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Question for Dr. Mark --> question regarding my clavicle plating

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Dr. Mark --

 

On March 27, 2014, I had ORIF of my left clavicle with bone graft from my proximal tibia. (I had a longstanding clavicle nonunion following a dumb fall from a motorcycle 20 years ago.)

 

I have been in PT since one week after surgery. But the pain in the distal part of my clavicle is increasing (with a burning, stabbing pain) with increasing swelling and heat. Went back to my surgeon, who said it looked like one of the screws might be in the AC joint. But more importantly, it looked to both of us that the plate was bent, with a broken bone fragment extending below the surgical site.

 

I had a CT scan on Friday. The radiologist's overall impression is "virtually normal postoperative study." But he also notes that the fracture is still visible and says nothing about screw placement. (In fairness to the radiologist, my surgeon had only asked that the study "evaluate fracture geometry.")

 

In any case, one of the screws appears to be in the AC joint. And the bone does not appear to have healed at all.

 

I have attached a few relevant images for your consideration. I would appreciate hearing your thoughts about what I should do next. My shoulder is hurting more and  more each day.

 

Thanks in advance, Dr. Mark.

 

- b

 

 

 

 

 

 

 

 

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The fracture hasn't done anything toward healing. If it still hurts, then it is either unstable or infected. Whether or not there is an aberrant screw is not an issue.

Necessary are blood tests for vitamin D deficiency, and markers for infection. Any tobacco products, including the E-cigarette, as well as second hand smoke must be avoided like the plague.

More than likely revision of the fixation with two plates is necessary.

It may be time seeing another doctor.

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Dr. Mark --

 

Thanks so much for your quick reply.

 

Your answer confirms my suspicion. The clavicle does not feel stable. When I move my arm a certain way, I can feel a "ca-chunk," reminiscent of how it felt when it was a frank non-union.

 

I will see the original surgeon in the next day or two and ask for the blood tests you describe. If it's an infection, I will take the necessary antibiotics to clear it up. And then see if I can come see you in Houston.

 

If I need revision surgery, would you expect I'd need another bone graft? If so, would you just take it from the contralateral leg? (I suspect you wouldn't go back to the same donor site.)

 

Thanks again.

 

- b

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Antibiotics do not cure an infection of this type.  Surgical debridement is necessary, and also stabilization of the fracture. Vitamin D levels and some other tests must be done.  The bone graft is not on the menu at this point in time.

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