[Closed] Broken collarbone - take surgical option?

I wish I had mine fixed. Decided against surgery as it would have meant more time off work in the short term, but it took an awful longer time to heal on its own. Almost a year before I could properly trust it off road. Now 4 years later it’s fine and the end result is the same but those months waiting for it to heal were a pain

Oh wow, I'd been told 6-8 weeks to heal, 6-8 weeks to regain strength. No MTB plans but was hoping to race CX in the winter.

Was yours a particularly bad break?

I had surgery, and although I still feel pain 7 years after, it is only if I knock it or it gets touched in a certain way. I suppose if I carried a rucksack the wrong way, it could hurt, but I wear one quite often and have had no problem.

The worst thing is probably the loss of feeling in the surrounding skin due to all the nerves severed during the surgery.

But on a day-to-day basis, it is really not something I even think about. Indeed, I would definitely have it again if I broke my other collar bone.

I've just seen your second post, and would say that the 6-8 weeks for healing, then another 6-8 for strength is pretty accurate.

I had a clean break and it healed fine in the usual time, but because physio wasn't started early enough I got a frozen shoulder which took months to fix, however my family appears to be prone to frozen shoulders. Personally I wouldn't take surgery unless there was a strong reason to. Your body is pretty good at sorting itself out.

Personally I wouldn’t take surgery unless there was a strong reason to. Your body is pretty good at sorting itself out.

So a friend of mine thought until he had to undergo one of his physical tests when applying for the Army. That's when he realised that the collar bone he broke playing rugby and that he didn't take surgery for had ended his career aspirations.

there's no danger of me joining the army

The ends of the 2 halves of the collar bone were separated by about the width of the bone. Not particularly shortened or overlapping. A couple of “north-south fragments” ie bits of bone st 90 degrees to the main bits. I was told 6 weeks and they were going to discharge me st that point until I asked when I could go mountain biking again....

My ex is a consultant surgeon and she advised me not to have surgery unless absolutely necessary. Mine was a compound fracture with a free piece broken off in the middle. That was 3 years ago and I can honestly say it hasn't really given me a moments trouble since. I was back on the turbo trainer 3 weeks after the fracture, out on gentle rides after 4 weeks, long rides at 8 weeks and did a week of uplifted riding in the Alps 9 weeks after the break. I even fell on it on day one of the Alps trip and although I shat myself, it was fine.

My experience echos Saxonrider above. Totally destroyed collarbone (was "tentinting" the skin) late April, was back on the MTB (albeit modestly) by late June. Downsides to surgery are slight discomfort whilst carrying things, for example I can't carry my kayak on that shoulder anymore. In my case it was down to a toss of a coin as they wee carrying out a research project at the time. To be honest I think if I had not have been given the option of the surgery I'd have dipped into the rainey day fund an got it done private as neither I no my wife (who is a doctor) couldn't see how it could possibly heal naturally

I broke mine at Mayhem in June 2005. I was told it would heal on its own. In October of that year the ends of the bone were still an inch apart. Then I had surgery. When it had healed properly I had the plate and screws removed, because the surgeon said that if I was to break it again (and my choice of leisure pursuits made it likely that I would) it would make a real mess if the hardware was still in there. I've since had some pretty heavy impacts and not re-broken it (yet).

I had pretty bad break about 8 years ago I think it was called a butterfly fracture.  No offer of surgery was off work 3 months and back to riding in about 4.  Shoulder is lower and I've lost about an inch off my chest.  I get a lot of pain all through the top of my shoulder and down to myfingers.

Wish I'd had it plated

I broke the tip of my left clavicle, not really operable other than removing the broken bit. I had a second opinion which concurred with the first prognosis not to operate.

It took me 17 months to start riding the trails I used to ride, although I was back on my bike after 6 months. I have done lots of physio and strength training, I have greater strength in my shoulders than ever, but still my shoulder is sore after a ride.

I don't regret not have surgery though.

