Any bone/fracture doctors in the house?
Discussion
OK here's what happened...
10 August, big mountain biking accident at Afan (S Wales), hit a tree very hard, broke my clavicle, air ambulance to Merthyr Tydfil. X rayed, painkillers, given a triangular bandage as a sling and sent away. Told to book into fracture clinic back home when I got there. As soon the the morphine wore off it hurt like hell as the sling was was putting pressure on the break, got a better blue sling thing a couple of days later from Swansea hospital, although still not great as it's a size M and I am fairly big.
18 August, asked for fracture clinic appointment from my local hospital (Rugby) but was told I had to come to A&E first regardless of the fact that it had happened a week ago. Saw a doctor in A&E who looked at the X rays done at Merthyr and new ones done at Rugby and said he would be amazed if it did not need surgery. Appointment made for the next day at the facture clinic. Given "collar and cuff" thing and more painkillers, much more comfy.
19 August, went to fracture clinic, was told probably would not need surgery at this time, come back in 3 weeks, and that was it.
During the course of this week I have been getting more uncomfortable and friends last night pointed out that I am now totally wonky. My broken side is a good inch and a bit in towards my neck and I've subconsciously also been carrying that shoulder "up" as it hurts loads if I don't. I'd really not noticed the wonkyness before as I don't tend to stare at the mirror but it's really, really noticeable.
04 September (today) went back to fracture clinic with my concerns, saw a doctor who took one look at the Xrays and said whatever I do, don't rest on my left arm as it's pushing my shoulder up and in. "OK" I said, sitting down in an armchair and lowering myself in with both arms. "Just like that...you must NOT do that!!!" he said. Apparently this is very important information and the first 3 weeks of healing basically has a huge impact on what shape you will be after it's sorted. I am really, really hacked off as this was categorically not told to me (other half was there too), and I know that I have been leaning on the broken side SHED LOADS and keeping it propped up as it hurts a lot less, which, it would appear is the worst thing I could have done.
I don't play contact sports as such, but I obviously want to get cycling again, ski, and dinghy sail, where I wear a trapeze harness that puts quite a lot of pressure on your shoulders. I want it to be fixed as well as it can be and I want to be symmetrical again if possible!
My question is, as I have private health cover through work, should I be taking advantage of this and getting a second opinion? I don't have much experience of this kind of thing at all, but would the NHS be quite happy for me to be basically fit, healed but totally wonky, where if I went private they might be more concerned with what it would look like? The bones are just starting to send out little stalagmites and stalactites towards each other now but they basically look the same as the X ray below which happened on the day. I just can't help feeling that if as the A&E doc had said, they'd plated it, or if as the doc today said, I'd not been leaning on it, it might look a much more sensible shape. I've really tried hard all afternoon just to let the arm hang and force it apart but it now hurts like hell despite painkillers and I really can't face another 4 weeks of this! If an operation would help I'd want it done now, to minimize any future time off work and also to give me a chance of going skiing in January.
Many thanks in advance for any professional opinions (and please, if you are not a medical person, say so, I really need an proper opinion here!) X ray below was taken on the day of the accident.
10 August, big mountain biking accident at Afan (S Wales), hit a tree very hard, broke my clavicle, air ambulance to Merthyr Tydfil. X rayed, painkillers, given a triangular bandage as a sling and sent away. Told to book into fracture clinic back home when I got there. As soon the the morphine wore off it hurt like hell as the sling was was putting pressure on the break, got a better blue sling thing a couple of days later from Swansea hospital, although still not great as it's a size M and I am fairly big.
18 August, asked for fracture clinic appointment from my local hospital (Rugby) but was told I had to come to A&E first regardless of the fact that it had happened a week ago. Saw a doctor in A&E who looked at the X rays done at Merthyr and new ones done at Rugby and said he would be amazed if it did not need surgery. Appointment made for the next day at the facture clinic. Given "collar and cuff" thing and more painkillers, much more comfy.
19 August, went to fracture clinic, was told probably would not need surgery at this time, come back in 3 weeks, and that was it.
