Plate versus screw for

[Dean McPherson]

I recently broke my collar bone in a mountain bike race and for reasons out of my control (the plate went to a different hospital and I had already been anaesthetised when they realised so they chose to proceed with the screw and not the preferred plate and screws). The screw runs right up the collar bone and the head leaves a good size bump on the back of my shoulder. I have a number of questions, the first (1) is what are the implications of having the screw versus the plate and screws. I understand this is slightly older technology, (2) why is the plate and screws the preferred means of fixing? I am after two weeks getting a sharp jabbing pain around the head of the screw. It occurs intermittently in certain positions and if the skin over the head is touched in a certain position. (3) Is this likely to be a nerve, internal stitches or other reason. I also understand the screw can back out, (4) does this occur often and does the screw option limit my outdoor activities until it comes out in 6-12 months?

[sydunisportsmed]

Management of clavicle fractures is evolving. A few years ago almost all were not operated on, now it is recognised that if the fracture is displaced a lot then too much shortening and too big a lump occurs with non-operative management. Plate and screws has been the recognised method for internal fixation, but recent studies have suggested that certain screws (e.g. Herbert screw) may be even better.

It is hard to comment on your injury without seeing X-rays. You could always photograph and post them on the Forum (attachments would only be accepted in low resolution to avoid huge files though). However, it is best to see your doctors and get re-Xrayed and see whether the screw has moved if it is bothering you.

I generally advise 3 months minimum before returning to contact sport, if you want to avoid risk of refracture. However you can run, swim and cycle a lot earlier.

[Dean McPherson]

As requested please find attached two x-rays, first one is day after surgery and second is today, 3 weeks later. Its very hard to tell if the screw has moved. At the end with the head of the screw it appears after three weeks it has moved signigicantly, but at the pointy end closest the neck it doesn't appear to have moved much at all. I have forgotten the name of the screw?, is it typically used for this application.

Whats the earliest I could have the screw removed assuming continued good healing given the sharp jabbing pain and discomfort I am experiencing around the head of the screw and should I be purseing further advice on this pain. I feel sporting activities are going to exasserbate this pain until it is removed, could I be doing more damage? Are you able to comment in a bit more detail now with x-rays and with reference to my original querys. Thanks for your time.

Dean


Management of clavicle fractures is evolving. A few years ago almost all were not operated on, now it is recognised that if the fracture is displaced a lot then too much shortening and too big a lump occurs with non-operative management. Plate and screws has been the recognised method for internal fixation, but recent studies have suggested that certain screws (e.g. Herbert screw) may be even better.

It is hard to comment on your injury without seeing X-rays. You could always photograph and post them on the Forum (attachments would only be accepted in low resolution to avoid huge files though). However, it is best to see your doctors and get re-Xrayed and see whether the screw has moved if it is bothering you.

I generally advise 3 months minimum before returning to contact sport, if you want to avoid risk of refracture. However you can run, swim and cycle a lot earlier.

[injuryupdate]

Looks like probably a bigger screw than they needed so it will have to come out at some stage as it will annoy you. On the positive side it should hold the fracture pretty well and doesn't look like it has moved too much.

If you can afford to go easy over the next few months, don't do too much with the shoulder (although cycling should be OK).

Get the screw out in a few months and maybe you will end up with a good result. Let us know how it gets on.

[Dean McPherson]

Could you please advise what the earliest time is I could expect to have the screw taken out and how soon after removal I could return to racing. Is there any limitation to rotation of the arm, ie could I swim freestyle now as well as ride!






Looks like probably a bigger screw than they needed so it will have to come out at some stage as it will annoy you. On the positive side it should hold the fracture pretty well and doesn't look like it has moved too much.

If you can afford to go easy over the next few months, don't do too much with the shoulder (although cycling should be OK).

Get the screw out in a few months and maybe you will end up with a good result. Let us know how it gets on.

[injuryupdate]

Sorry, can't give any extra advice because specific questions like this should be answered by the surgeon who put it in and knows the full extent of the fracture and the position of the screw (from visually it, not just the X-ray).

I appreciate surgeons aren't known to be generally great at giving full answers to all questions. When you pay a fee for the surgery (in Australia), this includes follow-up as well as the operation, so you are within your rights to book an appointment or make a phone call and expect these questions to be answered.

In theory you could complain to the medical board if the surgeon refuses to give you post-operative follow-up. However, it normally just requires persistence. If you call enough, the surgeon should eventually respond.