[Closed] orthopedics clavicle

One issue I could forgive but there's nothing about this that has seemed right.

First thing I'd do is get refered to another hospital and Consultant and have it looked at and treated properly. I live in Darwen and refuse to use Blackburn hospital. I'd rather go to Preston,Salford or Bolton.

When I broke my leg I was told it was a sprained knee even though the pain was nothing like a sprained joint. They x rayed it but we're in their words unsure and discharged me with crutches and pain killers. I never had a orthopaedic follow up which in most trusts is in the guidelines.

Two weeks later still in pain unable to weight bear my gp sent me for a mri scan and the results came back after 7 days I was rung up to come in to be told fractured fibula,ostechondral fracture and torn meniscus.

Was refered to fracture clinic at Bolton the following day the fibula treated conservatively in a cast, the chondral fracture operated on after 8 weeks and the meniscus was done elective later in the year.

I made a medical negligence claim under the advice of my consultant at Bolton and a work colleague another orthopaedic consultant.
Claimed 12 months after the initial injury in February 2014 was paid out in August 2014.

Very poor diagnosis and the proper follow up guidelines were not followed.

That's rough and I hope it all gets sorted. Late November I broke my knee cap into several pieces, was taken to Medway Hospital which has been in special measures for some time and I was worried. Everyone and everything have been superb and I can't fault it.

That's the thing with the NHS Bolton are having a hard time finance wise but the care I received was absolutely brilliant. Salford saved my Step Mum's life but if it wasn't for Bolton prompt A&E staff getting her to Ct scan then transferred over to Salford and into theatre we would of lost her.

Just some trusts aren't good at all. Poor management and not enough staff!

I am a doctor but have no interest in orthopaedics so I'm sure someone else can answer more accurately.

If you've operated and have had the bone exposed then you'll know if you've caused a fracture (or indeed a pneumothorax). So I can understand why an x-ray might be unnecessary.

Yes, the screws were into the bone. How else did you think they worked? As any armchair engineer will tell you, the holes have the potential to cause stress risers and further fractures. The bone would remodel over time after the screws come out.

Basically I think it sucks that this had happened, but it just sounds like bad luck.

I hope she gets it sorted.

I think it sounds like bad luck but also [i]possibly[/i] bad advice; 2-3weeks to go back to front line duties is bonkers optimistic for a front line police officer, but would probably be fine for most jobs. I don't think many people understand quite how potentially physical the duties of a street bobby can be. You're basically waiting for bone to fill the voids left by the metalwork; 6-8 weeks would seem more sensible.

My private consultant advised me to leave the titanium plate in, unless it was causing problems. It isn't, and is still there!!!

X-ray seems to show screw point poking out the other side of the bone, so entry and exit hole. They did say extra morphine was needed due to how much effort it needed to get the plate out. I don't think the bone would have survived the "officer safety training" and if it had gone during this there would have been some questions asked.

You're basically waiting for bone to fill the voids left by the metalwork

Nah you're not. The bone won't fully remodel for months / years. The plate is really only there to allow the bone edges to heal in alignment. After that it doesn't really contribute much to the strength of the bone.

Return to work risk assessment for something like the police should be done by the force's occupational health team.

Plates need screws through both cortices I.e. both sides of bone. Through the other side, not nearly through.

Removing plate leaves a stress riser which is there for months or years - holes may always be weak - rugby players often won't have plates for this reason.

There is still massive debate about what should and shouldnt get plated and will be for some time.

Medical treatment is always best guess - little of it is based on 100% fact. A key part of it is trust in the doc treating you - I would ask to be seen elsehwere or by someone else if not happy. Sounds like all been unideal for you, hope things improve.

If you've operated and have had the bone exposed then you'll know if you've caused a fracture (or indeed a pneumothorax). So I can understand why an x-ray might be unnecessary.
Yes, the screws were into the bone. How else did you think they worked? As any armchair engineer will tell you, the holes have the potential to cause stress risers and further fractures. The bone would remodel over time after the screws come out.
Basically I think it sucks that this had happened, but it just sounds like bad luck.
I hope she gets it sorted.

