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Clavicle ORIF with nonunion questions

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I had surgery 8/11/2015.  I have attached 4 xrays.  The latest in October.  It doesn't look to be joined together.  The doctor has now prescribed an Exogen bone growth stimulator.  My deductible starts all over again next year.  Doctor said lets look at it again in December with another Xray.  I don't smoke and am 32 years old.  He suggested maybe needing a bone graft if it doesn't  heal and have to do surgery again.  I will also post the injury xray.  The clavicle was displaced 3 CM and comminuted.  Any thoughts or similar occurrences from anyone else?   DR Mark opinion?  The xrays in October was done with a different machine which I thought showed more clarity than before.

 

Has anyone else had to go back and get a bone graft?  most of the pictures are at a 15 degree angle from the xray machine.  The one in october shows the xray straight on so he butted the bones against each other I'm thinking.

 

Note the 4th xray is shot straight at me.  The first 3 xrays are at a 15 degree cephalic angle.  The 3rd and 4th xrays are the same day but just at different angles

 

Xray 1 8/17/2015

Xray 2 9/14/2015

Xray 3 10/26/2015

Xray 4 10/26/2015

 

 

08172015.jpg

09142015.jpg

10262015 15 degrees.jpg

10262015.jpg

Original Broken Clavicle.jpg

Edited by ruthlesz

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The next to last pic looks like some growth, I'm no Dr though. I had my roughly 6month appointment today. The last 2 are the xrays are from today. He said I dont need to come back, he says not fully healed but on its way. He also said plate can stay, It doesnt bother me, I am just still kinda numb / weird feeling in a few tiny spots. I guess it is what it is. I just ride a little slower ( still a little gun shy) Good luck on yours, I sure as Sh$t dont wanna go thru this again

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2.jpg

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Yeah the 3rd and 4th xrays are the same day but at different angles.  I have those numb spots also.  Do you have any more xrays throughout your check up period?

 

I thought our clavicles are suppose to be healed at the 3 month mark.

Edited by ruthlesz

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I have had no luck at all with the Exogen.  It just isn't worth a dam to getting the bone healed.

This clavicle is not healed, and needs to be bone grafted and compressed. It needs to be done by someone who does this stuff all the time.

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I have had no luck at all with the Exogen.  It just isn't worth a dam to getting the bone healed.

This clavicle is not healed, and needs to be bone grafted and compressed. It needs to be done by someone who does this stuff all the time.

Do you think I should wait one more month?  I was operated on 8/11/15.  Right now I don't have any pain, but I also don't do anything with that arm since it is not healed.

Edited by ruthlesz

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I never recommend that people who don't have pain have surgery.  And that doesn't matter what the X-ray looks like.

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Any updates on this?

 

I still worry I have a non-union. In the x-rays I can still see a faint black outline of the original crack line. I don't know if this is normal but I figured after 4 months it would be filled in completely and you shouldn't be able to see it.

 

Yours looks like a huge gap there. 

 

Are you able to do everything you have done before?

 

If you push on your collar bone really hard do you feel any pain? My bone felt pretty solid at about 4 weeks. 

 

I am back to almost 100%, and lifting heavy weights for a while now without any issues. I'm actually trying to do everything I can to stress my collar bone to see if it is maybe a non-union. 

I hope this is a sign that it isn't a non-union but I heard the only way to tell for sure is if I got a bone cat scan.

 

Here is my last Xray at around 3.5 months. I had a pin put in and not a plate but you can still see a crack line on mine. It doesn't seem it has changed much from the xray I took 5 weeks before this.

 

I'm going to wait 10 weeks from this last xray to hopefully see it fill in or some change.

 

Oh well.

 

collar%20bone%202_zpsdisswq8f.png

 

collar%20bone_zpsmftav94n.png

Edited by Question Man

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Now you are asking me?

 

 

When a fracture appears to be healed on ordinary X-ray imaging, it still may be unhealed on more advance study like CT

When a fracture appears not to be healed on ordinary X-ray imaging, it is unquestionably not healed, on any advanced study.

 

You should visit your doctor.  Since he installed that device, and you are an educated consumer, the two of you will come to the right decision.

Edited by DrMark

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Isnt this the asshat who was pedaling his new fixation goods here?

Edited by hackman162

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Isnt this the asshat who was pedaling his new fixation goods here?