During the course of this week I have been getting more uncomfortable and friends last night pointed out that I am now totally wonky. My broken side is a good inch and a bit in towards my neck and I've subconsciously also been carrying that shoulder "up" as it hurts loads if I don't. I'd really not noticed the wonkyness before as I don't tend to stare at the mirror but it's really, really noticeable.
04 September (today) went back to fracture clinic with my concerns, saw a doctor who took one look at the Xrays and said whatever I do, don't rest on my left arm as it's pushing my shoulder up and in. "OK" I said, sitting down in an armchair and lowering myself in with both arms. "Just like that...you must NOT do that!!!" he said. Apparently this is very important information and the first 3 weeks of healing basically has a huge impact on what shape you will be after it's sorted. I am really, really hacked off as this was categorically not told to me (other half was there too), and I know that I have been leaning on the broken side SHED LOADS and keeping it propped up as it hurts a lot less, which, it would appear is the worst thing I could have done.
I don't play contact sports as such, but I obviously want to get cycling again, ski, and dinghy sail, where I wear a trapeze harness that puts quite a lot of pressure on your shoulders. I want it to be fixed as well as it can be and I want to be symmetrical again if possible!
My question is, as I have private health cover through work, should I be taking advantage of this and getting a second opinion? I don't have much experience of this kind of thing at all, but would the NHS be quite happy for me to be basically fit, healed but totally wonky, where if I went private they might be more concerned with what it would look like? The bones are just starting to send out little stalagmites and stalactites towards each other now but they basically look the same as the X ray below which happened on the day. I just can't help feeling that if as the A&E doc had said, they'd plated it, or if as the doc today said, I'd not been leaning on it, it might look a much more sensible shape. I've really tried hard all afternoon just to let the arm hang and force it apart but it now hurts like hell despite painkillers and I really can't face another 4 weeks of this! If an operation would help I'd want it done now, to minimize any future time off work and also to give me a chance of going skiing in January.
Many thanks in advance for any professional opinions (and please, if you are not a medical person, say so, I really need an proper opinion here!) X ray below was taken on the day of the accident.
Hard-Drive said:
My question is, as I have private health cover through work, should I be taking advantage of this and getting a second opinion?
I'd be on the phone finding out what they will/won't do. If you've got it why not use it? Worst thing they can say is your insurance doesn't cover it.not qualified medical bod, but that looked like mine when i did it 10 years ago and isnt the fact your arm is in a sling a indication not to use the f
king thing?????
I was told that it wouldnt be until several weeks until they could tell if mine needed plating as to give the body a chance (that was from a private doc), then it was all the physio I could get off the private cover after 6-7 weeks due to the bone healing and no plate needed.
king thing?????I was told that it wouldnt be until several weeks until they could tell if mine needed plating as to give the body a chance (that was from a private doc), then it was all the physio I could get off the private cover after 6-7 weeks due to the bone healing and no plate needed.
It's actually very rare that clavicular fractures necessitate any surgery - the vast majority of the time (over 90% of the time) they are simply left to heal with the possible simple expedient of a sling. I wouldn't think a second 'private' opinion would advise anything different.
Edited by maddog993 on Thursday 4th September 17:59
This is from an orthopaedic surgical registrar who happens to be in my family:
[i]Should have been fixed, preferably with a precontoured plate such as the Acumed clavicular locking plate. Any NHS or private orthopaedic surgeon who keeps up to date should know that the current opinion is that in healthy adults clavicle fractures should be fixed if there is more than 1.5cm of shortening. This goes double for those who require normal shoulder dynamics for their occupation / hobbies. Furthermore, there is very possibly soft tissue interposition due to the separation of the two major fragments, which, if present, could delay union. The long-term consequences of malunion will be dimished power and perhaps chronic pain. Not to mention the poor cosmesis of a narrow shoulder girdle.
Formerly, the Europeans would use a figure-of-eight bandage in an endeavour to maintain shoulder girdle width. However, this is painful and poorly tolerated (as evidenced). In the UK, a broad arm sling is more usually employed, supporting the arm and preventing the shoulder dropping. The A+E doctor in rugby was correct with his supposition regarding the need for surgery, but provided exactly the wrong means of support. A "collar and cuff" supports the arm by the wrist, allowing the arm to hang dependent from the shoulder. This would be appropriate for a humeral fracture, where the weight of the arm acts as traction to realign the fracture. With clavicle fractures it distorts the fracture as this bone usually acts a strut to support the arm.