I'd have surgery no question. I did my left one after a high speed low level flying lesson in the Peak. It healed naturally and almost a year to the day I had a little roll in the grass and it broke again. I was due to go off on a 4 month tour a couple of weeks later and wasn't prepared to delay/cancel. I had it plated a couple of days later and was riding on the road within a week.

It took a couple of years for full feeling to return as mentioned up thread and I had a DVT so a week of Heparin in the stomach followed by a year of Warfarin.

I've left the plate in. I can carry a sac no problem but the bobbles on each shoulder (I did the right years ago on the road bike) hurt when carrying skis. I can't sleep on my stomach either.

All up, I'd go surgery again just for the certainty even with the DVT. There's also the risk of infection/MRSA etc to think of but as with everything, there are myriad reasons not to...

If its displaced or a bad break then I would go for surgery.  If not then conservative treatment.  However I would go for figure of 8 strapping as thats what I had when I did mine and my opinion ( general nurse remember not orthopaedic surgeon) is the reason I got good alignment.

Hmmm  pubmed does not agree

https://www.ncbi.nlm.nih.gov/pubmed/3554886

Its certainly an issue of debate.  some countries use a figure of eight routinely and some even a plaster jacket and spica ( holds your arm out to the side.)(

http://www.pappin.com/csot/winter-2010-rounds.html

Broke mine 10 years ago; it was a clean, textbook break (middle third region) with no fragments. Surgery was not offered as an option, but had to wear a figure-of-eight bandage for three weeks. It took about 2.5 more months to recover full mobility in the shoulder.

The problem with fractures is that they're all very individual.  All you can really do is go to a specialist you trust and do what they recommend.  If it can safely be left, that may be the bet option.

I did mine 9 years ago - very similar-looking X-ray to tomcrow99 with bone tenting the skin.  I am convinced it would have perforated the skin had I left it, so surgery was the only real option.  I had a plate and screws and it's been mostly fine - I am aware of the metal only very rarely and it doesn't stop me doing anything, including carrying Superficialito in a rucksack.

Having said that, I am sort of aware that it might be easier to break it again (and more serious if it did break).  Maybe I should have the metal out *shrugs*.

I broke mine quite a few years ago. Had a plate put in and removed after 3 months as it was meant to temporary to help stabilise the bone to allow it to grow together.  Didn’t work, apparently the further towards the arm lessens the chance of it being successful as the blood supply is poorer.

So mines still broken, called a non-union heal. Doesn’t give me any problems and can’t say I’ve noticed any restricted movement or loss of strength.

Broke mine in '07, reasonable overlap of the bone but ends of the bone were not touching as consequently shoulder not sitting right.

NHS Dr said to leave it and she how it heals as 'you'll have a reasonable degree of movement in the shoulder' and that it if hadn't healed properly or well enough in 9months they could look to re-break and re-fixed.

Didnt sound good to me... fortunately I could use private health option and had it plated two days later. Dr reassured me that if I broke the same one again that the plate wouldn't be an issue as there was nothing he couldn't fix!

One night in hospital approx. Week between bed and sofa in reasonable degree of discomfort. 12 weeks in total to get back to DH bike comfortably.

Never had a problem with carrying a rucksack. About once a year I clatter a bolt with something and know about it for five mins but other than that it's never given me any grief.

if I broke the other one I'd have it done again.

Ooh are we doing xray pics? Here's mine

Mine healed in about 2 months as I remember. The plate worked itself a bit loose so I had to go in and have it out. Had loads of time off work, it was great.

It’s not a straightforward decision particularly if it’s not that displaced. If it doesn’t knot together you will be 3 months down the line before you have surgery as it takes that long for the diagnosis to be confirmed most of the time. Then another 3 months before it’s proper.  Most pro sports folk get it fixed to eliminate any chance of this. Usually remove the metal work too later down the line too.

If course you have the risks of surgery and anaesthesia to consider if you have an operation.

I was advised avoid surgery if you can.

Go and see a good sports physio NOW.

