# Another clavicle ? pin it or leave it alone?



## J.B. Weld (Aug 13, 2012)

Two weeks ago I suffered a mid-shaft spiral clavicle fracture resulting in 5.5cm shortening of the bone. Doc says the best thing to do is leave it alone, said if I were a pro football quarterback and threw from that side he would recommend the same thing.

I'm thinking bs, my insurance sucks and I think he just doesn't want to deal with it. My scapula has dropped and is digging into parts unknown, hurts like a mo-fo, the doc says it will always be low (without surgery) and the clavicle will never be joined. Undetermined amount of bone separation because ER x-rays didn't get the right angle and the doctor didn't seem to find it necessary to get additional ones. I'm not convinced he even looked at the ones I had.

I feel like I'm being totally jacked but options are limited, I tried to set an appointment for a second opinion from a reputable orthopedic surgeon but was refused because of my insurance even though I told them I'd be paying cash.

I could make the doctor I have do it but I'm not sure I want someone slicing me open who doesn't want to. Opinions?


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## shagster (Oct 30, 2012)

5.5 CM is a lot of displacement. Without question, I would seek a second opinion.


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## d365 (Jun 13, 2006)

100% get the surgery to fix it, if you can. I did not, and regretted it. I didn't have insurance back then, and the recovery sucked. I soldier on with minimal issues, but every once in awhile it will ache still... 20 yrs later. Not to mention, I look weird in a suit jacket, being a 1/2" off on one side...


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## J.B. Weld (Aug 13, 2012)

Yeah, I think fixing it is probably the best option based on my research but I feel a little weird about twisting someone's arm to do the job. I'm working on getting a second opinion but my gut feeling is that I'll just get sent to see my current doctors brother.

I guess I'm mostly curious about how people with good insurance were treated in the same situation, and if anyone else's doctor recommend a closed treatment with similar damage. I realize every situation is different and that getting medical advise via the internet is dubious but I've managed to learn a lot more on my own so far than in the office, which isn't saying much since I didn't really learn anything there.


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## shagster (Oct 30, 2012)

I'll try to summarize my experience as short as possible.
I broke my primary arm clavicle 2.5cm displacement medial third with a large fragment broken off as well. I also suffered a partially torn labrum. I was referred to a Ortho Surgeon who had a very traditional (conservative) approach and he said let it heal in a sling on its' own. I was surprised, based on my uneducated initial impression of the xrays but he insisted surgery was not necessary.
Jump ahead 9 weeks later, it still had not healed and I was still told not to use my arm and give it another 4 weeks. I said no thank you and sought out a new ortho surgeon. New surgeon had better referrals and a sports science background. His approach was to recommend surgery typically for cases of displacement greater than 2cm. Anything 1.5cm to 2cm would warrant further discussion based on job requirements and goals. So we did surgery right at 10 weeks post injury, ORIF using titanium contoured plate and I think 11 screws to hold it together both in the plate and where the bones came together. It hurt pretty bad the next day but nothing I couldn't handle on my own from the 36 hour mark onward.
I regret not having surgery right away. The complete lack of mobility has made it significantly harder to rehabilitate the arm. The bone was feeling strong from 3 weeks post-op on. I am 3 months post-op and the muscles continue to hurt every day and sometimes at night as they strengthen and go back to their anatomical form and shape. If I could go back, I would have got a second opinion sooner and elected for surgery just so I could get back to "normal" as sooner. Not to mention my shoulder would have healed slumped forward and way lower on the bad side, had I not gotten surgery. That can lead to strength and endurance issues (early fatigue) if left that way. All said, it will probably have eaten up 8 months before it isn't bothering me in some form or fashion.


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## WillTheGreat (Aug 26, 2010)

Definitely see an orthopedic surgeon if you can and get his/her recommendation. I had a distal clavicle fracture with a large displacement, and the first doctor I saw totally misdiagnosed it. Fortunately he did refer me to an orthopedic surgeon.


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## J.B. Weld (Aug 13, 2012)

WillTheGreat said:


> Definitely see an orthopedic surgeon if you can and get his/her recommendation. I had a distal clavicle fracture with a large displacement, and the first doctor I saw totally misdiagnosed it. Fortunately he did refer me to an orthopedic surgeon.


I did see an orthopedic surgeon but I suspect ulterior motives influenced his diagnosis, I'm working on getting a second opinion. Limbo-land sucks.


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## dledinger (Nov 29, 2014)

Go somewhere else and get it fixed. I wouldn't think twice about this.


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## Speeder500 (Oct 9, 2012)

J.B. Weld, where exactly are you from? I have a feeling you are not from the United States and in a country which has free universal health care, or what ever they call it.

