 Poster: A snowHead
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Opinions from orthopedic surgeon particularly appreciated:
A year ago, I had a bike accident in which I broke my collar bone. It was displaced in such a way all the ortho's (3) I consulted suggested strongly a plate was needed to fix it. That was done. And the bone had since grown back together on schedule.
At the time, I was also adviced the plate may need to be removed IF IT BOTHERS ME. Further more, I was adviced that I would probably be the unlucky few the plate would be bothersome, mostly because I didn't have much "meat" around my collor bone.
Fast forward a year. While the bone has healed nicely, the plate is bothering me considerably. I can't carry anything on my left shoulder, I can't wear a backpack, even seat belt rubs me the wrong way (pun intended). A "mate's greeting": a slap on the shoulder, is the worst...
Deciding to have the removal surgery is the easy part. The only thing left is the timing of it. After the plates got removed, the bone will have a bunch of pesky screw holes in it, which needs time to grow back to normal strength!
Unlike many of the snowheads here, but also like many other snowheads here, I'm a cycling addict!!! That means, right now is the middle of the cycling season. I really don't want to have the surgery done now and be off the bike. However, if I wait too long, it'll intrude into the skiing season!
Of the 2 orthopedic surgeons I considered to do the surgery, one said no "contact sport" (in which he included skiing) for 3 months! The other said 4-6 weeks of no "weight bearing exercise", into which he puts skiing, then I can do whatever I like to do!
The exact length is less important. It just seems neither doctor ski. So I'm not entirely confident of their recommended "waiting period" actually reflects what skiing really is!
In the cyclilng circle I am in, there had been one or two cases of re-breaking of the bone after the plate got removed, when the rider fall off the bike again! Granted, falling off the bike often puts direct impact on the collarbone while skiing falls tend to be more of a glancing hit. (I don't fall much skiing but also don't want to chance it and go through the whole process AGAIN!  )
Rather than trying to educate my non-skiing doctors what skiing really involves (or more HOW I ski), I wonder if there's some understanding of what's going on with the healing process of those pesky holes? Basically, how many weeks does it "typically" take for the bone to grow back a good portion (x%?) of its "normal" strength. Any ortho doctors can shed some light on that?
One thing that particularly intriggs me is, I was cleared to go skiing 2 months after the surgery PUTTING IN the plate, on the doctor's advice "it's no more likely to break than normal" even if I fall. So, if the growing back of the holes in the bone is no slower than the original break, shouldn't it be strong enough to withstand the occasional falls while sliding in similar amount of time?
Last edited by Poster: A snowHead on Fri 2-01-15 22:24; edited 1 time in total
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Not sure there is a black/ white answer to as this bone will improve upto 18 months. Holes will never completely fill in.
I wouldn't think there would be a great deal of difference at 2 months and 4 months .
A heavy fall at 6 months ? The problem is that the bone is compromised for quite along time mainly because the plate reduces the amount of extra bone produced which would have occurred if not plated.
I would, if it me, ski a bit more cautiously at two to 3 months.
Jonathan Bell
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| Jonathan Bell wrote: |
| The problem is that the bone is compromised for quite along time mainly because the plate reduces the amount of extra bone produced which would have occurred if not plated. |
So does removal of the plate allows that extra bone growth eventuallY?
On the other hand, if "holes will never completely fill in", wouldn't the bone be permanently compromised?
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You need to Login to know who's really who.
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| abc wrote: |
| Jonathan Bell wrote: |
| The problem is that the bone is compromised for quite along time mainly because the plate reduces the amount of extra bone produced which would have occurred if not plated. |
So does removal of the plate allows that extra bone growth eventuallY?
On the other hand, if "holes will never completely fill in", wouldn't the bone be permanently compromised? |
Bones adapt to the loads they experience so will eventually end up pretty close to normal.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| Quote: |
I wouldn't think there would be a great deal of difference at 2 months and 4 months .
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Does it matter if any material is used to fill the holes after the screws are removed?
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Bones adapt to the loads they experience so will eventually end up pretty close to normal.
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Is there any way to tell how strong the bones are at any given point? When I got the plates in, the x-ray didn't show much difference. And the doctor was just using the typical 4-6 weeks time frame to release me for activity. I was left with the impression that it could go either way even 1 year later!
(In the past, I've fallen off my mtn bike numerous times with no ill effect. Would really like to re-start that at some point. But even though I was in no particular hurry, I was getting absolutely no guidience from the doctors. Perhaps because few doctors fall off bikes regularly. But is there any understanding AND any indicator that the bone WILL be as strong as before? That is, rather than falling off and see if it breaks!)
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I would try to find a medic with some applicable experience. Cycling organisations may be able to help. I don't mean a GP, I mean a team doctor who deals with athletes. I would say any sport experience is what you want, more than cycling specific experience.
