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Displaced fratured clavicle?
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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 3:04 PM

Displaced fratured clavicle?

So that was the diagonose of the ER doc.

More specifically, not only was the cavicle completely separated, the 2 sections are overlaping.

so I was surprised the ER doc said it may grow back together by themselves! He enen said specifically they may re-aligned themselves and join up. That seems like a physical imposibility. Though he said I must see an ortho to "monitor" that's happening. So I'll be hunting down an ortho tomorrow.

I want to be as educated as possible when I go see an ortho. (and recommendation in NYC area welcome)

Has anyone had this type of fracture (overlaping displacement)? What was your treatment and result?

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daddy-o
Joined: 12 Apr 2004
Posts: 3307
Location: Springfield

8/25/13 3:49 PM

Sorry to hear that, sounds exciting though. My fracture wasn't diagnosed like that, but decades later it's got a big knot. A second opinion sounds in order, and not just tracking the progress.

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ErikS
Joined: 19 May 2005
Posts: 8337
Location: Slowing boiling over in the steamy south, Global Warming is real

8/25/13 4:06 PM

At your age, maybe not.

My son had a shattered tib/fib two years ago and theset in the OR was less than stellar. With a little one pins and screws are a no go do to growth.

Well it remodeled perfectly and in two more years it won't even be visible on X-rays.

For an adult, get it right or end up bent fr life.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 4:13 PM

If the lump is only visual, I'm less concern about it, But if it result in funtional limitation, I'd rather get it fixed right.

(I'm not that old, so should heal fast. And although it's my non-dominant side, I do sport that needs symmetric power and control...)

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dan emery
Joined: 11 Jan 2004
Posts: 6884
Location: Maine

8/25/13 4:40 PM

My $.02

April, my advice is to put your efforts into finding the best specialist ortho that you can. As I recall the advice was to see a guy in the near future, and in my experience there is a big difference among surgeons. When I went to see guys for my hip and knee, I was confident they were the best local guys. Part of their job is to fully explain your options. Particularly on the hip, I hear advice other people get form other docs, and it seems bizarre to me.

I hope you, your car and bike are safely back in NYC!

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Matthew Currie
Joined: 11 Jan 2004
Posts: 800
Location: Vermont

8/25/13 4:51 PM

I've seen it both ways. After my cycling accident last year, one of my problems was a broken clavicle, which was not treated in any particular way except by using a sling for a long time. It ended up with what looks like a considerable overlap and crookedness, but has knitted quite fine. It was rather interesting to see the x-rays over time, and the new growth as it progressed. For a while it was together but flexible, and gradually got stiffer. I have some other issues with a bone spur, and with limited mobility from other aspects of the injury, but the clavicle is essentially trouble free after healing, which it did reasonably fast.

But I am visibly lopsided now. Oddly enough, though one might expect the overlapping clavicle to raise my shoulder because it's shorter, the affected shoulder is quite conspicuously lower. That is the least of my worries, and it does not seem to hamper use - I don't swim in circles now - but healing is certainly relative, and if appearance is an issue, you might want to think twice not only about whether it goes together but how.

My daughter broke her clavicle (also cycling, of course) in her 20's, and it never healed at all. It kept moving around and the doctors kept saying it would knit, but it did not for over a year. She finally had to have surgery and a plate put in, which solved the problem and incidentally left her without odd lumps and droops, since it was aligned properly by the surgeon. Years later she has no problems with it except for occasionally setting off metal detectors.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 5:06 PM

big thanks again, Dan

for all the help. I'm actually back in Westchester, with my bike. Bike was delivered by the person who stored it for me. (long drive for her, so I gave her double the gas money for the help)

Friends in the club already showed up and got me grocery.

Relatively minor in shoulder pain. I hope the road rash heal up enough in a few days. So the main focus is the collarbone.

I'm already compiling a list of orthos to call tomorrow. NYC has no shortage of good doctors. But that doesn't mean I can get an appointment with one when I needs it.

