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

[Bad Bob]

Broken collar bones 4 times over the years, without any surgery. All but 1 were single breaks so they set up easily. The bones did grow back thicker and stronger than original.

Being a big bloody chicken, would avoid knives cutting the body whenever possible. Incisions always require longer healing time.

 

[Beartown]

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

This is a pretty misleading statement. Dying during or after surgery from any cause (perioperative mortality) is relatively unusual, and is most frequently related to the reason one is having surgery or the patient's medical problems (comorbidities). Basically, really sick people having surgery or anyone having really risky surgery is at much higher risk of perioperative mortality. Healthy people having low-risk surgery are at exceedingly low risk of death (approaching but not reaching zero).

As an example, someone brought to the OR bleeding out from multiple gunshot wounds to the chest might have a 99% chance of perioperative mortality no matter how healthy they are. Or a patient with severe congestive heart failure, end-stage renal disease, pulmonary hypertension, and poorly controlled diabetes might have a higher risk of perioperative mortality even when having lower risk surgery (breast surgery, knee scope, etc). On the other end of the spectrum, a relatively healthy active younger person having their clavicle fixed has a very low risk of perioperative mortality (<<<<1%).

My other qualm is assigning risk of death during/after surgery to anesthesia. While anesthesia itself can cause death (lost airway, anaphylaxis, malignant hyperthermia, local anesthetic systemic toxicity, etc), the risk of death BECAUSE OF ANESTHESIA is a small subset perioperative mortality. Most perioperative deaths can be attributed to hemorrhage, infection, blood clots and pre-existing medical comorbidities. Statistics for perioperative mortality attributable to anesthesia vary wildly depending on the studies, but even the highest estimates are about 1:7000 (with other studies showing as low as 1:200,000).

I am just a bit sensitive about this as I feel like I spend too much of my day trying to reassure patients after their surgeon tells them their biggest risk from surgery is the anesthesia.

Long story short, there are a number of factors to consider when deciding whether to proceed with surgery. Anesthetic risk is one of them, but (for most people) shouldn't really be the main one.

 

[Ski&ride]

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

Except the clavicle surgery doesn’t need general anesthesia. It’s a “partial”, called nerve block.

 

[cosmoliu]

Maybe @Tony S will weigh in with some direct experience to relate

 

[Coach13]

Except the clavicle surgery doesn’t need general anesthesia. It’s a “partial”, called nerve block.

That may be an option but they put my son all the way out when he broke his playing football.

 

[Ski&ride]

Incisions always require longer healing time.

Incision takes 2 weeks to heal.

Did your collarbone heal in less than 2 weeks?

I’ve said more than I should have on the subject, as I’m not a surgeon, nor are the rest of the posters.

The OP has enough anecdotal information to ask the surgeon the right question without hearing more misinformation from those us who had totally unrelated injuries!!!

 

[Beartown]

Except the clavicle surgery doesn’t need general anesthesia. It’s a “partial”, called nerve block.

while ORIF of the clavicle "can" be performed under nerve blocks with sedation (there are some case reports), it is definitely not common. Most clavicle fractures are repaired under general anesthesia. The clavicle and overlying tissues get their sensory innervation from a few different nerves (with somewhat inconsistent patterns of innervation among different people), and depending on the location and extent of the fracture, it can be difficult to render the entire surgical area insensate with nerve blocks. This isn't to say that a motivated patient and a skilled anesthesiologist and surgeon couldn't get through the procedure without a general anesthetic. Just know that if you have a clavicle fracture, it is most likely (>95%) going to be repaired under general anesthesia.

 

[Ski&ride]

I’ve had 4 surgeries by 3 different surgeons (in 3 different hospitals). All are under nerve blocks.

Granted, these were all relatively recent surgeries. My understanding is, the technique was only widely used in the last 10-15 year or so. But I’m shocked to hear it’s only used by less than 5% of the surgeries.

 

[Beartown]

I’ve had 4 surgeries by 3 different surgeons (in 3 different hospitals). All are under nerve blocks.

Granted, these were all relatively recent surgeries. My understanding is, the technique was only widely used in the last 10-15 year or so. But I’m shocked to hear it’s only used by less than 5% of the surgeries.

