Broken Collarbone. Advice?

[jlawrence10]

Just broke my collarbone playing flag football (and my family worries about me climbing mountains?!). I've done the sling/pain meds thing for 4 days now, and go see an orthopedic surgeon today. Hopefully he knows what he's talking about... I understand for this sometimes they do and sometimes they don't do surgery. Not sure what that depends on, but I wouldn't be looking forward to getting knocked out and cut open.

Any thoughts from anyone on where to go from here would be much appreciated.

I'm a mountaineer, and get out on the rock and ice from time to time. With two winter climbs on Hood already completed this season, and some time before the summer season gets in swing, and crappy snow on Hood, I guess the timing is actually sort of good, in a way.

Thanks, y'all!

 

Josh

[Mtguide]

If it's a simple break surgery won't likely be necessary; for a multiple or more complex fracture your orthopedist will be the best judge of where to take it. For this particular injury, it can be helpful if your doctor is a shoulder specialist or sports medicine-oriented practitioner.

 

One of the best orthopedists in Portland is Dr.Ira Weintraub, a climber and skier himself, who has long and solid experience, and is one of the few who will take the time to talk and fully understand and explain. If he's not the doctor you're currently seeing, you can always go to him to get a second opinion, if you're unsure of your current physician's recommendations. NEVER be at all hesitant about seeking a second opinion in any instance where you have uncertainty, or feel you need a different perspective.

 

Although good physicians are constantly studying, upgrading and expanding their knowledge as medical research progresses, no one person can hope to know everything, so it sometimes makes good sense to get a second, or even a third, opinion, for a different perspective, especially with the type of injury which can be problematic in the future if not treated properly at the outset.

 

Dr.Weintraub is listed in the Portland phone directory. He also has excellent connections and relationships to first-rate physical therapists, which can be make-or-break for recovery. As I said earlier, an injury such as this may not require surgery or PT. And you can expect Dr. Weintraub to be absolutely honest in that regard; he's not a physician who would ever recommend an unnecessary procedure. If the nature of the injury is such that there are options, he'll make it all very clear as to pros and cons. All in all a terrific practitioner, and a great guy.

[jlawrence10]

Thanks for the advice, and the doc recommendation.

 

Just went in to see a Dr. Mirarchi at OHSU, and he recommends surgery for this type of break. It is broken into smaller pieces, and is also "shortened" by about a centimeter. He also said it heals just as quickly as not doing surgery, and with better results, better range of motion, and less long term discomfort. Of course, I could die as a result of the anesthesia, but that is less than 1% likely. I like those odds. I guess...

 

As much as I hate to go under the knife, and as little as I trust modern medicine and doctors, it looks like the way to go. I did call Dr. Weintraub's office but he's unavailable until next week, and I think I want to get this done.

 

I do welcome any other thoughts. Thanks again,

 

Josh

[Mtguide]

I would have no doubts about any physician at OHSU. It's one of the most highly regarded medical schools and hospitals in the entire country, and their staff is absolutely first rate. This would also include anesthesiologists. It sounds to me like you do have a more than ordinary fracture there; I would have absolutely no reservations about Dr. Mirarchi's recommendation.

 

Regarding trust of modern medicine and doctors, it's true that they don't know everything, but that tends to be an area more related to disease and pathology,( a vast and difficult area of medicine, filled with controversy and many mysteries yet to be solved) than surgery for broken bones. At orthopedics, modern Western medicine, particularly in the US and Canada, is unexcelled, without parallel anywhere else in the world. What they can do with the most horrific trauma is nothing short of miraculous. In your case, it's pretty simple and straightforward, but it nonetheless requires someone who knows what he's doing. Were it me, I'd agree to this surgery in a heartbeat. I think you'd find Dr. Weintraub in complete agreement as well.

 

Not only do you have multiple breaks, but the shortening of the clavicle by as much as a centimeter could be fairly serious in terms of affecting the mobility, range of motion, stress kinetics and weight-bearing integrity of your shoulder in the future, unless it's corrected. So it sounds to me like your doctor is doing exactly the right thing. You want that bone to heal up as close to what it was before, as possible. An OHSU surgeon is just the man to do it.