The physio will give you micro exercises to do now that you gradually build up. When I went back to the doc they couldn't believe my movement

It takes effort and time but worth it I think

My collar bone was a clearish brake but I broke the big bone at the back as well (clavicle?) plus a few ribs.

Get some baby wipes to avoid the armpit of doom!

Go and see a good sports physio NOW.

The physio will give you micro exercises to do now that you gradually build up. When I went back to the doc they couldn’t believe my movement

100% this..  I broke mine a couple of years ago, started seeing the sports physio the next day, and she had me doing passive movement exercises immediately.  Luckily as it turned out as I ended up with a 'fibrous non-fusion' which basically means my collarbone is still in 2 pieces and held together with fibrous tissue.  Took 4 months to heal properly to the point where i could get riding again.  Most recent x-ray looks like a fresh break as the fibrous tissue doesn't show up on the x-ray.  Orthopedic consultant was recommending a further 6 weeks immobilisation (this was after 8 weeks in a sling!), I asked to speak to his boss..  Chief Orthopedic Surgeon came in, asked me to hold my arm out.. move to the limits of comfortable movement and immediately diagnosed the fibrous etc. said I could have it plated but the way it has healed I needn't worry about it if it's not causing me problems (which it's not), and on the plus side if I have a collarbone breaking injury again I won't be breaking anything !!

By all accounts it's fairly common among motocrossers as they have high impact trauma i.e land directly on the bone rather than the shock being transmitted up through the arm in a crash and this disrupts blood-flow to the bone long enough that the 'backup' system kicks in to stabilise the bone.

As someone earlier in the thread mentioned..  the body is pretty good at sorting itself out.  Chief surgeon also mentioned that another accident with a plated bone would be a complete mess and hence not recommended unless absolutely necessary.

Broke mine 10 years back and surgery want wasn't mentioned and I never got to see the x Ray. I do feel a little cheated now, after this thread! 😃

On the other hand I've got a great big pointed bump sticking up under the skin to prove I did break it once.

I did everything wrong to be honest. Only wore a standard sling on the day of the accident and only wore it again to go to the check up so I wouldn't get told off. Unsurprisingly it took a bit longer to heal than expected. Don't be an idiot like me though.

My brothers shoulder hangs down like a deflated bouncy castle, with the bone tenting the skin, no op offered. A shining example of NHS statistically insignificant/lets minimise infection stats/don't bother treatment.

Whilst I accept it's not necessary in all cases. The NHS seem to ardently oppose it as a cost cutting and infection risk reduction exercise, regardless of the best long term outcome for patients. The same has not been the case (well big scar) for a friend who suffered similar in France (tiny sample not identical), where it was operated on straight away without any subsequent infections.

Each case is different but I would be very wary of the long term consequences of an NHS do nothing answer.

A shining example of NHS statistically insignificant/lets minimise infection stats/don’t bother treatment.

This is nonsense IMHO. In fact I raise my eyebrows far higher at the potential conflict of interest where a private surgeon will operate even after the NHS has turned a patient down.

Maybe for niggling sports injuries the NHS is less than perfect. But the NHS is proactive in treating fractures. The cost of missed work/chronic pain is huge.  Cost would never come into the equation for this sort of thing.

shining example of NHS statistically insignificant/lets minimise infection stats/don’t bother treatment.

Sorry that hat is a very ill informed statement.

OP we’re you speaking to the Consultant Surgeon or junior Doc?

Also agree that in a private scenario surgery is always more likely to occur as that’s where the money is made

did mine 3 years ago, I wasn't given an option, put straight into surgery. (in hospital at 7.30 am, out by 4.30pm)

48hrs recovering from the surgery were pretty unpleasant, but was on a plane to Spain on day 5.