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

8/25/13 5:37 PM

If your ortho thinks they [the pieces] will mend without reducing and a plate via surgery, as mine did, you will be in an X brace for a while. Else, surgery for you... Unless it can be reduced 'closed reduction' which will be good and possibly under sedation. Elaine sez it is not likely they will do a closed reduction [non surgical] with you awake.

Mine was 7 pieces, it had 5 little pieces and the two ends connected still. It took longer to heal, for the bone to connect if you will, but it did it without reduction in my case. Osteoblast formation can't happen if the bones are too displaced. I have one he!! of a clump in the middle where it all mended back together I can tell you. But some folks go through life without the clav reconnected.

Best wishes for speedy recovery!!

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dan emery
Joined: 11 Jan 2004
Posts: 6884
Location: Maine

8/25/13 5:42 PM

Glad to help

And I'm glad you got some groceries. When you asked if we could scrape up some food, I got right on it because I remembered when I got carted off to the hospital after riding a century, and didn't get anything to eat for quite awhile. I wasn't hungry, I was dying!

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

8/25/13 5:45 PM

Elaine said some Docs are more 'cut happy', so maybe do not settle for the first diagnoses which may suggest surgery. Unless you can be convinced it is better for you. Closed reduction = no cutting of nerves, arteries will be retracted, unless... Let's not go there...

If you have any specific questions Elaine will be happy to help. She is in the OR doing mostly Ortho daily.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 6:14 PM


quote:
Closed reduction = no cutting of nerves, arteries will be retracted, unless... Let's not go there...

Can someone please translate?

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 6:30 PM


quote:
And I'm glad you got some groceries. When you asked if we could scrape up some food, I got right on it because I remembered when I got carted off to the hospital after riding a century, and didn't get anything to eat for quite awhile. I wasn't hungry, I was dying!


I was hungry in the ER as soon as the painful cleaning was finished. By then the pain on my shoulder was subsiding and I was no longer worried about them forgetting to clean any of the bigger wounds. I didn't asked then, I thought we'd be at the tent soon and it was early enough to get food.

The discharge procedure took a lot longer so I was gertting hungrier...

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greglepore
Joined: 10 Jan 2004
Posts: 1724
Location: SE Pa, USA

8/25/13 6:50 PM

Don't worry about it, see a good ortho, clavicle fx is pretty routine unless its in a bunch o' pieces, Pro's get them plated and are back on the bike in a couple weeks; Jorge Lorenzo (moto gp motorcyclist) broke his, had it plated, raced the following weekend. They tend to be a little more conservative with civilians.

Not being insensitive, , I know it hurts like hell and you're concerned, but in the greater scheme of things its going to be ok. Have a serious a/c joint separation myself and it not interfered with much, and its likely to be more problematic motion wise than a healed clav..

See a good ortho and trust what he tells ya. You won't lean much from internet folks that have seen your films.

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KerryIrons
Joined: 12 Jan 2004
Posts: 3234
Location: Midland, MI

8/25/13 7:12 PM

Closed reduction

Open reduction is where they cut you open and align the bones (and typically add some hardware). Closed reduction is like in the old cowboy movies where they yank on it to put it back in place. So closed reduction is putting the bones in alignment without any surgery. For a clavicle this might mean a little physical manipulation (and associated pain) or just putting it in a X-bandage or brace or even just a sling.

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Dave B
Joined: 10 Jan 2004
Posts: 4511
Location: Pittsburgh, PA

8/25/13 7:22 PM

Hijack


quote:
Have a serious a/c joint separation myself and it not interfered with much,...

At the risk of hijacking this thread I had a pretty good bike crash about 6 weeks ago and, among a few other things, also had a major right side a/c separation. There was no other shoulder damage and I have a full range of motion. Also, since I'm left handed it hasn't been as limiting as it might have been.