It just sounds like you are in a country like England where getting medical treatment with the free health care takes a long time to get treated and also the doctors don't want to do surgery.

If you are from the USA then I would think you would find someone. 

Anyway, I'll tell you my story. A collar bone break can be a pretty serious thing as a lot of muscles attach to it, and like in your case the scapula is also tied into it. It affects a lot and especially the geometry of your shoulder.

I could have gotten mine fixed in USA for free because I signed up for obama care when I got hurt, or better called medicaid. But the doctors were terrible under medicaid so I researched the best doctor in the USA and the best way to fix the collar bone, called Sonoma CRX pin, and paid around $10,000 out of pocket to get it fixed right. I also had to fly to the other side of the country to get who I considered the best doctor for the job, he has done like over 1,000 collar bones so far. 

I read that you really want a doctor who does a lot of collar bones, and not some doctor who does only a couple a month. Lots can go wrong with this surgery!

Now almost 8 weeks later I'm finally all healed up nicely, no nerve damage, minimal scar, and today I finally am able to hang from a bar, yes I have been riding my bike for a couple of weeks already. I got a frozen shoulder from inactivity of the arm so that slowed me down a bit. 

Was it worth it, I don't know but I didn't want to take chances and I also didn't want a huge plate under my skin. But I'm out $10,000 dollars, but to me it was worth it because I'm fixed up properly and am happy with the outcome. Maybe I would have got the same outcome with my free medicaid insurance, I would have had to use a plate which I didn't want. 

Don't just limit yourself to your insurance, but I would think you should be able to find good doctors with it. 

Good news is that if you let it heal naturally, you can always get the surgery to rebreak it and pin it properly.


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## dledinger (Nov 29, 2014)

Speeder500 said:


> .... I researched the best doctor in the USA and the best way to fix the collar bone, called Sonoma CRX pin, and paid around $10,000 out of pocket to get it fixed right.


This is such a cool fix when it can be done. I have two plates in mine. After several months I still know they're there. Makes carrying stuff on my shoulder more difficult. I'm not sure I'd pay 10,000 to make the discomfort go away! In my case, it'd probably just be easier to have the plate taken out.


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## J.B. Weld (Aug 13, 2012)

Speeder500 said:


> J.B. Weld, where exactly are you from? I have a feeling you are not from the United States and in a country which has free universal health care, or what ever they call it.
> 
> It just sounds like you are in a country like England where getting medical treatment with the free health care takes a long time to get treated and also the doctors don't want to do surgery.
> 
> ...


Good info, thanks. I read about the CRX pin and agree that it sounds like the best fix.

I'm in the US, insurance is Medicaid. I would gladly pay $10,000 or more to get the right help but apparently it isn't an option, I have attempted to seek help from a specialist but was denied even though I said I would be paying cash.


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## Jamesjohn85 (Jul 11, 2015)

It's sad u have some the best insurance but yet can't get no help on ur injury. I'd search around in ur area or even within a short drive to have it fixed. I will have my pinned if I break it again.


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## Speeder500 (Oct 9, 2012)

J.B. Weld said:


> Good info, thanks. I read about the CRX pin and agree that it sounds like the best fix.
> 
> I'm in the US, insurance is Medicaid. I would gladly pay $10,000 or more to get the right help but apparently it isn't an option, I have attempted to seek help from a specialist but was denied even though I said I would be paying cash.


OK yeah, you have Medicaid the same I have and decided to pay out of pocket. It did help that I have a good lawsuit going, but I would have paid out of pocket either way.

The Medicaid doctors in my big city were pretty useless. I would never trust anyone taking Medicaid to touch my shoulder with a knife. But they should be able to recommend you to a surgeon to plate it. To be honest, I wanted to see a good follow up orthopedic doctor with Medicaid just to talk over some issues after the surgery and I didn't even waste my time as they were all pretty bad. Most of them are new doctors or clinics. But, Medicaid is free afterall, so don't expect much from it especially I certain specialty areas like orthopedics.

What state are you in?

I would get the xrays with your Medicaid and then contact a good doctor. Best option from my research is to pin it if you are able to pin it. Costs a little more but much less invasive and you don't have a plate which most people hate.

I actually always intended to get my Pin removed and the great thing about the Pin is that it is a very easy surgery as they cut a tiny incision to pull it out. With a plate to get removed they have to cut you open again with a big 6" incision, and then you need months for the bone to heal back because the screw holes need to fill in and harden. The Pin you get it removed and the bone is like 95% as strong so no time off for healing if that is important.


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## Nat (Dec 30, 2003)

J.B. Weld said:


> I could make the doctor I have do it but I'm not sure I want someone slicing me open who doesn't want to. Opinions?