On my question re rucksack and backpacking, consultant said they would remove the plate if if gave me any issues, otherwise it would stay there. I've done lots of walking, not multi day, but big days out with a reasonably heavy rucksack and had no issues (as said above every case is unique tho). One of the biggest days out 12 months later, was 10 hours on the Bernia ridge whilst also climbing/scrambling/absailing was carrying all the climbing paraphernalia for large parts of it, with absolutely no issue to my shoulder (my knee was a different matter).

I broke mine, right down at the clavicular end, so plating it wasn't really an option. It took a good 8 weeks to heal (pretty much 12 months ago last week I did it).

Mine was complicated, as they didn't really pick up on some other issues. Turns out I have a sterno-clavicular dislocation, which means it's all a bit wobbly still. I must admit I've been slack and not done much physio.

I was riding within 10 days of doing it though, if you don't count me trying to race on it the next day (didn't know it was broken at that point!). albeit basically on bridleways for the next 6 weeks to keep me sane...

I've broken my collar bones 3 times over the years. 2 significant ones with bone broken in to 3 or 4 pieces. Have been offered surgery but declined. I went to see these guys the second time (physioclinic.net) and while it might sound a bit hocus pocus it definitely works and all the big names in mtb, mx, moto racing etc use them.

Second time i was back on the road bike pain free at 3 weeks and back full mtb at 5 weeks for a weeks holiday. Consultant commented on how well healed it was for the time when I went for check up.

get contact with the physios and do the exercises. make sure those treating you know you ride and want to get make on the bike and back up to speed. if you haven't seen a physio yet, get on to someone and ask to see one now. you only get one shot at this and it's important. if you're going back in to see the consultant again in a couple of weeks ask to see the physio then, too, even if you've already seen one.

the biggest remaining problems with my first break were with the shoulder where i had kept it in the sling immobilised too much in the first couple of weeks. IME treatment from NHS was very good, but i live in a city with a university and they're used to dealing with sports injuries. a mate who lives further down the road was treated in a hospital more used to patching up old dears, and sadly his treatment was not so good.

with some of the big displacements in the images up there i would go for surgery. for misalignments of 1/2 the diameter or so between each part i would leave it, personally. from what i remember, these bones are inside some sort of sheath that tends to pull everything together.

i was back riding carefully at 8 weeks, much more confident at 10. a 'bit' of stress on it helps in the later stages of healing, IIRC.

Thanks all, seems to be a majority vote for surgery, but I still think I'm at the 'minor' end of the injury spectrum. although there is a bulge under the skin the nurses/doctors didn't refer to it as tenting and seemed quite relaxed about it.

I also feel quite good in myself, already able to dress myself and tie shoe laces etc. so doesn't seem like a bad break. Will chase up my X-Rays though, don't know if NHS can email them out or something...

Got an appointment with my usual physio who deals with a lot of rugby players, so I'm hoping he's confident with collarbones.

The sling seemed fairly useless for immobilising anything, even phoned the hospital after a couple of days to check that this was OK and they said yeah, complete immobilisation not essential, not to worry.

Personally, I'd avoid surgery and start seeing a good sports physio/trainer now.

I broke mine in 3 places last Easter and they plated and pinned. The plate got infected, the infection went to the bone (not good!) and the plate had to come out again at the end of June.

Of course the bones hadn't healed at all and had in fact been further weakened by 10 little screw holes, so I broke it again putting my t-shirt on over my head in the recovery ward.

Took until end October before I was riding outside and December before I felt confident enough to ride off road and race.

I've done a LOT of strength work with a trainer and it still niggles but the sticky out bit that the surgeon said would take a couple of years to go has gone completely already.

I have broken both of mine.

The right never fused and is a non-union.  Saw a private shoulder specialist who offered to plate it but advised if I could do everything I want, which I can, then to leave alone and "test it".  Ride trail, bike parks etc (and crash), don't notice any problems other than lumpy collar bones.

Joined the club last night, currently sat here in a sling waiting for a call from fracture clinic...assume they assess in my absence (I transferred all x-rays, paperwork etc to my local hospital this morning) then advise on Friday.

Bone managed to puncture a small hole on top of my shoulder, about 1cm across.

