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  1. #1
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    Post Clavicle Fracture Surgery Plate & Screw Removal?

    It's been three weeks after my surgery and for the first time two days ago I saw the post op x-rays.

    The Surgeon put in a plate and 11 screws later my Clavicle is mended. He then stated that I was in his top 5 worst cases. From the x-rays, the Surgeon said it's healing well. He doesn't recommend any ROM yet but maybe 3 more weeks.

    It's 2:39 in the morning and it's the discomfort and numbness that's keeping me up.

    All I can think of is getting it removed! I've read 96% of patients who opted to get the hardware out had close to zero discomfort an better ROM.

    Some thinks in theory, leaving them in can be worst if broken again.

    Please share your experiences on removal and leaving in. How did you cope with the discomfort? How did you get any sleep?
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  2. #2
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    I have just recently gotten the all clear for a broken collarbone, around 12 weeks ago it happened. The doctors decided that i should not undergo surgery as they said that as a racer and as it is likely something similar may happen in the future it was better to leave it combine this with that when the plate and screws would be taken out there would be another few weeks off the bike . My dad also broke his collarbone quite badly and required surgery and has had his plate in for a good 8 years or so i think now and has great movement still with the plate in and very very infrequently experiences any pain/discomfort and is able to swim for hours a week with no trouble apart from a slight grind occasionaly . In my opinion only you can decide wether to remove the plate or keep it in, if it is not likely for something similar to happen again then maybe leave it in? But if you are involved in racing and are likely to have a similar incident it may be best to have it taken out as the bone if broken will break around the plate as i'm sure you have been told as the plate is clearly stronger than the bone.

    Hope this helps, Cheers.

  3. #3
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    Recovery

    I think you are really early in the process to think about removing the plate. You are only beginning to heal after 3 weeks. Discomfort is normal. This is a big change for your body, and it has to adapt and recover from the trauma. Recovery takes time, unfortunately more then you think or doctors allow.

    I had a serious crash last June. A skipped gear in a sprint made me hit the deck at 35mph directly onto my shoulder. I broke six ribs, punctured a lung, broke the collarbone and the scapula. "Resting" became my biggest battle. It is completely different resting when healthy versus resting while seriously injured. Initially I was only able to sleep 3-4 hours before pain woke me up, and that was with the help of strong narcotic painkillers. Maybe I would get another hour of sleep in the next 4.

    Position matters a lot for resting while injured. In may case, the normal bed did not work. I needed a hospital bed to help me up, as I could not push against the shoulder. That was not very comfortable. I eventually found that the recliner offered the best position for resting and sleeping. Experiment to see what works best for you.

    Numbness indicates nerve damage, which heals very, very slowly. I had a numbness in my chest for a long time. It has slowly resolved and I don't notice it now.

    Let yourself heal and do physical therapy (PT). The PT will help rebuild the injury site. If you are still hurting after a year, then I would reevaluate the plate. It will probably take that much time to know how you have healed.
    Last edited by NJRoadie; 07-13-2012 at 05:50 AM. Reason: added info

  4. #4
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    I broke my right clavicle 9 years ago, and the surgeon put in a steel plate, I don't know how many screws. It is still there, and I have never considered having it removed. Actually, I don't think it is an option in my case, the surgeon said it was permanent.

    I have never noticed any problem with range of motion, and have been quite active. Handyman, painting, gardening, and a lot of riding. Since it healed, I have not had a problem with pain or discomfort, except when I try to carry a ladder or other heavy object over my shoulder. It doesn't hurt so much that I can't do it, but I usually shift the load to the left shoulder. And If I ride in the passenger seat of a car, the seat belt over my shoulder is irritating. I have never noticed any "grind." Also, I used to do some hunting, but I had largely given this up long before the accident. But I don't think I would want to fire a larger caliber rifle or shotgun shouldered on my right side. I have done a little shooting since with a shotgun, but I shot left handed.

    In my case, I don't think I would ever consider removing the plate, even if it was an option, unless something would change.

  5. #5
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    Keep in mind that there are different types of collar bone break. Often with different types of shoulder separation.....and perhaps other nearby fractures/breaks/tears/......

    So, responses to whether you should have the plate removed or not would only give you good feedback if you were comparing identical or similar injuries. And identical or similar plates.

    An example: last year I came down on my right shoulder. Shattered collarbone, separated shoulder and some rib/sternum separation. My clavicle was in >10 pieces. My surgeon opted for a z-plate and lots of bone graft. In my case, the z-plate was not something that could be left in; it restricted clavicle rotation. Removal was the only option.

