Broken clavicle – deciding between surgical and non-surgical treatment

Notice: The post should not be used for medical decisions – it just reflects my experience going through ORIF surgery and rehabilitation. Always follow your doctor’s indications and ask him any time you are not sure of the evolution.

 

This last weekend was the first that kept me out each day. It started with a hike with some friends on Saturday and continued with an easy ride (uphill and downhill) on Sunday. However, nothing is as simple as it seems. On the last downhill ride, I misjudged a turn and skid on the grass getting thrown between 2 different paths. There I could find 2 small pits. Everything happened so quickly that I came flying off my bike and took a major blow to my left shoulder and ribs.The bike was ok, I could move my hand (yet every move was so painful), so we headed back home.

I was hoping it’s a minor hit and the pain would eventually fade, but every move was painful, so I started thinking the worst. I went to the emergency room to get an X-ray. I filled a form and waited for my turn. The verdict: displaced midshaft collarbone fracture. They advised immobilizing the arm and visiting an orthopedics surgeon.

You truly appreciate the small things when you stop being able to do them. Simple tasks (like tying my shoelaces, putting a t-shirt on, washing hands) took 5 times more than usual or were very hard to do. I started wearing shirts or sleeveless tank tops around the house (they were the only clothing items I could put on alone). Sleeping was a pain – I had to sleep on my back and make sure I don’t roll. I placed a pillow besides me for that.

For the past 5 years, each time I had an accident, I was treated by the same doctor, so I scheduled an appointment with him on Tuesday. He always got me back on my feet, so I was hoping he’ll work his magic this time too. We had a nice talk about the benefits of surgery and the down-sides of the non-surgical treatment. Here are the reasons I decided to go with the surgery:

  • No need to immobilize the arm for a long time – this also helps to get back to activity quicker, because you start the recovery right after the surgery (I will detail this in a later blog post)
  • The pain would go away after the surgery because the bone parts would stop moving
  • Proper and complete healing. Non-surgical treatment might end up in non-union or long-term shoulder pathology. I didn’t want to find out sometimes over the next few years the improper union prevents me from doing a specific sport.
  • Scar vs bump

Surgery comes with some disadvantages too, but I considered the advantages overweigh them. It’s mostly the risk associated with any type of surgery and a few extras:

  • Risk of infection
  • Nerve injury – which would make your chest numb
  • Problems from anesthesia
  • Damage to an artery or vein
  • Going through another surgery at a later stage to remove the hardware

It was a rather quick and easy decision to make. The procedure I underwent was called ORIF (Open Reduction Internal Fixation). They placed a titanium plate and inserted screws through the collarbone to stabilize it. Until the surgery (and a few weeks after) I would be using an arm sling to try and keep my arm immobilized. No typing or using the left arm (it’s not like I could really do anything).

The next day I went through full medical examination and got an anticoagulant injection. The blood tests were ok, I had an appointment with the anesthetist and went back home. The pain got more intense, so I couldn’t wait to get the surgery.

The next day I went to the hospital and patiently (pun intended) waited. I was asked to get a shower and use a betadine sponge all over the body. Next, I got dressed in a hospital robe and put on some nice white compressing stockings. I got an IV cannula inserted in my right arm and some fluids – to prepare me for the surgery. When the time came, I walked to the surgery room escorted by a nurse. The anxiety started to kick in once I got myself on the operating table. Fortunately, I was given anesthesia before they actually started doing stuff, so this helped a lot with my anxiety. I quickly fell asleep and didn’t feel a single thing.

I woke up in the recovery room but fell asleep 2 or 3 times. Once I was truly awake, they moved me to my room. It’s the moment I realized I was wearing nothing but a sheet and an arm sling. The nurses came constantly to my room to check on me and see if I need anything.

I was hungry, so I asked for a meal and got up to eat after around 2 hours. 4 hours after getting to my room I could walk to the bathroom. However, I was feeling dizzy because of the painkillers. I could sleep for a few hours and in the morning a nurse woke me up to check my vitals and for another antibiotic injection. I was starting to feel some pain, so I asked for a painkiller. Everything was great! I ate the breakfast, got some sleep and TV and lunch. The doctor came to visit me and said the surgery went great, we discussed a few items:

  • Q: Do I need extra antibiotics? A: No, they administered it IV and it was enough
  • Q: Next appointment? A: in 7 days
  • Q: Allowed movement? A: Not really. Always wear the sling
  • Q: Painkillers? A: Only if needed
  • Q: Vitamins? A: Not necessary
  • Q: Bandage? A: Do not touch it. The doctor will change it

Also – do not let the water get to the surgery.

I got dressed and went home. The first 3 days you’ll feel very tired and not in the mood to do anything besides sleeping and watching TV. The pain really went away, but I ended up with a dull pain – I think it was the incision. The painkillers didn’t work, but the ice was magic. I got 2 packs of reusable ice gels (similar to Therapy Hot&Cold Gel Pack of 2 Reusable 5” X 11” by FORMAXCARE) so I could rotate them. Remember to not place the ice gels directly on the skin, but use the wrap or a towel.

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