Yeah I was the asshat who you all thought worked for the company and was trying to sell you sophisticated dirt bike riders a special type of surgery, LOL.

 

Other then the questionable bone union, which I have not seen the original doctor about, everything actually went well. No numbness anyplace, scar is hardly visible, full strength in shoulder. 

 

I just don't honestly know what should be seen in the xray at 3.5 months when the last one was taken. I'm lifting heavy weights for over a month now, heavy benchpress, shrugging over 200 lbs often and everything feels stable so I would be surprised if the hardware is the only thing still holding the collar bone in place.

 

But as you can see from the picture the bone is in perfect alignment and hasn't moved, and the device has pulled the two halves on the bone together tightly. The crack line that you can see has not gotten any larger either. 

 

Because I can't find anything on the internet about how xrays should look when you have hardware installed I don't know what to expect. When you have hardware the bone actually makes union more slowly than without because you usually don't form any callus. The bone heals only by I believe what they call direct bone healing a very slow process.  I also have seen pictures on the internet that show the bone healing and you can still make out the crack line.

 

There is a chance that what the x-ray is showing is normal progress at 3.5 months, but I honestly don't know. Maybe it didn't make union or partial union and stopped healing.

 

Is the hardware to blame in these instances? I doubt it because from the different xray the bone has not moved at all and is still in perfect alignment and pulled close together. Take a look at the plate installed in the first post from the guy using the plate, you can see how much black gap that left between the two bones because the devices doesn't pull the ends together tightly like my hardware. 

 

At this point there is nothing I can do as I have to give it a year to see if it heals up so I'll just have to cross my fingers.

 

If the bone has not made proper union it is probably my body to blame above all. I still highly recommend the Sonoma Crx (There it is I said the name, LOL)over a plate any day. When this bone finally shows healing, the hardware is easily removed while I'm awake with a tiny incision and the bone has almost full strength so no downtime. Because of the small incision I don't have any nerve damage now, which was the most important thing for my surgery.

 

I still have faith in the Sonoma CRX and that my bone is still healing as we speak.

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Well, I for one, would rather have a scar that chicks dig and a perfect union...

 

I still got hope. I'm going for an xray in a few weeks that will show 10 weeks of progress from my last x ray, which was taken at 3.25 months after surgery. Fingers crossed that it shows some improvement in the fracture line. 

 

I wonder if a possible issue may be that the Sonoma CRX is actually too rigid, and may actually work too well and not allow any movement of the bone. Kind of exact opposite of what Dr Marks thought of the device. It seems the plates may not be as stable and actually allow some micro movements which help healing. This is why I may be able to lift heavy weights without any issues even though the bone may not have healed. When the anchors of my device open up they actually pull the two pieces of the bone together tightly.

 

 

The other issue in delayed healing is my doctor used a synthetic bone graft which I believe he uses on most of these surgeries now. I believe as I can't find any research on the subject is that using a bone graft may actually cause slower bone healing but will eventually have a higher success rate in healing.

 

Time will only tell. Unfortunate my doctor who did the surgery is out of state and I can't visit him for a follow up. 

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Again, you have misquoted me.

Intramedullary devices typically do not offer the rigidity of the plate and screw construct, particularly in rotaton.  This includes the device that has been implantd.

 

Plate and screw constructs can be modified from the the ridgid situation to some flexability by omiting a screw hole or two on both sides of the fracture.  About 12% strain is ideal for bony healing.  You see too rigid a construct without intrafragmentary compression is also instrumental in nonunion occurrence.

 

So to get the bone to heal, you can get primary bone healing with intrafragmentary compression and absolute stability AND YOU MUST HAVE BOTH OR NONUNION IS GUARANTEED

-or-

Flexible fixation with no more than 12% strain for secondary bone healing with callus

 

​The Sonoma implant installation is not modifiable, and what you see is what you get.  Other constructs such as plates and screws can be utilized as the situation demands to offer absolute, or relative stability.

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I have my 10 week comparison Xrays. Taken at around 4 months and 6 months after surgery. 

 

BELOW is most recent FEB 2016 XRAY

jan%20xray%202_zps1rnnbr7n.png

BELOW is Nov 2015 Xray

collar%20bone%202_zpssdke4u7z.png

 

Looking at these two circled points in the most recent xray below it looks like the bone is still healing. Top part looks to have filled in the crack line and grown taller in that area. 

