Clavicle Fracture Surgery

[LukensR]

I have a non-union midshaft clavicle fracture. The fracture was the result of a Motorcycle accident nearly 6 months ago.  (I am a 35 year old female)  After the sling, the figure 8 brace, and an Ultrasound bone growth stim, still no union.  I have an appointment on Feb 14 to review MRI results and talk about surgery.  Are there options other than the Plate and screw procedure that my doc keeps telling me about?  

[JainMD]

Hi,
I think the surgeon does not have experience in External fixator therapy for Clavicle fracture, hence he feels people might be nuts talking about it. Well that is not our concern.
Have you taken a second opinion from another orthopedist for your condition?
Exactly there is a risk of disease transmission from using a bone from blood bank. What we are talking about is another incision on your body and risk involved with that. You need to discuss the comparison of risk of infection in either of two.
90% of non-unions are treated successfully with 1 surgery. In 80% of non-unions, limb length and alignment are restored. If infection is present, often >1 surgery is required.
What has the doctor explained you regarding the possible complication?
90% of non-unions are treated successfully with 1 surgical intervention, and healing occurs over a 3 to 4-month period. Full rehabilitation with muscle strengthening takes longer, because the patient often is debilitated before treatment.
Keep me posted.
Bye.

[LukensR]

I mentioned the external fixation option to the Doc and he sort of looked at me like I was nuts!  So, I am going with the standard Plate surgery.
The only information my surgeon gave me was to say that the Autograft has a better chance of healing.  Obviously there is the additional incision and risk of infection with that.  But isn't there a risk of disease transmission when using bone from the bone bank?  I am most curious about the amount of pain and recovery associated with the bone graft site.  

[JainMD]

Hi Lukens,
How are you feeling?
Did you mention to the doctor regarding the external fixation surgery? If yes, what he has said about it?
Bone graft may be autograft, allograft, or synthetic.
Autograft is the one where in bone pieces are taken from patient itself. Allograft is the one where in another human bone pieces are taken i.e. from bone bank and synthetic you know is one which is similar material like bone pieces.
The optimal bone graft material or bone morphogenic protein is unknown.
Factors to consider with the use of autograft include the need for a 2nd incision and the relative quality of the patient's bone.
Some patients may not want to have a 2nd incision with its risk of pain or infection.
What have you thought about autograft?
What has the doctor explained to you regarding the different options of bone graft available?
90% of non-unions are treated successfully with 1 surgery.
Keep me posted.
Bye.

[LukensR]

Finally, 6 months after the injury, with no signs of "Bridging Bone" my Doctor has recommended surgery.  As I was expecting, he is recommending the plate and screws surgery that seems to be the most common.  My question now is where to get the bone for the bone graft that will be required.  The options the doc gave me are either bone material from a "bone bank" or a bone graft from my own hip.  Any thoughts on this?  Does anyone know how painful the hip graft would be?  Is it worth the extra pain and incision?  Any thoughts or advice would be appreciated!

[JainMD]

Hi,
There are few articles mentioned but I have found where in 22 patients were treated with Hoffmann's external fixation for 51 days and very less complications were noted.
You can follow the following URL for further reading.
http://www.ejbjs.org/cgi/content/abstract/70/5/692
Keep me informed if you have any queries.
Bye.

[LukensR]

Is there an External fixation option?  Where the external device is needed for a period of time and then removed?  I have found a few articles about this type of treatment, but very little information.  Have you ever heard of anything like this???  I have read horror stories of the plates lifting, and screws pulling out.  I'm not crazy about the idea of this plate surgery that the docs keep telling me about.  My fracture was substantially displaced initially, but has now come back much closer and now is nearly touching.  (the bone ends are overlapping.)  It seems as though this plate/screw procedure is the most common, yet it doesn't sound as though it is all that reliable.

[JainMD]

Hi,
How are you feeling?
The clavicle serves as the primary bony connection between the thorax and upper limb.
Surgery may be needed for;
-Displaced fractures in patients who are highly active or have jobs with overhead activity; these patients may be unsatisfied with the deformity that will result from nonoperative treatment.
-Comminuted or displaced midshaft fractures.
-Displaced fractures of the lateral 1/5 of the clavicle: Controversy exists as to the effectiveness of surgery.
-Open fractures over the clavicle.
-Substantially displaced fractures with skin tenting.
-Nonunion of previous fractures.
-Floating shoulder.
-The exact determinants for surgical intervention and the type of surgery are controversial.
-The most common treatment is open reduction and internal fixation with a plate and screws.
-The plate may be placed superiorly, anteriorly, or antero-inferiorly.
-Hardware irritation is common after surgery, requiring plate removal.
-Pin fixation is a less invasive alternative.
-Threaded screws or titanium flexible nails may be used.
-A serious complication of pin fixation is migration of the pin into the intra-thoracic region.
-Usually the pin must be removed after fracture healing.
Keep me informed if you have any queries.
Bye.