Collarbone
Hi Guys,
I crashed my bike and broke my collarbone this morning. It doesn't look to bad. I have a consult with the orthopedist tomorrow. Just wondering if anyone has any thoughts on surgery vs. no surgery. Thanks!
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Hi Guys,
I crashed my bike and broke my collarbone this morning. It doesn't look to bad. I have a consult with the orthopedist tomorrow. Just wondering if anyone has any thoughts on surgery vs. no surgery. Thanks!
Comments
Surgery will have it's potential complication and recovery time and could potentially have you laid up longer. Also, in my broken clavicle experience, my father (at the time chief medical officer of the hospital) took me around to three separate orthopods and none of them could promise me a better outcome via surgery versus 5-8 weeks in a sling. They all wanted my insurance, but with my father in the room, none could sell me a surgery in good conscience.
Without surgery, I had minimal recovery time and was riding my bike in 7 weeks. I have no cosmetic, range of motion or strength issues. Letting it heal was the best outcome for me n=1
But, every case is different. Do what you think is best for you. I would however, urge you to be a bit cynical and gather multiple opinions before spending thousands on surgery.
Now for some fun! Here are my pics. I crashed on a club ride with about 30 people watching....
Before:
After 5 weeks in a sling:
I have a bunch of pics from your wreck... I will send them to you for posterity.
Here is my sling with our 2012 Christmas Jammies!
(I think I was on Vicodin. I never smile like that)
A. Jawa, MD, and colleagues[6] presented a paper entitled "Distal Third Diaphyseal Humerus Fractures: Operative vs. Non-operative Treatment" to compare the treatment of distal third diaphyseal humerus fractures with either functional bracing or plate and screw fixation. Thirty-four consecutive patients with closed, extra-articular fractures of the distal one third of the humeral shaft were extracted from a prospective trauma database. Seventeen were treated with functional bracing and 17 were treated with plate and screw fixation. The patients in the 2 groups were comparable in regard to their demographic data, with the main difference being the preference of the treating surgeon. Pretreatment radial nerve palsy was present in 5 patients treated operatively and 2 patients treated with functional bracing. All of the injury-related radial nerve palsies recovered completely in both groups. In the surgically treated group, 1 patient had early loosening of fixation and 1 had nonunion. Both patients healed after repeat plate fixation and bone grafting. Two new postoperative radial nerve palsies developed and had not recovered. One of these patients was treated with tendon transfers. One new postoperative ulnar nerve palsy developed but resolved without intervention. All fractures ultimately healed in anatomic or near-anatomic alignment with full or near-full range of motion of the elbow. Among patients treated nonoperatively, all fractures healed. Only 1 patient had greater than 30° of malalignment in any plane. One patient developed skin breakdown during treatment and completed treatment in a sling. Only 1 patient lost greater than 10° of elbow or shoulder motion. The study authors concluded that operative treatment achieves more predictable alignment and a potentially quicker return of function, but has higher risks for iatrogenic nerve injury and reoperation. Functional bracing can be associated with skin problems and varying degrees of angular deformity, but healing, motion, and function are usually excellent.
No surgery unless things get complicated.
I am a surgeon, but not orthopaedic. I broke mine 2 years ago, almost exactly same x-ray as yours. I saw a sports medicine orthopod (former UT linebacker) and he did not even consider surgery. I just wore the sling you have for 2 weeks and then he let me out of it. It was mainly to remind me not to move it and minimize pain. I agree with Dino's post that unless you get some strong advice for surgery, that it is probably not the best option. In fact, if you get that rec, I'd suggest finding a sports medicine orthopod for a second opinion. Clavicle fractures usually do just fine with immobilization, unless grossly displaced or in a strange spot. The figure-8 sling that Dino had does a little more to reduce distraction/overlap, but yours does not look too displaced to me (again....not an orthopod!). The figure-8 is much more uncomfortable, and my ortho friends tell me it's not advantageous over just a regular sling like you have unless it's a more significant injury.
By the way, the ER gave me a sling.....after asking me if I wanted one (they diagnosed the fracture in the ER). I thought that was odd....why would I NOT want one???? Then, I got a bill from some medical supply company a month later for $71. I called my insurance company (BCBS) and asked why I got this bill....."over the counter" devices like slings, are not covered.? I could've bought one just like it a Wal-Mart for $10 probably!
Also, remember what happened to Coach P?.....hardware got infected, had to have additional surgery to remove it.
Just remember that while surgery today is more advanced/successful than in the past, it's still always with some risks......
There are several orthopods in the haus, so hopefully one of them will chime in.
Rest up, play it smart, and you'll be fine. I was not back on the trainer as fast as Dino, but probably could have done that, if I just sat up and didn't try to bear weight on the horns or aerobars with that arm. Running will be tough for at least 4 weeks, if I'm remembering how I felt, as the constant sway of the arms leads to a lot of torsion/torque/strain on the shoulder girdle.
