Well I had a good crash early July, and our emergency department at our hospital prescribed the "usual treatment" ... put it in a sling and let it heal itself.

2 weeks later at the follow up appt, I stressed I did not think it was healing properly, as my skin started to form a blister from the pressure underneath.  Luckily, the doctor on duty referred my x-rays to an orthopaedic surgeon for review this time, and after review, I was immediately booked in for surgery (3 days later .... to let skin heal)

What was anticipated to be a "routine repair", turned out to be a fairly elaborate surgery. The distal end was in several fragments and a LOT of screws were required to put things back together.  The bones had a lot of tissue build up around them that had to be cleaned up, or off,  before the plate could be applied (since 18 days had passed between injury and surgery date).

I am now stuck in an arm sling for another 5 weeks (7 total) as the surgeon indicated that its imperative to immobilize the arm as there is nothing of substance holding my collar bone together until the bone starts to heal (as its in pieces).  The plate and screws are doing all the work.

I have never seen so many screws on x-rays for this type of repair.  Is this normal considering the distal end was in pieces?  Perhaps "rebar reenforcement"?

Would appreciate any input Dr. Mark could provide on the x-rays, recovery plan below, etc.??

Its feeling much better now after 16 days, but I still have a long road ahead of me. Doctor is recommending 6 weeks in a sling with minimal movement and no lifting.  Physio to start around week 7 and very light lifting.  He stated that this was a VERY challenging repair and that its a "one shot deal" ... If I mess it up, then I'm in big trouble.  Going to take 6-8 months off the moto (yes this decision is killing me), hit physiotherapy and the gym to strengthen up over the winter.  Rather than risk it, I want it to be 100% good to go again.

Will continue with follow up x-rays along the way and can post if they would provide any value?

FWIW ... I urge anybody who is considering buying a neck brace to do your homework !!  For off road riding (where crashes are not likely coming off triple jumps), my suggestion is to try on every model and choose the one that is least likely to concentrate energy directly to the clavicle area in the event of a crash.   Read "real time" testimonials from actual riders.  There's TONS of info out there,  as to why each braces design is different, so research before buying.  I will be buying a new brace (different brand) for next year.  That's all I am going to say on that one

Initial x-ray after crash




X-ray of Repair plate and ton of screws (10 days after surgery)

Edited by supervokes, 05 August 2012 - 10:45 PM.

I have had poor results witht that repair.  While the bone may heal, the coracoclavicvular ligaments are attached to the lower piece of bone which is not well fixed.  This will lead to stretching out of the superior capsule of the AC joint and dislocation of the AC joint.   In fact as I looked again at the AC joint, it is starting to dislocated.  Notice how the distal clavicle is riding higher up than the acromion.

Edited by DrMark, 06 August 2012 - 10:00 AM.

DrMark, on 06 August 2012 - 09:59 AM, said:

First off ... thanks

Any advice on what I could ask/do in this instance ... i.e. follow up questions I should be asking at my Sept visit?

Is there any chance the collarbone "may" drop on its own back into better alignment or is it likely to get worse?  Ever seen this happen?  

Would this be classified as an AC separation "as is" right now?  The surgeon indicated that all the ligaments were still intact, but it would appear that the ligament connection between the actual clavicle and acromion are not attached at the end to cause such a "lift".  Would an ultrasound shed some light?

I am really concerned about this.  Any reason for optimism ? Thanks.

Edited by supervokes, 06 August 2012 - 03:51 PM.

Why do we need an ultrasound when its obvious on the X-ray?    Its 100% displaced, making this a Grade III AC seperation.  I would reoperate now and tie down the clavicle to the coracoid.  Not in September.

DrMark, on 06 August 2012 - 04:36 PM, said:

OK, thanks.

I will book an appointment with my surgeon in the next few days to discuss.  

Seems odd to conduct such an elaborate repair on a collarbone if its not attached to the coracoid?  Based on your experience, have you ever seen a Grade III AC separation happen after surgery, or are they typically present right from the time of injury ? The AC joint appears intact in the pre-operation x-ray, hence why I am asking.  Also, a lot of grade 3 AC injuries are allowed to heal via immobilization rather than surgery (after researching all day .. mountain bike forums, etc.).  Any thoughts on the non-operative approach?

Much appreciated for the advice.  Any input into what I should ask for specifically would be welcome (i.e. suggest tying down the clavicle).   I want to tread very lightly on this when I speak with him in person, choosing my questions/concerns appropriately.

Your input has been extremely valuable.  Cannot thank you enough. !!!

Edited by supervokes, 06 August 2012 - 06:30 PM.

I have had several of my own cases dislocate back when I had a full head of hair.

Will arrange for a visit.

Last question ... if its recommended to allow for non-operative healing (which I suspect will be the approach) ... would it not make sense to also apply Leukotape (or equivalent) to the area where the clavicle is showing signs of protrusion from the skin?

Any opinion on the validity of "applying tape" to the skin to help stabilize the AC joint?  Any reason why I would not want to do so with this repair.

Thanks ... you have been immensely helpful

IN order to hold the clavicle down, there must be such force applied, that the tape will cut right through the skin.