I'm curious as to how you would force a surgeon to do surgery on you when he said he didn't want to do it?


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## BoneDoc23 (Aug 17, 2015)

As someone who fixes clavicles, thought I'd share my thought process/
Training in regards to clavicle fractures. 

Most heal without surgery no matter how bad the X-ray looks. However, young and active persons, trying to get back to work and activities...I'll offer surgical fixation. I do inform of all risks associated with surgery. I do believe fixing clavicle gets people back to activity much quicker, but outcomes are the same wether it's fixed it not. 

From an orthopedic perspective, if non surgical outcomes are equivalent to surgical outcomes, most tend to lean towards non operative management. This is a discussion to be had with the patient. I ultimately let the patient decide if they want it fixed surgically once they're informed of all potential risks and benefits. 

These all pertain to mid shaft clavicle fractures. Distal clavicle fractures are a different beast


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## bakerjw (Oct 8, 2014)

You sound like my kind of doctor there Bonedoc. Thanks for lending your expertise and insight, I am sure it is appreciated by all.

I am not superstitious but I tread lightly on discussions like this. Kind of like talking about getting a flat while out riding. We just don't do it. I would likely go the surgery route. I like things aligned but that's just me.


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## J.B. Weld (Aug 13, 2012)

Nat said:


> I'm curious as to how you would force a surgeon to do surgery on you when he said he didn't want to do it?


They recommended not doing it but I still had that option.



BoneDoc23 said:


> As someone who fixes clavicles, thought I'd share my thought process/
> Training in regards to clavicle fractures.
> 
> Most heal without surgery no matter how bad the X-ray looks. However, young and active persons, trying to get back to work and activities...I'll offer surgical fixation. I do inform of all risks associated with surgery. I do believe fixing clavicle gets people back to activity much quicker, but outcomes are the same wether it's fixed it not.
> ...


Thanks a lot for your opinion on the matter. My main concern was the long term prognosis so it's good to hear that you think I'll be no worse off by not having surgery. Being out of work (and off the bike) is a drag though, I'm a month and a half out now and they don't want me to even start physical therapy yet.


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## Speeder500 (Oct 9, 2012)

J.B. Weld, when they fixed your collar bone did they mention if you had any ligaments torn?

What about your Scapula hanging, did that get corrected when they fixed your collar bone?


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## J.B. Weld (Aug 13, 2012)

It didn't get fixed. The first doctor I spoke with said everything would remain exactly where it is forever, but I'm not sure about that info because I really don't trust him. No torn ligaments that I'm aware of, and I suppose I'd be aware if they were.


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## Speeder500 (Oct 9, 2012)

If your scapula did move because of the collar bone break I would think the ligaments were torn that hold the scapula to the collar bone. 

I don't know enough about your break but if those ligaments were intact your scapula would be in its normal position.


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## radair (Dec 19, 2002)

my dilemma as well. i'll get some opinions this week.


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## J.B. Weld (Aug 13, 2012)

BoneDoc23 said:


> Most heal without surgery no matter how bad the X-ray looks. However, young and active persons, trying to get back to work and activities...I'll offer surgical fixation.


Pardon the expression but if anything that seems bass-ackwards to me, young people have a lot more time to kill than older folks.



radair said:


> my dilemma as well. i'll get some opinions this week.


Sorry to hear that, hope your doc is better than mine.


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## Speeder500 (Oct 9, 2012)

Remember, after lots of research I went with the Sonoma CRX pin. radair you should at least always see a doctor who performs this new surgery if you can. They have a physician search for it. It is pretty rare for anyone to get this surgery and most regular doctors don't even know it exists. 
Fractured Clavicle Solutions | Bone Fracture Solutions | Sonoma Orthopedics

Much less invasive and easier to remove the hardware later on.


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## radair (Dec 19, 2002)

Speeder500 said:


> Remember, after lots of research I went with the Sonoma CRX pin. radair you should at least always see a doctor who performs this new surgery if you can. They have a physician search for it. It is pretty rare for anyone to get this surgery and most regular doctors don't even know it exists.
> Fractured Clavicle Solutions | Bone Fracture Solutions | Sonoma Orthopedics
> 
> Much less invasive and easier to remove the hardware later on.


unfortunately their website indicates the closest place is more than 4 hours away. i am seeing a surgeon tomorrow for an evaluation. thanks


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## radair (Dec 19, 2002)

Update - had my surgery on 12/9, plate with 9 screws. It is feeling great. I rode my fat bike around the driveway and on a short snowmobile track loop down to my gravel pit & back only 3 weeks out from surgery. I am not going to push it but pedaling on flat ground is totally comfortable.

Glad i had the repair done. My surgeon said it was in 4 or 5 pieces and fully displaced.


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