It’s never the black runs...(broken clavicle)

[mallthus]

So, last Friday, I was having a fun solo day at Vail. Spent the morning and early afternoon pounding the back bowls and having a blast. About 2pm, I decided to start wending my way back over to Lionshead for an early après and much deserved beer. I’m heading down into mid-Vail on an easy but people choked blue when the light goes flat. I swerve to avoid an out of control pizza girl and hit an icy bump that I couldn’t see in the flat light. Double release on the landing and I fall. As I hit the snow, I hear a loud “pop” on my right side. I take a few moments to compose myself and realize I’m in intense pain. “Must have torn something.” I tell myself as I wave off a “host”. Back into my skis and down to mid Vail, I snap out of my skis. I bend to pick them up and realize I can’t pick them up. Ouch. Someone hands me my skis and I carry them a few feet before sitting down and looking pathetic. An employee calls patrol and a patroler comes to my aid. He quickly points to my collarbone as the culprit before helping me download the gondola.

A quick ride to Vail Health and a couple xrays later, it’s confirmed. My clavicle is in four pieces and my season is over. I’m fitted with a sling and pain meds while my wife comes to collect me. My orthopedist looks at the xrays and simultaneously schedules me for an exam and surgery.

In my exam, he notes that I’m in that gray zone where surgery is indicated, but not required. Everyone I’ve talked to has said how much better they felt post-surgery, but the doc himself says he’d probably not choose surgery for himself in this situation (a surgeon advocating against surgery?). Nevertheless, I opt for surgery.

During surgery prep, the surgical team becomes concerned about a rash on my arm where I’d been in contact with the sling. My body loves opportunistic fungal skin infections where there’s skin irritation combined with trauma elsewhere and it’d had gone wild on my arm. Anyway, surgery’s a no go and I’m sent home. That was yesterday and I’m on track to getting the rash under control. I’ve also switched from a sling to a figure 8 brace that leaves my arm free to breath.

Questions:

• Anyone want to weigh in on whether I avail myself at another chance for surgery next week? (Already offered by orthopedist)
• Downsides to not having surgery, in terms of long term mobility and recovery?
• Your experiences post recovery, including PT and impact on sports/activities, especially skiing, hiking, and weight training.

https://www.dropbox.com/s/bt4c0ngk1bdsrj9/IM-0001-1001.jpg?dl=0

 

[RuleMiHa]

My opinion as an Ob/Gyn Surgeon--If your surgeon says he wouldn't have surgery, DON'T have surgery. Corollary, If your physician says they wouldn't take a medication, don't take that medication.

Sometimes physicians are prevented from practicing exactly the way they want or they have had experiences which cannot be quantified or easily explained. It might be as simple as a procedure or a med being recommended by the national governing body but the surgeon's complication rate is high.

The fact that your surgeon told you he wouldn't have the surgery is a very, very important communication. Don't ignore it.

 

[François Pugh]

I've never even been offered surgery. Most of my broken bones have been fine without it though. My broken clavicle did not mend straight, it's like the two ends did not quite line up, so I'm stuck with a bump there.
I would say if your clavicle has started to mend and everything is in line, just call it a day, but if it's not lined up properly do something about it.

P.S. I wouldn't let a little thing like a broken clavicle stop me from skiing

 

[mallthus]

My opinion as an Ob/Gyn Surgeon--If your surgeon says he wouldn't have surgery, DON'T have surgery.

I was certainly gung ho on surgery going into my initial meet with the orthopedist, based on what I’d heard, the comments of the ER doc at Vail Health, and the fact that the orthopedist himself had scheduled both the exam and surgery after looking at the X-rays as the on call the night of the injury. That I was in a lot of pain on Tuesday, when I had the exam and made the call, certainly went a long ways towards coloring my judgement too. But now that I’m in less pain and able to take a more nuanced view, I’m leaning against surgery unless there’s some compelling reason I haven’t thought of.

 

[mallthus]

My broken clavicle did not mend straight, it's like the two ends did not quite line up, so I'm stuck with a bump there.

I wish I had two ends.

I’ve got three breaks, so I’ve got six ends to match up!

 

[Coach13]

I’d have the surgery to ensure it’’s set/aligned and heals correctly.

 

[crgildart]

Surgery because it usually heals quicker and straighter with plates and screws... and chicks dig scars..

 

[Analisa]

My boyfriend destroyed his at the closing day pond skim 2 years ago. (Shout out to Stevens Pass for getting us the drone footy). They offered surgery or to wait and see what happens, but his surgeon said the chances of it not healing on its own were high enough he recommended surgery, and his collarbone would've been pretty jacked without it.

Recovery was quick - 2 weeks out of work (pretty physical job with a lot of driving), did a lot of short distance hiking & walking over the first two weeks, broke doctor's orders and ran the third. Once he had clearance to wear a pack again, we skied the SW chutes on Mt Adams that June - a nice 14 hour day to ease back into it

The biggest issue was wearing a pack over the plate. The surgeon who put in his hardware said he'd only ever taken it out from one patient. The plates really bothered him under a pack strap. They said scar tissue would eventually cushion it and make it more comfortable never worked out, so after a year and a half, he got it removed. It was more comfortable for him 2 weeks after the removal surgery than it ever was with the plates in, even with extra padding over his collarbone & awkwardly weighting his pack to one side. He skipped a lot of backpacking trips and alpine climbs over the past 2 summers.

 

[Dwight]

Warm days of pond skimming. It how the ski patrol gets their numbers up.

