure have any advice on when to start skiing again?

[drmark]

An operated clavicle should be good for skiing in six weeks provided a bridge plating is perfomed, and the butterfly fragments are bypassed, rather than dissected out and anatomically repaired, but that's my opinion.

Considerable disagreement exists amongst docs regarding treatment of the fracture clavicle. I was taught a generation and one half ago, that they all did fine. It has now been proven that many folks with high energy injuries actually do poorly. 25% don't heal, 40% don't like how their shoulder feels in sports, and 45% don't like the look of it.

Here is a landmark article from the June 2007 Journal of Bone and Joint Surgery. Unfortunately, like everything else, it will take two generations before the information is absorbed into general medical knowledge.

The weight of medical evidence today favors restoration of normal anatomy, because 24% of bad clavicle fractures never heal, and 40% of patients have symptoms referable to imgingement of the crookedly healed bone on the brachial plexus (nerves to the arm) and/or weakness of the shoulder.

Here is the Abstract from the Journal of Bone and Joint Surgery (American, 2007)

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures
A Multicenter, Randomized Clinical Trial
Canadian Orthopaedic Trauma Society

Disclosure: In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopaedic Trauma Association and Zimmer Inc. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Zimmer Inc.) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

NOTE: The authors acknowledge the advice and knowledge of Lynn A. Crosby and Carl J. Basamania.

This manuscript was prepared by the Canadian Orthopaedic Trauma Society, c/o Michael D. McKee, MD, FRCS©, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address: mckeem@smh.toronto.on.ca

Principal Investigator: Michael D. McKee

Lead Investigators (Site): Michael D. McKee (St. Michael's Hospital), Hans J. Kreder (Sunny-brook and Women's Health Science Center), Scott Mandel (McMaster University), Robert Mc-Cormack (Royal Columbian Hospital), Rudolph Reindl (Montreal General Hospital), David M.W. Pugh (Brantford Hospital), David Sanders (London Health Science Center), and Richard Buckley (Foothills Hospital). Study Design: Michael D. McKee, Emil H. Schemitsch, Lisa M. Wild, Hans J. Kreder, Robert McCormack, Scott Mandel, Rudolph Reindl, and Edward Harvey. Data Analysis: Jeremy A. Hall, Lisa M. Wild, Milena V. Santos, Michael D. McKee, Christian J. Veillette, and Daniel B. Whelan. Radiographic Analysis: Lisa M. Wild, Milena V. Santos, and Michael D. McKee. Manuscript Preparation: Michael D. McKee, Jeremy A. Hall, Lisa M. Wild, Emil H. Schemitsch, Rudolph Reindl, Robert McCormack, David Sanders, and Christian J. Veillette. Patient Enrollment and Assessment: Michael D. McKee, Emil H. Schemitsch, James P. Waddell, Lisa M. Wild, Milena V. Santos, Hans J. Kreder, David J.G. Stephen, Terrence A. Axelrod, Edward Harvey, Rudolph Reindl, Gregory Berry, Bertrand Perey, Kostas Panagiotopolous, Robert McCormack, Beverly Bulmer, Mauri Zomar, Karyn Moon, Elizabeth Kimmel, Carla Erho, Elena Lakoub, Patricia Leclair, Christian J. Veillette, Bonnie Sobchak, David M.W. Pugh, Richard Buckley, Scott Mandel, David Sanders, and Trevor B. Stone.



--------------------------------------------------------------------------------
Background: Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate fixation of displaced midshaft clavicular fractures.
Methods: In a multicenter, prospective clinical trial, 132 patients with a displaced midshaft fracture of the clavicle were randomized (by sealed envelope) to either operative treatment with plate fixation (sixty-seven patients) or nonoperative treatment with a sling (sixty-five patients). Outcome analysis included standard clinical follow-up and the Constant shoulder score, the Disability of the Arm, Shoulder and Hand (DASH) score, and plain radiographs. One hundred and eleven patients (sixty-two managed operatively and forty-nine managed nonoperatively) completed one year of follow-up. There were no differences between the two groups with respect to patient demographics, mechanism of injury, associated injuries, Injury Severity Score, or fracture pattern.

Results: Constant shoulder scores and DASH scores were significantly improved in the operative fixation group at all time-points (p = 0.001 and p < 0.01, respectively). The mean time to radiographic union was 28.4 weeks in the non-operative group compared with 16.4 weeks in the operative group (p = 0.001). There were two nonunions in the operative group compared with seven in the nonoperative group (p = 0.042). Symptomatic malunion developed in nine patients in the nonoperative group and in none in the operative group (p = 0.001). Most complications in the operative group were hardware-related (five patients had local irritation and/or prominence of the hardware, three had a wound infection, and one had mechanical failure). At one year after the injury, the patients in the operative group were more likely to be satisfied with the appearance of the shoulder (p = 0.001) and with the shoulder in general (p = 0.002) than were those in the nonoperative group.