Really sorry to hear about your "recent unpleasantness" as we call those things in the south.
I am an Orthopedic sports medicine physician and I pretty much echo the sentiments above. Much of what Bob said is correct. Unfortunately, the distal 1/3 fractures like yours commonly disrupt the coraco-acromio ligaments which can predispose the fracture to be unstable and displace later. The one view of the x-ray that you posted looks like the alignment is acceptable, however, that just shows one plane and more views are required to ensure that the alignment is acceptable overall. Dino is also correct in the fact that a "figure 8" brace tends to hold the shoulders back and allow the fracture to heal with less shortening.
Typically, the indications for surgery are 1. completely displaced fracture (ie the ends of the bone are not touching) 2. more than 2 cm of shortening of the fracture (shortened collarbone can affect shoulder function later) and 3. comminution of the fracture site (ie bone is broken into more than 2 bone fragments)
Based on that, I would agree with Jeff and say surgery is less likely to be indicated unless the fracture is more displaced on another x-ray view or becomes more displaced over time. If it stays in acceptable alignment it will probably heal uneventfully.
Be interesting to see what your Ortho guy says. He may suggest a CT scan to check the 3D alignment of the fracture site.
http://members.endurancenation.us/Forums/tabid/57/aft/12637/Default.aspx
Jeff is correct. On my trainer, I could not hold the bars initially. I just put my road bike on it and sat up and spun in a comfortable gear. I actually wore my figure-8 as well. I had two, so I could always wash one after a ride. I would just sit up and watch movies on my laptop for 60-90 minutes. After a couple of weeks, I could hold the bars but not pull against them without wincing. My doctor's advice was "let the pain be your guide. If it hurts, don't do it." In the 4th or 5th week I was doing intervals. One day I did a 60 minute TT. I was just trying to find ways to keep the "blues" away.
I was bummed because I was not training or riding with with friends and I think I was withdrawing from the exercise endorphins. Trainer rides seemed to keep the mild depression at bay.
In the first few days, I would recommend you challenge yourself to shower twice per day (pain medicines made me clammy), try and sit outside when you can and be as active as possible. I found that if I kept clean and fresh and found outside time, I felt better. Plus, my wife had to wash me in the shower. Big bonus there.
The other weird thing is that initially, you can feel the broken ends move quite a bit. When they do, you can almost hear it. It is very strange. Then, slowly, the ends will get "sticky" and you notice they move far less every day until you don't feel movement anymore, juts soreness. Slowly, your body heals itself. Then the soreness is gone too. It's weird, but wonderful.
Keep chin up! Call me if you need anything..... (except the shower part. I still need to buy you some hipster soap)
x2 Dino....on the "grating" sensation the first week or two.....almost like fingernails on a chalkboard but with some pain!
Why I did not think to pretend I could not shower myself and require my wife to do so is beyond me....well played!
He gave me better sling, told me to stop Motrin, have 1000mg calcium per day and actually wants me back on the trainer soon.
Here are some more X-rays:
http://imgur.com/P7DmQnQ
Motrin? What are you a Girl Scout? I needed a triplicate when I broke mine.
Peter, good to hear no surgery needed . Wishing you a speedy recovery.
@Bob I am trying my best to get calcium from natural sources. I went shopping this afternoon and picked up sardines, kale, brocoll. I am also eating a lot of yogurt and almonds. Have gone higher on my calories the past few days but just feeling hungry so going with it. I have also been eating a ton of fiber. I have already had 2 healthy BMs even though I am on narcotics!
I discovered that Oatmeal + Sardines + Onion / Garlic + Amino Acids + Sriracha + Basil is actually a pretty good savory dish. Calcium and fiber!
Day 5 update.
I am now taking hydrocodone only at night, nothing during the day. I have ridden the bike twice on the trainer. First 15 minutes, and today 30 minutes. I am still trying to figure out what works best for riding. On the day of the accident I averaged 284 watts for 18 minutes and my heart rate peaked at 169. Today I did 2 minutes and 30 seconds at that effort and my heart rate shot up to 179!
Did I lose fitness that quickly? Am I out of whack from Narcotics? Does trauma do this?
Anyway, I am having my ups and downs. I am glad that it wasn't worse, but I can't stop thinking about how I was at the peak of my fitness and soon to start tapering for St. George.
Here is a progress pic. The swelling/bruising is quite pronounced.
Hey Peter,
Thanks for checking in. Your post reminds me that I have an upright sleeping system of special pads, pillows and whatnot from my shoulder and back injuries. Much more comfortable than trying to sleep in your back with a broken clavicle. Let me know if you're interested and we can try to figure out how to get it to you.
With regards to training...just ride. Don't worry about zones, power, etc. Just do what you can but don't rush to do too much.
Sounds like things are progressing well! With my internet doctors hat on...