The ortho surgeon I saw said he didn't recommend surgery and to pretty much live with it. It isn't painful at this point just a bit odd feeling the clavicle move around that freely. I've been back on the bike for about 3 weeks and still getting used to the separation. A PT gave me some exercises to maintain shoulder strength but admitted it wasn't going to do much.

So, Greg, what has been your experience? Do you just get used to it? Does it feel "normal" after a while? Any recommendations?

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Chris Klaren
Joined: 13 Jan 2004
Posts: 82
Location: Iowa

8/25/13 8:24 PM

@ Dave B: shoulder separation

I experienced a third degree shoulder separation in Nov 1998 after a dog ran out in front of me while traveling down a hill with a tail wind. Got two opinions, the first essentially recommended "suck it up" because Terry Bradshaw played with the same type of injury, but said it could be fixed with about 6 months recovery. The second said surgery was an option (he was doing a lot of them), but because my livelihood didn't depend on it being fixed, he recommended leaving as is, which I did. The shoulder is still loose (visible lump of about 1/2") and it never really feels normal. The PT didn't do much for me either. But after 4 or 5 months of getting used to it, it really hasn't inhibited my lifestyle, which still includes lots of riding, some backpacking and canoeing, some wrenching, and household maintenance. I have had to be more careful lifting weights, and bench pressing is a thing of the past.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/25/13 8:34 PM


quote:
Not being insensitive, , I know it hurts like hell and you're concerned, but in the greater scheme of things its going to be ok.

Actually, I'm probably the one who's "insensitive" in the reaL sense: it doesn't hurt much any more.

Or perhaps it's because the road rash is hurting so much!

(outside of elbow,knee cap... every movement tucks and tears on the newly formed scar)

Last edited by April on 8/25/13 9:46 PM; edited 1 time in total

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

8/25/13 9:08 PM

Opsite or Tegaderm bandages will allow the skin to heal moist and not scab and dry crack. Pharmacy may have them.

Yes, open=surgery, closed is them wrestling with you in an attempt to reduce the fractures. Closed does not always work, thus surgery would be required.

I was looking/cleaning up my hard drive the other day and came across the jpg I had posted here in 2000 of my x-ray/clav fracture.

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greglepore
Joined: 10 Jan 2004
Posts: 1724
Location: SE Pa, USA

8/26/13 5:36 AM

Dave-had a 2nd degree at 16 and a third degree of same shoulder 20 yrs ago. Aside from cosmetic issue, its been transparent to me. I was offered surgical repair and refused, and was told that the end of the clav could be removed later if it became arthritic, but no issues to date. Now, the spinal cord injury, otoh...:)

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Dave B
Joined: 10 Jan 2004
Posts: 4511
Location: Pittsburgh, PA

8/26/13 6:34 AM

Chris and Greg

Thanks for your replies and insights. I believe mine is a third degree. Except for the odd feeling and the minor cosmetic issue, the separation doesn't seem like it will be much of an inhibitor long term. As I mentioned, I'm back on the bike and even cut my grass a couple of days ago with no problems.

I looked up the surgical repair and the minimum recovery time I found was 8 weeks with the arm/shoulder immobilized and then several months of rehabilitation. It would have to get pretty bad before I would be willing to go through that at my age.

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Steve Katzman
Joined: 12 Jan 2004
Posts: 452
Location: Orlando, FL

8/26/13 7:41 AM

Sorry to hear about this. I probably missed a previous post, but I assume you had a crash on your bike. Good luck with your orthopedist. Hope you heal quickly.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

8/26/13 8:35 AM

Matthew

I just saw your post on the other thread about your accident. Really sorry you had such a horrific one.

Your experience on your collarbone break will be helpful for me when I see the ortho. I have some reference of the real world meaning when the doc talk about possible outcome.