I broke my shoulder in a track bike crash earlier this year. NHS facilities are great for getting old people mobile after falls. They do not in my experience of a fairly good hospital trust cater for athletes. It felt like I was the only person in the place who wasn't obese or ancient. They were set up to reassure old people that they will eventually walk again, not to help me get riding again quickly.
I just threw money at it. They'd told me I'd be "down" for several months. In practice it took six weeks for me to get from their "do not put load on this" stage to "you can now load it". At that point they had no restrictions on how much pain I took, so with private help I just hammered the thing until it was functional again.
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As far as holes are concerned - ask a medic. I had a ton of bone grafts done in the USA for dental work though, they put Gore-Tex and bits of dead people to build up bone. If it matters, I'm sure they could fill your holes with that, although in the UK they're squeamish about cadaver bone I believe.
Strength wise - ask a medic. I don't notice that my shoulder is any weaker than it was before I cracked it, although arguably it may have less impact resistance, not that I particularly want to rely on that strength. My dental work is stronger than the original stuff, ready for the next punch to the face.
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I had a very similar situation to you. I fell off my bike, broke my clavicle and had a plate inserted that was horrible to live with. I had it out at the beginning of October and was OK for skiing come the New Year. I have had no subsequent problems but I guess it depends on what sort of cyclist/skier you are though!
As for the holes, I'm no expert or doctor but I was always told that it would take 6-8 weeks for the fracture to heal. I can't see how the same doesn't apply to the holes - they are an injury to the bone in the same way that a fracture is.
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| nickle wrote: |
| As for the holes, I'm no expert or doctor but I was always told that it would take 6-8 weeks for the fracture to heal. I can't see how the same doesn't apply to the holes - they are an injury to the bone in the same way that a fracture is. |
That's my thought.
However, if there's good reason/indicator that it isn't so, I'd rather be told ahead of time than to find out the hard way after I land on it.
What is NOT too helpful is "don't ski till x weeks" or "OK to cycle but just don't crash". That had the doctor's assumption of what cycling or skiing means to him/her, but may not be applicable to the patients actual practice on the activity! (e.g. while I haven't had any other high speed crash while riding a bike, I've had my share of not getting out of my pedal and slowly tipping over... normally good for a laugh of my riding companions, not as funny if my clavicles are in a compromised state)
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| nickle wrote: |
As for the holes, I'm no expert or doctor but I was always told that it would take 6-8 weeks for the fracture to heal. I can't see how the same doesn't apply to the holes - they are an injury to the bone in the same way that a fracture is. |
The holes have healed already. The problem being is that they had a screw in them. So when you take the screw out there is a hole left behind , as there would be if you removed a screw from wood. On extracting the screw the bone doesn't bleed so there are no new " bone healing cells" in the hole. The only way to stimulate the holes to start healing again would be to drill them a bit bigger to make the bone bleed again - it would then go on and make new bone and fill in the holes. The problem is that the screw diameter, including thread, is 3.5 mm. So you would need to drill out to at least 4.0 or bigger to get the bone to bleed. That's a big hole when compared to the width of the clavicle.
The holes diminish with time but only because there is a slow turnover of bone the whole time. Over years the bone turned over around the holes would gradually fill them in.
Jonathan Bell
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Jonathan Bell, That's really interesting - I genuinely thought the bone would just regenerate on removal of the screw. Today's medical lesson!
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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If only all surgeons could explain things so clearly . . .
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Jonathan Bell wrote: |
The problem is that the screw diameter, including thread, is 3.5 mm. So you would need to drill out to at least 4.0 or bigger to get the bone to bleed. That's a big hole when compared to the width of the clavicle.
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But, but, but... that's not any worse than a completely broken off & seperated clavicle in the original break, which usually heals in 6 weeks (give or take)...
Or does multiple "break" factor in in this case?
| Jonpim wrote: |
| If only all surgeons could explain things so clearly . . . |
If only most surgeons would explain at all!
Granted, their time is valueable so patient shouldn't expect lengthy explanation on every little detail. But too many surgeons have the attitude that patients can't understand anyway so NO planation of the mechanism.
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Granted, their time is valueable
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indeed, but it should be possible for a less expensive health professional to explain these things. Even a well-produced patient leaflet would be better than nothing.
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You know it makes sense.
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| pam w wrote: |
| Quote: |
Granted, their time is valueable
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indeed, but it should be possible for a less expensive health professional to explain these things. |
I'm not sure I trust an explanation from a "less expensive health professional", unless he/she has an equally good understanding of the science behind. But someone having such understanding would be unlikely be "less expensive".
Actually, "the internet" would be best for that.
But I didn't find any medical website going into that kind of (physiological) detail.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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| abc wrote: |
| pam w wrote: |
| Quote: |
Granted, their time is valueable
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indeed, but it should be possible for a less expensive health professional to explain these things. |
I'm not sure I trust an explanation from a "less expensive health professional", unless he/she has an equally good understanding of the science behind. But someone having such understanding would be unlikely be "less expensive".