By three to four weeks the fracture may well be well on the way to healing. This would render surgery more difficult, but not impossible. The opinion of a shoulder surgeon should be sought as soon as possible if this chap is interested in surgery. Finally, he should expect the need for removal of the plate after 9-12 months if he wishes to carry bags with straps, or use shoulder harnesses comfortably.
Hope this proves useful.[/i]
He also says can you post up any more x-rays - here or in PM?
[i]Should have been fixed, preferably with a precontoured plate such as the Acumed clavicular locking plate. Any NHS or private orthopaedic surgeon who keeps up to date should know that the current opinion is that in healthy adults clavicle fractures should be fixed if there is more than 1.5cm of shortening. This goes double for those who require normal shoulder dynamics for their occupation / hobbies. Furthermore, there is very possibly soft tissue interposition due to the separation of the two major fragments, which, if present, could delay union. The long-term consequences of malunion will be dimished power and perhaps chronic pain. Not to mention the poor cosmesis of a narrow shoulder girdle.
Formerly, the Europeans would use a figure-of-eight bandage in an endeavour to maintain shoulder girdle width. However, this is painful and poorly tolerated (as evidenced). In the UK, a broad arm sling is more usually employed, supporting the arm and preventing the shoulder dropping. The A+E doctor in rugby was correct with his supposition regarding the need for surgery, but provided exactly the wrong means of support. A "collar and cuff" supports the arm by the wrist, allowing the arm to hang dependent from the shoulder. This would be appropriate for a humeral fracture, where the weight of the arm acts as traction to realign the fracture. With clavicle fractures it distorts the fracture as this bone usually acts a strut to support the arm.
By three to four weeks the fracture may well be well on the way to healing. This would render surgery more difficult, but not impossible. The opinion of a shoulder surgeon should be sought as soon as possible if this chap is interested in surgery. Finally, he should expect the need for removal of the plate after 9-12 months if he wishes to carry bags with straps, or use shoulder harnesses comfortably.
Hope this proves useful.[/i]
He also says can you post up any more x-rays - here or in PM?
I had a bit of a battle getting mine sorted but in the end the surgeon did a brilliant job.
This was the first X-Ray....
At this point I was told that it was 50/50 whether I would need surgery or not, I had a lump which was bone sat about 3/4 out from my collarbone area. I couldn't wear a bag on this shoulder and it was noticeable even with bulky clothes on.
I was then told I would need surgery, so I got prepared, went in to the hospital and had another X-Ray, the surgeon then decided it wasn't needed and I would be fine.
All during this time I had very little free movement in my shoulder and the lump had not reduced.
After another consultation and another surgeon looking at my shoulder they then gave me the choice of either letting it fix itself naturally and leaving a lump, which they said could be shaved flat in the future, or having it plated. I do physical work so I wanted it as strong as possible so opted for surgery.
When they cut me open it was found that a section of bone was 90° to the rest of the collarbone and it would never have healed, so 10 screws, a metal plate later and I was stitched up.
The next morning I had a physio ask to look at my shoulder, I removed my arm from the gown myself, had full movement and no pain apart from the incision, the NHS did an amazing job on me in the end, pure craftsmanship.
Apart from some nerve damage which is actually improving week on week I have no issues with my shoulder, the first few weeks after surgery are very important though. I was taking extra calcium, getting good nights sleep etc.
A second opinion is definitely worthwhile, i'd be sat here with some errant bone floating around in my shoulder and it far weaker than it is now if the other surgeon hadn't taken an interest.
Good luck.
Dave!
This was the first X-Ray....
At this point I was told that it was 50/50 whether I would need surgery or not, I had a lump which was bone sat about 3/4 out from my collarbone area. I couldn't wear a bag on this shoulder and it was noticeable even with bulky clothes on.