[Maine-iac]

This is long, sorry, but it helped me and will be helpful for similar issues.

 

I will be four weeks out of surgery tomorrow for a broken clavicle. I had surgery 4 days after breaking mine. My break sounds a little worse than yours does; mine was in 3 pieces, shortened by 3cm, displaced by 200% and I had a piece trying to poke out of my chest. I had a good fall if you are wondering

My doctor flat out told me he fully recommended surgery for me as the chance of mine healing correctly (in any shape or form) was roughly 70%. I told him that was 100% what I wanted because I am on a tight schedule for my summer plans and I could not afford to have it not heal correctly.

 

There are many side effects and issues that were told to me upfront but not emphasized fully. I will try to explain what those were/are as helpful information for you and for me.

 

On saturday the 16th, I fell off a cliff and landed directly on the back of my shoulder so my clavicle was blown straight out. In some of my xrays you can not tell it is broken, but it looked like a Z in the 45 degree view (granted my pectoral area had double in size and I had a point coming out...) All of the doctors in the ER told me I would have surgery and in fact I waited in the ER to see if I needed surgery that night. Luckily the orthopedic center was open on MLK day and I went in to see a doctor. Our meeting was less than 5 minutes long because I told him I wanted surgery; so the next morning I met with the surgeon and anesthesiologist. And the following day (wednesday) I had an Open Reduction Internal Fixation preformed.

 

My doctors were great! I received a interscaline nerve block which was heaven.

It was the first time in 4 days that I could literally take a deep breath, lie down, and think clearly. If you are wondering why I couldn't take a deep breath it's because my expanding lungs would push on the broken bones and I will tell you first hand that feeling bones grating and popping is not pleasant. I was told that my nerve block (which made everything from my shoulder to hand completely numb) would last until around 14-16 hours from when they did it and to pre-load for when it wore off with massive dosages of pain killers....

 

The surgery went very well, probably the best sleep I have ever gotten. I was told that I received 11 screws and a plate holding everything together (later confirmed when i saw the xrays). After a few more hours of recovery in the hospital I went home. I was in no real pain because the nerve block was still in effect. I got heavy dosages of pain meds just before leaving the hospital so i only took a small dosage around dinner time; and I wanted to let some things clear out before hitting them hard around midnight when I thought the nerve block would end. I was wrong.

By 8pm it was totally gone. It felt as if somebody had my shoulder in a vice and was literally crushing it. I told the ER doctors I was a 6 in pain but when that block wore off I was easily an 8 or a 9 (on a log scale). I had already maxed out my meds so I sat there for 4 hours in the most intense pain I have ever been in and waited until I could take more medicine. It was not until around 1am when the oxicodons finally kicked in.

 

I pushed the max dosage of oxi every 4 hours for 48 hours straight then managed to slowly cut back and 6 days after surgery I was totally off the meds. Two weeks in a sling with NO movement besides extension of the elbow and I went back to the doctors where I was given the green light to start my ROM activities.

 

Within 3 days of starting I had almost 100% full range of motion back. I was told that during my crash or during surgery my AC joint might have torn and I was not to lift anything over 5lbs (in any direction) and to not lift anything over my head for another 4 weeks. This includes wearing a backpack. So if you are keeping count I am not allowed to use my arm for anything but waving until I am 6 weeks out of surgery. If my 6 week xrays show positive bone growth I might be allowed to start wearing a light pack and start lifting (or climbing or skiing!!!!)

 

It took me (21 year old male with a drive to get outside because I took 8 weeks off from climbing to let a finger heal right before this happened) 5 minutes to figure out how to tie my shoes one handed, longer to figure out how do to up a zipper one handed, 6 days to get off the pain medications, just under 2 weeks before I could sleep laying down (I sat upright for 2 weeks from when I broke it), 4 weeks before I slept through the night. Right up until a few days ago I had constant pain in my shoulder from a suspected torn AC joint. It still hurts enough that people notice and ask me about it. I am still very bruised and completely numb in a 1 inch wide area underneath the incision (this could be permanent because the nerves were cut). Besides all of the random pains and issues (and being slapped on that shoulder) is the mental issues of not doing anything for weeks and weeks. You have all of the time in the world to think about things and that blows because now I do not know what I will think about on my next unplanned bivy.