Actually, "the internet" would be best for that.
But I didn't find any medical website going into that kind of (physiological) detail. |
The internet is a fantastic resource for information but not knowledge.
Jonathan Bell
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Poster: A snowHead
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| Quote: |
information but not knowledge.
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Ah, nice distinction!
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| Jonathan Bell wrote: |
The internet is a fantastic resource for information but not knowledge.
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Except in this case, there's no even information on the subject.
The vacumn is instead filled by people who're not qualified, such as past patients and whoever wishes to throw out anything from facts to rumors.
BTW, that lack of information is in addition to doctors/surgeons not having the time to make such lengthy detailed explanation to each and every patient who ask.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Plates removed, so were all BUT ONE of the screws.
One of the screw snapped off near the head. So the surgeon left it in there.
To get that screw out, he said he would have needed to cut out some of the bones, which he said "it doesn't make sense". And from the sound of it, it's not uncommon to leave broken screws in there?
Looking at the x-ray 5 weeks post-op, I can see the very tip of the lone screw protrude slightly out of the bone.
Now, my understanding is clavicle flex and rotates a lot. Without a screw head, what's there to stop the rest of the screw from keep on advancing and work its way out of the bone?
Or is that such a common practice to leave broken screws in the bone, precisely because those screw rarely work its way loose?
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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I've had a plated clavicle, and also pinned and plated wrist, all have been removed. The wrist is a bit weak but the collar bone is great. The UK in general in my experience doesn't plate broken bones but if they do they don't bother to remove the metalwork (rant over). I was told by the german doctors who did my clavicle that the plate should come out in between a year to 1.5 yrs. It would be just about as good as new as a properly healed broken bone is actually stronger than the bone around it. (Correct me if I'm wrong here Jonathan Bell, but it was all in german which is not my firzt language.)
I ski with a dainese motorbike body armour on which has full upper body protection, including clavicles. Maybe a bit OTT but I'm sure it has limited damage to my body in skiing when I've cocked it up.
S'funny, but I don't use it for the mtb tho but then my falls are harder whe II ski.
I have mates who have the odd screw still in their body for the same reason as you with no ill effects but mrs gixxerniknik still has a french plate in her ankle (skiing accident) that uk doctors refuse to remove despite it giving her grief and she can't wear a ski boot because of it.
Hope this helps.
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Sorry, it doesn't. 
I know plenty of people keep their hardware. And plenty had them COMPLETELY removed. But in my case, a screw with no head was left in there. I was hoping one of the orthopedics on this board to tell me if it has any risk of working its way to harms way. I was more interested to know if I need to have it monitored.
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My (rather long winded) point was if you are in any way worried, protect it. You should always "monitor" bits of your body that have been injured or hurt, especially when subjecting those bits to repeated stress or cold. The best person to do that is you as it's your body mate.
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| abc wrote: |
Sorry, it doesn't.
I know plenty of people keep their hardware. And plenty had them COMPLETELY removed. But in my case, a screw with no head was left in there. I was hoping one of the orthopedics on this board to tell me if it has any risk of working its way to harms way. I was more interested to know if I need to have it monitored. |
Couple of points raised above.
The UK do plate fractures, however there is probably a bit too much plating going on. ( Clavicle fractures in particular).
It is difficult to find a convincing case for removal of all plates.
I have never removed them routinely.
I will remove them if they cause local irritation which tends to occur where they are superficial ( Outside ankle, outside tibial plateau etc)
Screws will not migrate and do not require monitoring as long as they are embedded in bone.
Broken screws are common place and are usually best left alone unless causing trouble.
On attempting to remove metal it is common the find that the screws either do not come out easily or they have broken.
Quite alot of modern metal is titanium which can be hideous to remove as it is quite soft and the screw head strips very easily either when it was
put in or attempting to remove the screw. The end of screw driver fits into a small hex hole like an allen key hole rather than a slot or philips as
you would find on a conventional screw. The hex hole is very easily stripped in titanium so it becomes round. The screw then has to be drilled out
or left. Drilling out screws is slow and lengthens the operation considerably which increases complication rates like infection.
I make a particular point of trying very hard not to remove titanium plates and screws for this reason.
The last titanium plate i had to remove had 13 screws and the plate was about a foot long. The first 3 screws came out easily, the 4th with
difficulty and screws 5 and 6 had the be drilled out because the head had stripped. When the 7th was also stripped i decided to cut the plate off
removing just the part i had freed up and leaving a third of the plate there. As i had removed the part causing the trouble this was better than
spending another hour or so drilling out screws.
In short it is quite possible to create a lot more trouble by removing metal than it is by leaving it in situ. There are many scientific papers that
document that fact.
Jonathan Bell
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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