Sounds like it's definitely catching on in your area. Not a bad thing at all; just a bit complicated to consistently do well in practice. I had actually never heard of anyone doing clavicle ORIFs under nerve blocks. I have done hundreds in my career at several institutions (including the Mayo Clinic), and keep pretty up to date with the literature. I did a lit search and did find a few case reports and a single case series (n=10), mostly from India/Nepal. In the discussion sections for all of these, they mention that almost all clavicle fractures are repaired under general anesthesia. Basically if something is novel enough that a journal will publish a single case report about it, it's definitely not happening frequently

 

[RuleMiHa]

This is a pretty misleading statement. Dying during or after surgery from any cause (perioperative mortality) is relatively unusual, and is most frequently related to the reason one is having surgery or the patient's medical problems (comorbidities). Basically, really sick people having surgery or anyone having really risky surgery is at much higher risk of perioperative mortality. Healthy people having low-risk surgery are at exceedingly low risk of death (approaching but not reaching zero).

As an example, someone brought to the OR bleeding out from multiple gunshot wounds to the chest might have a 99% chance of perioperative mortality no matter how healthy they are. Or a patient with severe congestive heart failure, end-stage renal disease, pulmonary hypertension, and poorly controlled diabetes might have a higher risk of perioperative mortality even when having lower risk surgery (breast surgery, knee scope, etc). On the other end of the spectrum, a relatively healthy active younger person having their clavicle fixed has a very low risk of perioperative mortality (<<<<1%).

My other qualm is assigning risk of death during/after surgery to anesthesia. While anesthesia itself can cause death (lost airway, anaphylaxis, malignant hyperthermia, local anesthetic systemic toxicity, etc), the risk of death BECAUSE OF ANESTHESIA is a small subset perioperative mortality. Most perioperative deaths can be attributed to hemorrhage, infection, blood clots and pre-existing medical comorbidities. Statistics for perioperative mortality attributable to anesthesia vary wildly depending on the studies, but even the highest estimates are about 1:7000 (with other studies showing as low as 1:200,000).

I am just a bit sensitive about this as I feel like I spend too much of my day trying to reassure patients after their surgeon tells them their biggest risk from surgery is the anesthesia.

Long story short, there are a number of factors to consider when deciding whether to proceed with surgery. Anesthetic risk is one of them, but (for most people) shouldn't really be the main one.

I won’t disagree and the 1% is an old statistic and is more complicated. But as I’ve spent the day with arguing with my anesthesiologists about what I can and can’t do surgically because the anesthesia risks are too high I’m not going to back down completely from my statement, but I do recognize (and teach) how complex the topic is. However, I was mostly trying to address the idea that surgical complications are the only thing to worry about.

The biggest thing (IMHO) is to always think about both the risks and the benefits when making a decision to proceed with surgery. Too often people are so focused on the benefits, they don’t properly evaluate the things that can go wrong.

 

[François Pugh]

It's been a week. The clavical should have already mended, although OP might want to wait a few more weeks before putting a high load on it. Is it straight or is it FCKD-UP? If it's not good then better get it fixed now, otherwise a little on the late side imho (not an MD) for an operation, but you gotta do what you gotta do.

 

[mallthus]

Except the clavicle surgery doesn’t need general anesthesia. It’s a “partial”, called nerve block.

Actually, it's usually a general anesthesia operation in the US and would have been for me if I'd gone through with it.

 

[mallthus]

It's been a week. The clavical should have already mended, although OP might want to wait a few more weeks before putting a high load on it. Is it straight or is it FCKD-UP? If it's not good then better get it fixed now, otherwise a little on the late side imho (not an MD) for an operation, but you gotta do what you gotta do.

I'm now a little over a week post-injury and healing is actually going quite well. All movement of the bone pieces has stopped and the pain is wholly absent except when I'm changing positions (standing after sitting, getting out of bed, etc). There's a decently prominent "bump" that's now visible as the swelling decreases, but it's no worse than if I'd wound up with plates and an incision. I'm still wearing the brace and studiously not using my right arm (which remains out of a sling as the skin heals from the fungal infection!).

Anyway, firmly not getting surgery and not, so far, regretting that call. Given that my only previous serious injury was a shattered pinkie that's now held together with wire, I'm looking for a close to complete recovery. I wasn't ever supposed to regain movement in that pinkie and it's now got 99% mobility, so the odds are in my favor thanks to stubbornness and an accommodating physiology.

 

[Ski&ride]

Actually, it's usually a general anesthesia operation in the US and would have been for me if I'd gone through with it.

Ok, so add one more risk factor.

Though as pointed out by, I’m assuming an anesthesiologist, a tiny risk. (I, on the other hand, had experienced rather unpleasant after effects in the past. So it’s always an involved conversation with the anesthesiologist every small surgery).

As for the benefit of surgery, google “clavicle fracture sequelae”. Also pay attention to “functional score” of surgery vs conservative treatments.

Truth be told, there’s always doubt from the patients. I had surgery and was happy with the result, despite the hassle and worry. Others in my club were either “happy” with their non-surgery result (even in cases it’s not 100%), or wondering should they have chosen differently and had better results. The difference however, were typically not big enough to go through the surgery later. So it does begs the question if the risks are worth it.