 

[Ski&ride]

How old are you? How old is the surgeon?

In the “good old days”, surgery are “only” recommended for situation when there’s a high chance of the ends not joining back together.

But a bunch of recent studies had found many of those “healed” had some degree of movement impediments. That’s more of an issue for people who make a living doing manual labor. Bet your surgeon asked you what you do for a living?

For people who do a lot of sport for recreation but not as a profession, you maybe willing to give up those you can no longer do as “well”... Whether that’s important to your quality of life, only you’re the best judge.

Let’s face it, a desk jockey and couch potato can live with significant limitation. While an avid gardener may find the restriction difficult to deal with.

Surgery means you’ll be good to run and swim in 6-8 weeks. No surgery may take as long as 3-4 months. But in the grand scheme of things, that’s really not that big a deal.

(I’m a cyclist. Seen many such in my club. Witnessed many different outcomes too. I broke mine more than once too. Surgery worked well for me, so I’m biased)

 

[Monique]

I think you should probe into WHY he wouldn't have the surgery. Is it the length of the recovery? The pros and cons of the outcome? Pain levels? Inability to work during that time? etc etc.

My current perspective is to avoid surgery as long as possible - I'm doing a ton of shoulder exercises after my ortho doc said I'd likely need surgery in both shoulders "some day," and I'm gonna do my best to make that "never." But with actual fully broken-off chunks, I dunno.

Completely different story: My 78yo mother broke her ankle in several places in October. There was too much swelling at first to do the surgery, and then they decided that the bones were setting well enough on their own. Well, last week she went to the doc because her pain wasn't getting any better, and it sounds like she'll be getting an ankle replacement. That's gonna suck. But on the other hand, if the non-surgical option had worked, that would have been a lot easier on her. So ...

 

[mallthus]

How old are you? How old is the surgeon?

In the “good old days”, surgery are “only” recommended for situation when there’s a high chance of the ends not joining back together.

I’m 50. The surgeon is younger and also the orthopedics professor for a major medical school.

I do have to say that one week post-injury, I’m significantly more mobile and virtually pain free.

 

[Coach13]

I’m 50. The surgeon is younger and also the orthopedics professor for a major medical school.

I do have to say that one week post-injury, I’m significantly more mobile and virtually pain free.

As I said earlier for me it’s about the bones aligning and healing correctly. If you can heal quickly with no signs of future problems no surgery is an option. A good friend of mine is an orthopedic guy and he typically recommends surgery for complete breaks. I am positively sure you don’t have to worry about the competence of your surgeon regardless of age. In the orthopaedic world there is not much simpler than correcting broken clavicle.

 

[Ski&ride]

I wasn’t implying the competence of the surgeon. But how up-to-date his treatment plan, as this is an injury the treatment had changed over the years.

You should ask the surgeon to elaborate on the specific pros and cons of surgery vs conservative treatment.

The biggest risk of surgery is something goes wrong during the surgery. There’re tons of nerves and blood vessels in that area, so in theory there’s a risk of one of them nerve or blood vessel got cut. But I’ve not heard anyone suffering from that. So it’s mostly a remote risk.

There’s also the risk of infection, which a friend of mine did experience. It was really unpleasant.

The outcomes of a surgery without complications are usually better than the conservative non-surgery. The risk of complication above notwithstanding.

 

[Doug Briggs]

I had a non-displaced fracture in my clavicle a few years ago. It healed without surgery. I have had no repercussions.The three broken ribs, among other things, took longer to heal and hurt a lot more.

 

[mallthus]

You should ask the surgeon to elaborate on the specific pros and cons of surgery vs conservative treatment.

I think the surgeon’s POV is that the risk of infection or nerve damage is greater than any expected benefit.

 

[RuleMiHa]

I wasn’t implying the competence of the surgeon. But how up-to-date his treatment plan, as this is an injury the treatment had changed over the years.

You should ask the surgeon to elaborate on the specific pros and cons of surgery vs conservative treatment.

The biggest risk of surgery is something goes wrong during the surgery. There’re tons of nerves and blood vessels in that area, so in theory there’s a risk of one of them nerve or blood vessel got cut. But I’ve not heard anyone suffering from that. So it’s mostly a remote risk.

There’s also the risk of infection, which a friend of mine did experience. It was really unpleasant.

The outcomes of a surgery without complications are usually better than the conservative non-surgery. The risk of complication above notwithstanding.

Actually the biggest risk for any surgery is anesthesia. It can be as high as a 1% risk of death.

 

[scott43]

Actually the biggest risk for any surgery is anesthesia. It can be as high as a 1% risk of death.

My son got a few ear infections..everyone was on the "get the tubes" bandwagon..my GP said "That requires general anesthetic..do you have any idea how relatively dangerous that is?!? Give him some Tylenol and we'll talk after his 20th ear infection!!" He got about 3 and we're good. We shouldn't rush into surgery I don't think..

 

[Noodler]

You need to ask your doctor if healing without surgery will achieve a 100% return to normal function with absolutely no impact on your quality of life. I wish my doctor had asked me the right questions before providing me my options (dealing with a major leg injury in my case). Had I known what I know now I would've made a different decision. If your goal is to get completely back to where you were before the accident, then ask whether that's actually possible without surgery.

In my case I really wish they would've gone in and realigned and plated my breaks. I now have to deal with the decrease in my quality of life until I'm done with this world.

 

[Coach13]

Actually the biggest risk for any surgery is anesthesia. It can be as high as a 1% risk of death.

No question you are correct!