    Removal was a breeze compared to the initial surgery. Pain free in 1 week - I only took 2 or 3 pills from the Percocet prescription. ~6wks more PT followed. Was sleeping on the damaged shoulder a few months later. Struggling to hang on to the CX field shortly after that!

  6. #6
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    I had a plate and 8 screws put in after my crash last summer. i agree with you that it is painful and very uncomfortable, but, these plates help your body heal correctly.

    My doctor , (who is supposed to be one of the best in these matters) told me that he could remove the plate after 18 months, not before. i do not know the science behind this time frame, but, i am taking his word for it.
    i am planning on having it remove because of the plate location. i cannot use the car seatbelt over my shoulder because it hits the screws and pushes my skin against them. not the best feeling. also, if i try to carry a backpack or laptop case, the straps usually do a number on that area.

    wait a lillte while before you decide to take it out. keep in mind that as someone else mentioned, the numbness is caused by nerve damage. i am sure that whenever the open up the area to remove the plate, there will be more damage to the nerves.
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  7. #7
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    I snapped my clavicle clean in half in '03, and opted for letting it overlap an inch or so and heal. I have no regrets. Not as pretty maybe, but it is strong.

  8. #8
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    Quote Originally Posted by pinarello_man View Post
    But if you are involved in racing and are likely to have a similar incident it may be best to have it taken out as the bone if broken will break around the plate as i'm sure you have been told as the plate is clearly stronger than the bone.

    Hope this helps, Cheers.
    This makes a lot of sense. Can anyone attest?

  9. #9
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    I know I am in the early stages of healing and maybe some of you can sympathize that I itch to ride everyday and even though of setting up my trusty trainer. 😁

    I do however believe in healing takes time just as forcing a rest day from training. But 8 weeks is a whole lot of rest.

    I've been doing toe raises and body weight squats just to feel the burn. There are little to no shoulder movement while doing this exercises. I also do some leg raises and hold both legs up for some abdominal exercises.

    Care to share other routines that does not involve the shoulders?

  10. #10
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    Exercise

    Your desire to exercise is excellent, and should help your recovery. As the shoulder heals, you'll be able to ramp up the intensity. Some suggestions:

    Good, old fashioned walking. Initially you can use a sling. After some time, transition away from the sling for a period. Keep the sling with you, as you can tire during the walk and use it later. The swinging arm motion is helpful to breaking down scar tissue and recovering the range of motion.

    Indoor trainer. Again, use a sling initially if you need it. You don't need to put your hands on the bars initially. Riding hands free is fine. Transition to the bars as you are able. It doesn't have to be 100% one way of the other; let your body guide you as to how much it can take.

    My initial shoulder rehab exercises were the pendulum and the pulley. The pendulum is an exercise where you stand, bend forward and let the arm hang down. Swing it gently. This breaks down scar tissue and starts to recover the range of motion.

    I also had a pulley. It hooked to the top of a door and had a rope with two handles. The pulley part was at the top of the door. Holding on to both handles, you use the good arm to pull the bad arm up. This exercise increases the range of motion and breaks down scar tissue.

    A gym is incredibly useful in rehab. You should be able to do leg weights. The exercise bike where you sit down is great. The elliptical is a winner, and was used extensively by my PT folks. If the gym has a pool, you can do range of motion stuff underwater. The resistance and buoyancy of the arm in water are wonderfully helpful in reestablishing movement.

    These exercises are really going to challenge, especially at first. The first time I used the pulley I think I used it for 10 minutes and then slept for 2 hours. Walking was the same: a 20 minute walk and then a nap. Breaking down scar tissue hurts, but that pain will go away when the scar tissue leaves. The basic PT regimen seems to be to break down scar tissue, reestablish range of motion, and then reestablish strength.

  11. #11
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    All plates and screws can come out. However since this involves another surgery and the associated risks (mainly infection ), surgeons see no reason to remove them unless the patients have complaints or loss of ROM.
    Some countries in Europe even require all implants to be removed after a specific period of time after fracture healing
    There are also studies suggesting there is no advantage to healing with surgical intervention.....if you are willing to relax and let it heal (which most cyclists aren't).
    Sitting around waiting for a fracture to heal sucks but lots of timea in the medical field new technology isn't always better, just different and allows patients to be mobile faster due to the support from the implant but healing rates and patient happiness after 8weeks is basically the same with or without implants

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