And

Plates need screws through both cortices I.e. both sides of bone. Through the other side, not nearly through.
Removing plate leaves a stress riser which is there for months or years - holes may always be weak - rugby players often won't have plates for this reason.
There is still massive debate about what should and shouldnt get plated and will be for some time.
Medical treatment is always best guess - little of it is based on 100% fact. A key part of it is trust in the doc treating you - I would ask to be seen elsehwere or by someone else if not happy. Sounds like all been unideal for you, hope things improve.

Some good advice here ^^

Id go back and see the consultant first see what he/she has to say , if it was them that did the removal in the first place , but id say that metalwork is normally left alone unless its causing an issue or the patient is going to outgrow it .

Thanks for the contributions. Feels a bit Friday afternoon from start to end.

The original break had three pieces the small traingular piece rotated through 90 degrees. This was left for 8 weeks before they admitted it wasn't going to heal. I'm guessing this will have reduced the bone ends ability to rejoin and that's why such an ugly bit of meccano was used.

this is mrs klunks before and after xrays from her off on nanty (the break was "deliberately" missed by aber a&e) these were taken when we got back to civilization. She was told the plate would never be able to be removed. She had the surgery about 3 weeks after the crash.

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Ouch. Mrs MR had one plated over a year ago. It was in at least 5 pieces and tenting badly, yet it took us three attempts with two consultants to get them to plate it. They also took three X Rays on three ocassions to get a useful angle before saying 'oh!'

After the fracture was reduced and plate installed they said to leave it for a couple of years before even considering having it out, but she has bone disease/fragility so not generally recommended to remove it. Impingement and immobility of the shoulder joint since the op resulted in a subluxating shoulder, consequent overuse of other shoulder resulted in two subluxating shoulders. They haven't explained why now a year down the line she still hasn't received treatment for these, even though she is near completely helpless with two shoulders out of joint, not to mention constant pain 24/7. She has even received subsequent counselling via the NHS, provided because of depression from the stress of the ongoing untreated injury. Wtaf? Counselling referral that arrived quicker than they could provide the actual physical care for which she still waits. I despair, but know of no way to move things along

All the best with it, I would always get a second opinion at least. How to deal with lax treatment/no treatment/endless fudged referrals - I have no idea yet hope you have a smooth path to a good outcome. Keep us updated, I know from experience that the frustration and confusion is wearing/stressful sometimes to the extreme.

Nah you're not. The bone won't fully remodel for months / years.

There is one person on this thread who knows what they are on about. The others are guessing 🙂

So we're seeing a different consultant today, but last night had a phone call, from yet another medic to say she'd be in on Wednesday for a bone graft and plate. Something that was mentioned December '14.

Smells of realisation that it's not gone well.

We'll still start the complaints procedure today.

Ive had similar experiences. Ill post something later as its a bit of a ramble. Basically they wont plate things unless absolutely necessary. In many cases they are happy to leave you with a broken collar bone.

In the us there is a lot of information (i had 12 months of researching this) to say an early plate or pin is the way forward for quick recovery. They refuse to acknowledge this in the uk.

Taking the plate out has risks. Ive been advised to have mine removed but tbh i dare not due to the hassle i had int he first place.

So much this^ I love the NHS but it seems very backward in this particular area. It seems to consider a functional malunion as an acceptable clinical outcome, where elsewhere it obviously isn't. I found all of this out in the two days between my fracture and my first fracture clinic appointment fortunately, and was forwarned. If I hadn't been so certain of what I wanted, I would have been left 'to see how it goes' probably with poorer clinical outcome as a result. I'll post a link to my thread from the time, if any one is interested;

[url= http://singletrackmag.com/forum/topic/ouchy-ouchy-ouch-first-mtb-related-fracture ]linky[/url]

Today's new consultant didn't say anything was wrong with what was done but at each stage when asked said he'd not have done the same. Even let out a surprised "oh" when shown how prominent the plate was.

In tomorrow for full operation if there's a bed.