Conclusions: Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group. This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence

[boarderline]

Powersauce-

Just an update so you know what you might expect. I'm now 9 weeks post-surgery, and my shoulder is doing great. No more pain at all, and I've been hitting the gym pretty hard for rehab so I actually feel stronger in that shoulder than before the accident. The skin numbness underneath the surgical incision is getting better and better, I hope over time it will heal completely. I rode my street motorcycle 140 miles round trip to/from the racetrack today to say hello to some friends who were riding at a trackday there and the shoulder felt fine. I plan on returning to racing next year. Hope you have a great outcome too.

[Base733]

Powersauce-
I rode my street motorcycle 140 miles round trip to/from the racetrack today to say hello to some friends who were riding at a trackday there and the shoulder felt fine. I plan on returning to racing next year. Hope you have a great outcome too.

My friend broke his collarbone at the Apex track day on Sunday, major bummer. Good luck racing next season, I'll be out there too in the twins group.

[Roxtar]

Broke (well, kind of exploded it. Broke in three places) my clavicle on a Thanksgiving morning MTB ride about 4 years ago.
Felt so-so for about a year (also had nerve damage) but since then it's like it never happened.

[PeterK]

Broke mine 1.5 weeks ago. The bones overlap by around 5 cm (2 inches) so in the end the conclusion was to have an operation. Will get that done tomorrow afternoon. As far as I've understood, it will be similar to what Powersauce got, i.e. a plate and some screws. Mine is a clean break though, no shattered bones or fragments.

boarderline: You said after 9 weeks you were hitting the gym fairly hard. When where you able to get on with "normal" life without noticing the collar bone?

Considering the start of the season we got here in Europe, this is pretty much killing me right now... *Really* hoping for a speedy recovery.

[boarderline]

Broke mine 1.5 weeks ago. The bones overlap by around 5 cm (2 inches) so in the end the conclusion was to have an operation. Will get that done tomorrow afternoon. As far as I've understood, it will be similar to what Powersauce got, i.e. a plate and some screws. Mine is a clean break though, no shattered bones or fragments.

boarderline: You said after 9 weeks you were hitting the gym fairly hard. When where you able to get on with "normal" life without noticing the collar bone?

Considering the start of the season we got here in Europe, this is pretty much killing me right now... *Really* hoping for a speedy recovery.

PeterK-

It took a couple of weeks of rehab in the gym before the bone felt normal. I can still feel the plate/screws underneath the skin. It's noticable but not painful.

Heal up fast.

[PeterK]

Thanks for the info, appreciate it

Back home again from the hospital now. All went well according to the doc. Got a plate and 5 nice screws. Scheduled for another visit next Thursday to remove the stitches and get some sort of rehab plan going. Seems like I've been luckier than you, no major pain except for when they woke me up just after the operation. One of the first things I remember is intense pain. A while after that, I overhear someone tell one of my nurses that they have now given me "pas mal de morphine" which roughly means quite a bit of morphine. Good stuff, basically felt no pain since then even though the shoulder obviously feels strange and I've taken it very easy since the operation...

[Lawrence64]

How is it now, a few years later? I broke my collarbone (3 pieces) on Xmas Eve and have surgery planned this week to plate it back together, as it has deformed into a large lump and isn't obviously healing properly. Have been told that it will heal faster and more 'normally' with a plate, though there may be cause to remove the plate via further surgery some way down the line (not entirely sure what the circumstances would be to force me down that course). Anyway, I'm a skier, and keen to return to the slopes - maybe not this season, but certainly by Xmas 2013. So I'd be interested in knowing how your long term healing progressed.

[justinspau]

You're gonna be fine in 6-8 weeks. Just take it easy and dont do anything stupid while its still fresh. Plating a comminuted fracture like that should help you heal a bit faster. I have broken my R side 2 times and the left once. I was more standard in care and never needed sx. The 2nd break on the R was years after the first and caused by a DH crash ie completely unrelated or influenced by the first break. Good luck and the season should not be completely lost.

Sent from my Parrot using TGR mobile technologies.

[mobygrape]

good info here from lots of folks.

fractured clavicle, bones overlapping 1 1/2 inches. My shoulder is just kind of hanging, but pulled out of line. I could not stand up straight until yesterday.

My doctor said the same thing, " if you put two pieces of bone in the same room they would find each other." But also that for active folks, putting the bones in the right place gives better range of motion and recovery, so surgery tomorrow to add a plate and put things where they belong.

Glad I found this thread, lots of good info. Have a better idea of what to expect now!.

[PowerWhore7]

fractured clavicle, bones overlapping 1 1/2 inches.

Did the exact same thing in 2005 and didn’t get surgery (no health insurance at the time). At first I thought I was fucked for life, but after after 8 weeks I was good to go and really the only complication I experienced was numbness in my arm for about 6 months. Fast forward 8 years and all I have to show for it is a knot at the break point, no pain and 100% healed.

Hope you are as successful, good luck.