Discuss with your surgeon what specific benefit you gain from the surgery. Then YOU make the decision, rather than the surgeon making the decision based on his understanding/misunderstanding (or assumption) of what YOU want.

 

[Tony]

I broke my clavicle, some ribs and had a lung partially collapse from a dirt bike crash almost two years ago, about the same time as @Doug Briggs was hurt. I also broke my collarbone when I was a kid playing football on a neighbor's lawn and I was tackled where the sidewalk crossed lawn. Both of my breaks were only in one place and healed without surgery although I remember wearing some kind of brace when I was a kid to prevent movement.

The Drs. who looked at my recent break said the problem with surgery on a clavicle is that there is not much between it and the skin so any screws or other devices used to repair it will be something you will feel similar to how friend of @Analisa had to have device removed as it was irritating under a pack.

Mine healed without problem although it seemed like there were a few days when it mended overnight then broke again in the morning due to strain of getting out of bed. I was told not to resume risky activities until 12 weeks. I did easy bike rides at 8 weeks and took a little more difficult ones about two weeks later and got back on dirt bike at 12 weeks with a chest and shoulder protector and a lot better helmet.

 

[Tom K.]

I'm now a little over a week post-injury and healing is actually going quite well. All movement of the bone pieces has stopped and the pain is wholly absent except when I'm changing positions (standing after sitting, getting out of bed, etc). There's a decently prominent "bump" that's now visible as the swelling decreases, but it's no worse than if I'd wound up with plates and an incision.

IIRC, that "bump" is formed of callus, which will fully calcify over time, and reduce markedly in size.

My two cents is if there isn't significant displacement, let your body fix itself.

I did mine 20 years ago, and had nearly an inch of displacement. Went the no surgery route, and it was hell for a month, and I've got a good-sized bump there now, and it's shorter. Today, in the same circumstances, I'd definitely do surgery, but only with significant displacement.

 

[Tahoma]

No question you are correct!

As an anesthesiologist, I'd say "it depends on the surgery and patient." Young healthy folks having minor surgery (eg, carpal tunnel release) are probably more at risk driving to the hospital or surgery center than having a brief anesthetic. But add more and more pre-existing illnesses (especially heart and lung disease) and magnitude of surgery (open heart, chest, big abdominal, big spine) and anesthetic-related risk goes way UP.

Clavicle fractures come in all flavors. I probably see more repaired these days than not, likely cuz there are better ways of fixing the fracture and a lot of athletic folks who get them want good functional recovery. Annalise's BF undoubtedly benefited from surgery, cuz his fracture was REALLY comminuted, as we say in the business (it was all busted up).

But it's not a trivial area to have surgery on--some big blood vessels live very near by, plus the chest cavity, plus the brachial plexus (nerve supply to the arm). Years ago, I stupidly chopped wood all afternoon and got what's called Paget-Schroetter syndrome, where you pinch the subclavian vein so often between the first rib and clavicle that you get a blood clot. No bueno! After having the clot dissolved by a local vascular surgeon, he wanted to do a first rib resection to prevent reoccurence. I politely asked for a second opinion from a very well-known vascular surgeon in my area, who had treated 50+ patients with that problem. He recommended against surgery precisely because of risk of nerve damage, which in my trade would be a career-ender. 14 years later, I'm glad I didn't get surgery, and my arm's fine.

Second opinions in elective cases aren't always a bad thing.

BTW, mallthus, I twanged MY knee at Vail in February doing almost the same thing at the end of the day!! Luckily, it ended up being a bone bruise/contusion vs. a tibial plateau fracture, which would have REALLY sucked. Dodged another surgery bullet!

 

[mallthus]

Just a quick update after 7 weeks of recovery. I'm back to normal function and without any supports, braces, or slings. My range of motion is still somewhat limited at extremes (reaching up, reaching out, etc), although I think much of that is because my physical therapist has told me that I shouldn't do anything that hurts yet. I continue to have a low ache across my shoulder, but I've been told that should decrease as the breaks fully calcify.

I've considered pulling out the skis, given the amount of snow we've still got, but I'm going to defer to caution. Not only am I concerned about re-injury, given that the bone's not fully done healing, but my conditioning has gone to hell too.

 

[mallthus]

Just an update as ski season begins again in North America.

At this point, the break is fully healed. The callus at the primary break location is still quite prominent. Although it's not painful, when I'm lifting at the gym I'm, for lack of a better word, aware of the bone, which is obviously unusual for a clavicle, but physician friends chalk that up to scar tissue movement and stretching as opposed to anything to be concerned about.

Hitting the slopes this Friday!