I was then told I would need surgery, so I got prepared, went in to the hospital and had another X-Ray, the surgeon then decided it wasn't needed and I would be fine.
All during this time I had very little free movement in my shoulder and the lump had not reduced.
After another consultation and another surgeon looking at my shoulder they then gave me the choice of either letting it fix itself naturally and leaving a lump, which they said could be shaved flat in the future, or having it plated. I do physical work so I wanted it as strong as possible so opted for surgery.
When they cut me open it was found that a section of bone was 90° to the rest of the collarbone and it would never have healed, so 10 screws, a metal plate later and I was stitched up.
The next morning I had a physio ask to look at my shoulder, I removed my arm from the gown myself, had full movement and no pain apart from the incision, the NHS did an amazing job on me in the end, pure craftsmanship.
Apart from some nerve damage which is actually improving week on week I have no issues with my shoulder, the first few weeks after surgery are very important though. I was taking extra calcium, getting good nights sleep etc.
A second opinion is definitely worthwhile, i'd be sat here with some errant bone floating around in my shoulder and it far weaker than it is now if the other surgeon hadn't taken an interest.
Good luck.
Dave!
RetHard-Drive said:
Many thanks in advance for any professional opinions (and please, if you are not a medical person, say so, I really need an proper opinion here!) X ray below was taken on the day of the accident.
Really sorry about the accident, no joke by the look of the x-ray.... but this is an internet forum...." I really need an proper opinion here"... sorry but you've come to the wrong place.Get a second opinion, air your concerns.
Dear all (and especially Motco)
Thanks very much for the advice and experiences, I appreciate it. Swilly, I am not looking for an accurate medical diagnosis on an internet forum, that is clearly impossible, I was asking anyone qualified whether it is worth me getting a second opinion (which will cost me a £75 excess). No point in doing that if anyone who looks at it just says "+1 what they said before". However I don't begrudge the £75 if there is just a slim chance of someone saying that it might need surgery.
Don't get me wrong, the NHS in the past did an incredible next day job on my spine that potentially saved me from a wheelchair for life, full credit to them, and although I know the consequenses of getting this wrong are nowhere near as bad, I am mightily narked that the first doctor forgot to tell me this vital piece of "dangly arm" info. I am always a big beleiver in "two ears one mouth" and get the impression that no-one has really listened to my points. I asked about being able to go sailing and was told "should be fine" however when I try to explain that I don't mean sitting on the deck of a yacht and drinking G&T, I mean wearing an over the shoulder trapeze harness and hammering a skiff downwind at 20 knots with a high possibility of sending the thing end over end and hitting my crew or the mast at a much higher speed than a flat out rugby tackle, the chap had already stopped listening and was asking me when I'm free for my next appointment...
Thanks again all for the advice and I will let you know what happens!
Thanks very much for the advice and experiences, I appreciate it. Swilly, I am not looking for an accurate medical diagnosis on an internet forum, that is clearly impossible, I was asking anyone qualified whether it is worth me getting a second opinion (which will cost me a £75 excess). No point in doing that if anyone who looks at it just says "+1 what they said before". However I don't begrudge the £75 if there is just a slim chance of someone saying that it might need surgery.
Don't get me wrong, the NHS in the past did an incredible next day job on my spine that potentially saved me from a wheelchair for life, full credit to them, and although I know the consequenses of getting this wrong are nowhere near as bad, I am mightily narked that the first doctor forgot to tell me this vital piece of "dangly arm" info. I am always a big beleiver in "two ears one mouth" and get the impression that no-one has really listened to my points. I asked about being able to go sailing and was told "should be fine" however when I try to explain that I don't mean sitting on the deck of a yacht and drinking G&T, I mean wearing an over the shoulder trapeze harness and hammering a skiff downwind at 20 knots with a high possibility of sending the thing end over end and hitting my crew or the mast at a much higher speed than a flat out rugby tackle, the chap had already stopped listening and was asking me when I'm free for my next appointment...
Thanks again all for the advice and I will let you know what happens!