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mag7
Joined: 11 Jan 2004
Posts: 888
Location: Lake James, NC

8/26/13 9:11 AM

Wound Care RN Wife recommends for Road Rash Treatment - hydrogen peroxide wash, blotted with gauge to dry the area followed by Polymem Silver trimmed to fit the affected area and then secured by Tegaderm.
Worked for me and the best part was the fast healing and no stick wound changes.

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rickhardy
Joined: 11 Jan 2004
Posts: 1492
Location: Needham outside of Boston - the hub of the universe

8/26/13 9:19 AM

Shoulder expert

Have had

Separated shoulder
Fractured / dislocated shoulder with accompanied nerve damage (lost posterior deltoid)
fractured clav

So if you have questions I may have some experience :)

An good friend of mine just broke his, you might find his emails illuminating:

Matches yours. Did it all by myself up glen doing a all out effort. Must have been oxygen deprived looked up and was an inch from curb rode the gutter and went down.

Looks like a plate inserted on Monday.

I have a call into ProSports who did my AC joint repair. If they can't get me in Monday then I will look around.

Not sure I want that Frankenstein collar bone like yours. Does the hardware always show?

This is not bad compared to the AC joint. From what I have heard it feels 100% better only days after the surgery.

I was able to sleep ok propped up in bed pain meds every 4 hours. I have a figure 8 sling holding the shoulders together.

I do feel the bones moving around.

So I went back to Dr again today. I was seen by 2 others who also could not believe this happened and fixed itself.

The first pic is from Sat.

The next one is the same view today showing near perfect alignment. The next one from above shows just a 6 mm gap and many rice crispy pieces but nothing that surgery will make better. So looks like it is to heal on its own. I have been off pain meds since Monday. Rather be in pain ,vs. full of shit. The narcotics bound me up. I have been driving my wife's automatic since day 2.

went to see the surgeon and he said that it clinically does not look like the initial X-ray. He said let's take another X-ray and see what it looks like.

He said in 20 years he has only seen this happen once before but it looks well aligned and surgery might make it worse. He said come back Thursday and see it it held together if so no surgery. If back to as before surgery Friday.

I have been at work the whole time and driving my wife's automatic since day 2.

Back to DR next week but all is looking good. I guess this harness is doing the trick…

So I am almost 4 weeks in now and this figure8 is a medieval torture device. I go back to the surgeon tomorrow for more x-rays and consult. I had read so many conflicting reports about recoveries and time surgery vs. not etc. I really do not feel better in fact I think the pain is worse now than it was the first week. I have been off all pain meds since day 3.

I would think by now the pain would get better each day. I do get a day or two that are ok but most are not. Sleeping is still the biggest problem and without Ambien it simply does not happen. On top of that I think because of lack of sleep I got a cold, so add in the pain of coughing and sneezing to the equation. I have been taking calcium sups and got a OrthoFix bone stimulator using 3 hours a day. I have been on the trainer a hour a day 4 day s a week doing tempo.

I hope tomorrow to get positive news that there is some healing and the bones are aligned well. if not I am going to push for the plate though I have been reading lots of horror stories about the surgery and recovery. how was your recovery after the procedure? From all I am reading you end up in pt. for months and a sling for many weeks.

I am sure you saw this forum below, there are lots of guys complaining about the plate. I guess every break is different.

I went the BR on Thursday and he took the figure 8 brace off Thursday. Everything got 100% better immediately after getting that torture device removed. As you can see from the before and after the pickup sticks are pretty well aligned and seem to be knitting. The pain is much less. I went to PT for range of motion and in 3 weeks start strengthening.

I can not sleep so I ride the bike to get rid of excess energy, I am not pushing anything on the trainer tempo and below.

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Andy M-S
Joined: 11 Jan 2004
Posts: 3377
Location: Hamden (greater New Haven) CT

8/26/13 10:29 AM

April, heal fast!

Just a quick note to say I hope you're up and about soon. During whatever recuperation period you have, remember to watch funny movies--it's been argued that humor helps the body heal. Even if it doesn't, it helps you take your mind off the pain!

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