 

One of the largest issues I still have to face is whether or not my bionic shoulder will be a problem when backpacking. There is a chance that I will have to have the plate removed. My fingers are crossed that that is not the case.

 

 

I was told that if I had not had surgery my bones would have healed faster because stresses would be placed on them, but I could have a deformed shoulder... Easy choice to make. Was the crash (or football game) worth it? Hell no. Not much is worth 6+ weeks of doing nothing and potential future problems with it. I am glad I experienced the pain I went though because it will put things into a better perspective. I am very glad I have health insurance because this would have been a large burden. Once something like this has happened to somebody you know or yourself you will quickly realize that health care is quite important.

 

Jlawrence I wish you the best and if you have any questions feel free to PM me

[Buckaroo]

I would get the operation. I busted mine falling off my sport bike. It was overlapped about 2cm. I have a titanium plate with 8 screws.

 

I think climber's muscles can be imbalanced and it causes the bone to pull out of position. Mine was healing overlapped and after 2 weeks had the surgery, they had to separate it and re-align

 

just make sure your doc has done a few of them already, they are kind of tricky.

 

ALL the nerves that go to your arm go right under your collar bone, so don't be surprised if you get some tingling in the healing process, sometimes I'll wake up and my 2 smallest fingers will be asleep.

[jlawrence10]

Thanks for all the advice, folks. Opted for surgery, which happened this morning. It went smoothly, and after seeing how broken up it was in there, the docs are even more optimistic that surgery was the right choice. I had already been good with the decision, especially given how everything was pushing out, and the likelihood of a big bump, and weird healing.

So far there is amazingly really no pain. I had a one shot nerve-block, and I fully expect that to wear off soon and for the pain to start at some point. But so far so good.

Really appreciate all the input and stories.

 

Little bit bitter about how nice the weather is right now.

 

Josh

[Mtguide]

Keep us updated on how it's going from time to time; I'd be interested to know how your recovery progresses. Best of luck.

[jlawrence10]

Well, so far so good.

 

The pain never really came on strong despite my worst expectations. I would say later Friday night it reached its height at only about a 3, and has gotten better since. I've been off the pain meds now since about Monday, because they were doing worse things to me than the surgery. The incision looks to be healing well, and I'm pretty much out of the sling already, with about 70% use of the arm already. Overall, I couldn't have hoped for a better result, and I'm obviously pretty pleased with my decision. At this rate I hope to be close to normal after about a month, although I won't know what the docs say until March 9th.

I guess in my case the break, while definitely severe, was contained to the collarbone only, and luckily I didn't have any of the shoulder issues like Maine-iac had. Hope everything is progressing well for you...

Thanks again, guys, for the input, referrals, and stories. It's good to know what to expect, and in this case to have my expectations set for much worse than actually happened.

See you out there!

 

Josh

[Maine-iac]

Glad to hear things are going well for you!!!

I was told to stay in the sling for two weeks post surgery, but I guess different doctors have different recommendations. This weekend marks 6 weeks from my accident and I see the doctor on monday to have xrays taken. Hopefully I can start weight barring activities again.

I would caution you about getting your hopes up too quickly... Things were explained more clearly at my two week post-op, about how quickly I could return to activities. But we are all different and have different doctors. I wish you the best Josh. Keep us up to date with how things progress. I kept a journal of when I got certain abilities back, so that I could look back upon it.

[Maine-iac]

Just saw my doctor again today (6 weeks out now)and he told me that I still cannot climb, or any strength related activities above shoulder level, for another 6 weeks. I asked about skiing and I got that look... I shouldn't ski because a fall on my shoulder could re-break my semi-broken bone and bend/break my plate holding it all together.

 

At 12 weeks from surgery you are good to go for everything because that is how long the bone takes to heal fully. It heals correctly because of the surgery, but slower than a non-fixated break because the stresses are not put directly on the bone.

 

[Buckaroo]

I was doing a few pull-ups in 3 weeks and light climbing in 4 weeks and back to normal in 6 weeks. Putting metal in makes it quicker to the time it's strong enough. It's still good to be careful and nurse it like no impact or don't try to hold a fall with your bad arm.