My family orthopod reports that what Howitzer has is the device he mentioned.
orthopod said:
...sure enough, that's a 10-hole, precontoured, Acumed locking clavicular plate, with 6 locking screws and 2 non-locking screws through the plate, and 2 lag screws holding the butterfly fragment at the fracture site. That's exactly what I meant!
Quick update...
I have health cover through work so today I saw a consultant. He took one look at the original X rays from the Merthyr hospital and said he recognised them...turns out the first doc I saw the Rugby fracture clinic is one of his juniors and my consultant had looked at following my orginal appointment and expressed concern. Basically, he said it needs plating and I'm having it done on Saturday, same day op thank goodness!
As it was, I did have an appointment at the same fracture clinic this coming Wednesday, and it would have been the same consultant I saw today who I would have seen, however under the NHS. He would have told me the same story, and plated it, however via the NHS instead.
However, this is what narks me. Last week my friends had pointed out how wonky I was, which I had not noticed before and I got very concerned about, so I was able to get the appointment that should have been this Wednesday, brought forward, and I was seen last week by a different doctor under the NHS. However he was quite satisfied that it was all healing just fine, to stop making a fuss about the wonkyness, and just continue to rest and not drive, and come back in a further 3 weeks to see how it was looking and whether I could be discharged as basically be deemed fit and able to drive again. He was also the chap who just kept interuppting and just did not seem to listen when I said that what he might think cycling and sailing are, are not the types of cycling and sailing I want to be able to do! So basically, I would have come back in 3 weeks, fused and wonky, and never have seen the consultant who I saw today.
Today's consultant (who says if I want to drive before the operation, I can do, as long as I am not in discomfort and promise not to crash) assured me that I would not have fallen thorugh the NHS net (?????) but who knows? Anyway, he was a very decent guy and I am very glad indeed it will be him doing the honours on Saturday.
So, thanks to all who replied, but especially to Motco and his son. My consultant was very surprised indeed at my highly unorthodox PistonHeads diagnosis, but said that the diagnosis was done by someone who clearly knows their stuff and was absolutely spot on.
Thanks again and I'll report back next week!!!
I have health cover through work so today I saw a consultant. He took one look at the original X rays from the Merthyr hospital and said he recognised them...turns out the first doc I saw the Rugby fracture clinic is one of his juniors and my consultant had looked at following my orginal appointment and expressed concern. Basically, he said it needs plating and I'm having it done on Saturday, same day op thank goodness!
As it was, I did have an appointment at the same fracture clinic this coming Wednesday, and it would have been the same consultant I saw today who I would have seen, however under the NHS. He would have told me the same story, and plated it, however via the NHS instead.
However, this is what narks me. Last week my friends had pointed out how wonky I was, which I had not noticed before and I got very concerned about, so I was able to get the appointment that should have been this Wednesday, brought forward, and I was seen last week by a different doctor under the NHS. However he was quite satisfied that it was all healing just fine, to stop making a fuss about the wonkyness, and just continue to rest and not drive, and come back in a further 3 weeks to see how it was looking and whether I could be discharged as basically be deemed fit and able to drive again. He was also the chap who just kept interuppting and just did not seem to listen when I said that what he might think cycling and sailing are, are not the types of cycling and sailing I want to be able to do! So basically, I would have come back in 3 weeks, fused and wonky, and never have seen the consultant who I saw today.
Today's consultant (who says if I want to drive before the operation, I can do, as long as I am not in discomfort and promise not to crash) assured me that I would not have fallen thorugh the NHS net (?????) but who knows? Anyway, he was a very decent guy and I am very glad indeed it will be him doing the honours on Saturday.
So, thanks to all who replied, but especially to Motco and his son. My consultant was very surprised indeed at my highly unorthodox PistonHeads diagnosis, but said that the diagnosis was done by someone who clearly knows their stuff and was absolutely spot on.
Thanks again and I'll report back next week!!!
Edited by Hard-Drive on Monday 8th September 14:37
Hard-Drive said:
Quick update...
I have health cover through work so today I saw a consultant. He took one look at the original X rays from the Merthyr hospital and said he recognised them...turns out the first doc I saw the Rugby fracture clinic is one of his juniors and my consultant had looked at following my orginal appointment and expressed concern. Basically, he said it needs plating and I'm having it done on Saturday, same day op thank goodness!