Does that sound normal by the way ^ to be sent home and promised a phone call from fracture clinic a few days later?

Never used to work that way when I’ve broken ankles etc. in the past

I think the phone call might just be to schedule a follow up appointment? That's how mine worked A&E > schedule follow up > Attend follow up in person

Thanks, I guess it makes sense it’s just a little different to how I remember it 👍

@Haze - I'd say so yes (at least in my experience).  If the A+E doctors don't think it needs surgery immediately then they'll refer you to a fracture clinic.

In general on shoulders I'd say beware frozen shoulder. It's a fine line between immobilizing enough to heal well and too much leaving a frozen shoulder. I've broken my right shoulder twice and the first time it was immobilized a bit too long and took 6 months for me to get full range of motion and had to do some fairly unpleasant exercises.

I broken mine (fairly near one end and with butterfly fragments) in 2005. I wasn't offered surgery and got a not very restrictive sling. No physio offered either. My collarbone has fused with a big step in it, so it's a bit shorter than it used to be and that shoulder is prone to a log of muscle aches, which I've presumed to be because the muscles and the bones now have different opinions about what shape it should be.

I don't know what would have been a better course of treatment but I'm fairly sure that what I got wasn't the best outcome possible.

Snapped mine at Antur last August.No op offered.Probably my age 54 🙂

Healng time was pretty good around 3 weeks until i was running and biking.

Full MTB  around 8 weeks and DH about 10 weeks.

Didn't use a sling for more than 3 days,drank lots of skimmed milk(apparently more calcium in skimmed)

Fusion was around 3 weeks i think.Used a lot of ice packs to aid inflammation.

Hmm... seven weeks in now, not sure how to feel.

Last X-Rays didn't appear to show much healing, but consultant doctor (seemed the more junior of the two I've seen) decided to consult with some other Drs/surgeons, and phoned back to say no surgery necessary. So I pulled my socks up and committed to healing naturally.

All was well until about ten days ago but now I'm getting some quite sudden and painful shooting pains when I move in certain ways, can also feel something a bit loose under the skin and would swear I've heard/felt a couple of clicks under the skin almost like it did when it was freshly broken.

Don't think I've overdone anything, still been quite careful of shoulder, at least not using it in a way that causes pain, perhaps driving was a bit too soon, and picking up the baby was perhaps a bad idea.

Certainly not on the bike any time soon, 1st round of the Scottish CX series mid-September already looking tentative... Got another follow up this week but seem to remember from the phone call that the location of the break (close to the shoulder) perhaps precluded surgery.

Are private surgeons likely to have access to better techniques/products than NHS, i.e. are they more likely to be able to deal with an awkward break, or are they all much of a muchness bar waiting times?

Unlikely that a private surgeon will be any better.   Probably the same person in practice

Phone the fracture clinic?

Now 4 weeks since I had mine plated, wasn’t really given a choice. Also had ac joint reduction and cc ligament reconstruction.

Very uncomfortable few days afterwards but finally I’m getting a decent range of movement back. I’m told I can mobilise and remove sling for periods although no lifting (“nothing more than a cup of coffee”}, assume that’s down to giving the ligaments a little more time.

I’ve been in touch with a sports physio for an assessment but they’ve basically said do nothing until after my follow-up in 3 weeks. For now it’s the odd 30 minutes or so on the trainer, just spinning with my good arm taking most of the weight. With the rate of improvement I’m seeing I’m hopeful of getting the nod to start riding outdoors, maybe get to appreciate this nice weather you’ve all been having!

Have never broken a collarbone before so can’t honestly compare to conservative treatment, long term will tell but so far I’m happy with progress and no significant nerve damage.

doubtful private will have better options, however they maybe less likely to recommend the 'cheap option of do nothing.

mine is like ChrisL up there significant step and went from a 40 chest to 38 in suit jackets...constant battle with neck and shoulder pain and have to stretch and trigger point every day or I'm in lots of pain.