The bottom circled gap part is also getting smaller. I used to be able to feel that gap at the bottom with my finger, now I can't feel the gap. This happened during the last two months. 

jan%20xray_zpswujjxmdx.png

 

Below is Xray taken 10 months ago to compare with the xray picture above the areas that filled in. 

nov%20xray_zpsb9b44dm4.png

 

 

To me it looks like the bone is still slowly healing, even after my surgery in August. The bottom of the bone felt differently also, I used to feel the sharp edge and now I can't. 

 

Xray images were taken very slightly off but using the screw as reference it is close enough and shouldn't change results. I don't think you can ever get two xrays perfect.

 

I'll have to get xrays in a couple of months and hope to still see more improvements. I've been hitting the weightlifting  as heavy and hard as possible to try and stimulate the bone to heal.

 

I assume primary bone healing takes a very long time, but does it take this many months?

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Doc says I'm healed.  Here is mine a week ago.  Looks like we both had surg. at same time in August.  Good luck.

20160210_095057.jpg

Edited by ruthlesz

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Doc says I'm healed.  Here is mine a week ago.  Looks like we both had surg. at same time in August.  Good luck.

 

 

Hey wait a second, that Xray you posted is the same angle as your first post xray that also looked healed, I believe it was a straight shot.

 

I want to see see a 15 degree cephalic angle xray! The same one that shows the large cracks and gaps in your first post. 

 

The xray you just posted is the same as the 4th xray in your first post, both look healed.

 

 

 

 

Have you used the exogen bone simulator? If so how long did you use it for? 

Edited by Question Man

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Hey wait a second, that Xray you posted is the same angle as your first post xray that also looked healed, I believe it was a straight shot.

 

I want to see see a 15 degree cephalic angle xray! The same one that shows the large cracks and gaps in your first post. 

 

The xray you just posted is the same as the 4th xray in your first post, both look healed.

 

 

 

 

Have you used the exogen bone simulator? If so how long did you use it for? 

 

 

Yeah I used it.  I'm going to sell it in 6 more weeks.  Dr said to continue to use it.  I started to use it around the october time frame when those xrays were taken.  Preinsurance price is like 4500$ (good thing I had it).  I'm going to get mine refurbished back at the factory and its going on Ebay.  I seen a few sonoma's get taken out on this website here and replated.  I hope you don't have to do that.  Bad thing about yours is the straight on shots show a nonunion at 6 months.  I'd hate to see at 15 -25 degree xray.

http://www.drdavidduckworth.com.au/case-study/clavicle-case-study-18

 

If you like to look at xrays- look on that website.

20160210_095116.jpg

Edited by ruthlesz

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Got my Sonoma Pin removed this week, around 8 months. I was a bit worried because one X-ray still showed a bit of a crack line, but I read x-rays aren't 100%.

 

It made sense anyway that my bone healed long ago because it felt very solid and I was weight lifting for a while now.

 

I'm happy to have the hardware out. This was a big benefit of getting the pin because it was very easy to take out and all I have is a tiny incision to heal. No risk of nerve damage also.

 

The last xray before taking it out you can see a little crack line at the bottom. I can actually feel that crevice through the skin. Xrays can be deceiving. 

 

4%201%2016%20straight_zpsltlc4qeq.png

Edited by Question Man

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It started out straight.  The fixation failed and it healed crooked.  Look at the angulation and compare it to the X-ray of Dec 2015.

 

I probably would be slammed all over the internet and at the courthouse if one of mine turned out that way. I will admit you are an honest man for showing  this. 

 

But now a year later, I will continue performing anatomic reductions and plate fixation.

 

Satisfaction.

Edited by DrMark

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DrMark, yes I wonder if that happened. By comparing Xrays it seems to have bent up a little bit. This was after I hit the weights heavy.

 

I don't know if it grew at the top to make it look like that, or maybe the xray angle is just a bit different.

 

Either way, I'm just happy to have it out and have it healed. Maybe the reason it finally healed was because it failed and healed with a callus. I never felt any pain or anything that would lead me to believe it failed.

 

Because of the way my clavicle was shaped I had to have the pin poking the top of my shoulder and tenting the skin slightly, and it was very irritating. I'm happy to have it out.

 

I'm going to try and figure out if it really did bend up. 

 

And you bet I am worried how healed it is. Definitely going to go easy on it for a while. No way I'm touching any weights. 

Edited by Question Man

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