As it was, I did have an appointment at the same fracture clinic this coming Wednesday, and it would have been the same consultant I saw today who I would have seen, however under the NHS. He would have told me the same story, and plated it, however via the NHS instead.
However, this is what narks me. Last week my friends had pointed out how wonky I was, which I had not noticed before and I got very concerned about, so I was able to get the appointment that should have been this Wednesday, brought forward, and I was seen last week by a different doctor under the NHS. However he was quite satisfied that it was all healing just fine, to stop making a fuss about the wonkyness, and just continue to rest and not drive, and come back in a further 3 weeks to see how it was looking and whether I could be discharged as basically be deemed fit and able to drive again. He was also the chap who just kept interuppting and just did not seem to listen when I said that what he might think cycling and sailing are, are not the types of cycling and sailing I want to be able to do! So basically, I would have come back in 3 weeks, fused and wonky, and never have seen the consultant who I saw today.
Today's consultant (who says if I want to drive before the operation, I can do, as long as I am not in discomfort and promise not to crash) assured me that I would not have fallen thorugh the NHS net (?????) but who knows? Anyway, he was a very decent guy and I am very glad indeed it will be him doing the honours on Saturday.
So, thanks to all who replied, but especially to Motco and his son. My consultant was very surprised indeed at my highly unorthodox PistonHeads diagnosis, but said that the diagnosis was done by someone who clearly knows their stuff and was absolutely spot on.
Thanks again and I'll report back next week!!!
How did it go Hard-Drive?I have health cover through work so today I saw a consultant. He took one look at the original X rays from the Merthyr hospital and said he recognised them...turns out the first doc I saw the Rugby fracture clinic is one of his juniors and my consultant had looked at following my orginal appointment and expressed concern. Basically, he said it needs plating and I'm having it done on Saturday, same day op thank goodness!
As it was, I did have an appointment at the same fracture clinic this coming Wednesday, and it would have been the same consultant I saw today who I would have seen, however under the NHS. He would have told me the same story, and plated it, however via the NHS instead.
However, this is what narks me. Last week my friends had pointed out how wonky I was, which I had not noticed before and I got very concerned about, so I was able to get the appointment that should have been this Wednesday, brought forward, and I was seen last week by a different doctor under the NHS. However he was quite satisfied that it was all healing just fine, to stop making a fuss about the wonkyness, and just continue to rest and not drive, and come back in a further 3 weeks to see how it was looking and whether I could be discharged as basically be deemed fit and able to drive again. He was also the chap who just kept interuppting and just did not seem to listen when I said that what he might think cycling and sailing are, are not the types of cycling and sailing I want to be able to do! So basically, I would have come back in 3 weeks, fused and wonky, and never have seen the consultant who I saw today.
Today's consultant (who says if I want to drive before the operation, I can do, as long as I am not in discomfort and promise not to crash) assured me that I would not have fallen thorugh the NHS net (?????) but who knows? Anyway, he was a very decent guy and I am very glad indeed it will be him doing the honours on Saturday.
So, thanks to all who replied, but especially to Motco and his son. My consultant was very surprised indeed at my highly unorthodox PistonHeads diagnosis, but said that the diagnosis was done by someone who clearly knows their stuff and was absolutely spot on.
Thanks again and I'll report back next week!!!
Not as impressive as Howitzer's but still pretty good!
Hurt like fook for a few days after the op but settling down a bit now. Still another month of no driving and the whole thing has had massive implications on sports, social life, fitness, and of course targets and earnings as I'm a home based IT sales person. Ho hum.
Still, glad it's on the mend and thanks again to y'all, especially Motco and his son!
Hurt like fook for a few days after the op but settling down a bit now. Still another month of no driving and the whole thing has had massive implications on sports, social life, fitness, and of course targets and earnings as I'm a home based IT sales person. Ho hum.
Still, glad it's on the mend and thanks again to y'all, especially Motco and his son!
and see what he says. Glad it is sorted (potentially) and hope it will resolve totally soon. 
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