're healing cycle.  Mine felt loads better at 8 weeks and I thought I was doing well, but x-ray showed it hadn't fused.  a lot of the inflammation went down and it started hurting more weeks 9 -11 presumably the swelling had been helping to stabilise the joint.  I also heard clicking presumably the shards of bone getting into position.  it's a massive solid lump of bone now imagine it's stronger than before.  just the litigants / muscles an on going issue.

good luck

That's interesting DT78, almost describes my progress e.g. decent but slow healing then an increase in discomfort and clicking/movement around joint. Can understand the logic as well.

Already got an idea of how tomorrow's check up will go, X-ray will look identical to previous x-rays, consultant will still act like this is OK, and will start to talk about physio. I would be fine with this but have been chasing them for two weeks to give me a referral note for physio so I can book it on my company healthcare, means I can start quicker, no more half days off work to make the trip to Livingstone, and surely a win for the NHS as I'm not taking up NHS physio time.

Needless to say no referral has been forthcoming yet...

Unlikely that a private surgeon will be any better.   Probably the same person in practice

This.

My experience of letting it heal naturally was OK, except it didn't heal that cleanly. This wasn't a problem for 90% of things, until I started training more to apply for the military. Aside from being weaker due to the non-great join, the edge of the break was cutting me internally while swimming; this persuaded me to go for surgery. As the recovery period is very similar it's what I'd do again.

In general on shoulders I’d say beware frozen shoulder. It’s a fine line between immobilizing enough to heal well and too much leaving a frozen shoulder.

Good advice. I've had a frozen shoulder for nearly a year now following a broken collar bone (didn't have surgery as I'm on warafarin which complicates things)................

I think I'm at the opposite end of the spectrum re: immobilisation and frozen shoulders, if anything I'm starting to worry that I've not kept it mobile enough and perhaps disrupted the healing...

Pimpmaster, was your surgery a full plating etc. or did they just 'tidy up' around the join? All the pain I'm getting seems very specific to the back side of the break, as if there's just a localised issue rather than across the whole break, in my imagination there's a wee bit of bone or ligament or something that's ended up somewhere it's not supposed to be...

What are the symptoms of a frozen shoulder?

As I expected the consultant at the hospital (3rd consultant in three visits, nothing like a bit of continuity!) was adamant healing was going fine, and he was able to indicate evidence of new bone formation on the X-Ray.

He couldn't explain the sudden, grabbing shooting pains I was feeling from time to time, just passed them off as 'something muscular'. Personally I think it's something to do with a nerve passing over the shoulder, as the pain can end up travelling into my scalp above and behind my ear, don't think the muscles under my scalp are connected to my shoulder!

Seeing my usual physio tonight, hoping he can do a better job of diagnosing it than the Orthopaedic doctor did...

What are the symptoms of a frozen shoulder?

Shoulder becomes painful and stiff (limited range of movement, struggle with simple things like putting a shirt on) and it can last for years...............

https://patient.info/health/frozen-shoulder-leaflet

Pimpmaster, was your surgery a full plating etc. or did they just ‘tidy up’ around the join?

Rebroken, full titanium plate and eight stainless screws. I'll see if I can dig out the before and after x-rays. 🙂

I had a frozen shoulder following a rotator cuff tear. Symptoms I had;

1) limited range of movement before it became painful. This was the case even if all my muscles were relaxed and a physio or doc was moving the arm for me.
2) Intense (proper going white in the face and sweating, needing to sit down for ten minutes) pain if I caught my shoulder on a door frame or something.

I was given some exercises to try and sort it out but they really didn't help even after a month of trying.

Ended up having a procedure under a general aneasthetic - basically they move your arm around under a general anesthetic to 'pop' all the capsules made a good popping sound the surgeon said) and then give some cortisoid injections to promote healing.

I had full, pain free, movement back immediately post procedure but needed pyhsio and exercises to get mucle strength in the shoulder back.

I'd recommend going down the procedure route if it's offered - it really was an instant cure