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Clavicle Screw Migration

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I broke my right clavicle 8 weeks ago after ATV accident. Break was in the middle. The bone was offset 100% Had surgery to repair 7 weeks ago with plate and 8 screws. 6 screws on top of plate and two located on side to repair horizontal fracture. Two week x-ray all good - all in place. Just had 6 week xray and two of the screws on the shoulder have started to migrate out slightly +/- 10-15% - now have slight gap on top of the clavicle - looks like plate bent slighty ??. The outside screw is completely in place. My range of motion is great and have no pain. Performing range of motion execercises as prescribed by doctor two or three times a day. I did have a clicking popping sound +/- 2-3 weeks ago but has not happened again. Doc has ordered bone stimulation machine and also told me to limit activity as much as possible. Do not want to go through surgey again - any advise or comment on migration - how concerned should I be.

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Just had 6 week xray and two of the screws on the shoulder have started to migrate out slightly +/- 10-15% - now have slight gap on top of the clavicle - looks like plate bent slighty ??. The outside screw is completely in place. My range of motion is great and have no pain. Performing range of motion execercises as prescribed by doctor two or three times a day. I did have a clicking popping sound +/- 2-3 weeks ago but has not happened again. Doc has ordered bone stimulation machine and also told me to limit activity as much as possible. Do not want to go through surgey again - any advise or comment on migration - how concerned should I be.

Doc will say post the x-rays.

I wonder if your screws are pulling out of the bone. I have the good fortune to have had that happen. the original doc used a plate that was too short and the screws were too close to the fracture zone. I ended up flying to houston to get it fixed by dr mark.

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Dr. Mark - Thanks for the reply - going to pick up x-rays after work. They do not have them digitally. Will I be able to scan??

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Dr. Mark - Thanks for the reply - going to pick up x-rays after work. They do not have them digitally. Will I be able to scan??

That depends on your technical savvy and equipment. I know some folks have done ok taking a digital photo of the xrays.

Hard to believe anyone is still using old-school xray film. Even here in idaho we are digital.

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There is a loose screw sitting in scar tissue-not bone.

If it doensn't hurt, I can't imagine redoing the whole thing, but my guess is that the plate will break soon, and then you will have no choice.

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Any advice on not breaking the plate - Should I hope for the bone to heal and stay very inactive? Iam supposed to return for another x ray in two weeks - if continues plate continues to bend should I have another surgery to repair. What is you opinion on the quality of the job or did I possibly due to much prior to bone healing ?

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To me the biggest problem is the screws that were placed not through the plate. To place those screws, requres signifigant stripping of the muscle off the bone. Bone is a living tissue, not stone. By stripping the muscle off the bone, the bone loses is blood supply and dies. That makes healing take forever, like Madday's.

The secondary problem is too many screws too close to the fracture, making the working length of the plate too short. For example, I always leave three or four screw holes unfilled adjacent to the fracture.

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They were, but it would have been better to just bridge those fragments, rather than remove their blood supply.

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Thanks for your opinion. Any advice on not breaking the plate - Should I hope for the bone to heal and stay very inactive? Iam supposed to return for another x ray in two weeks - if plate continues to bend or screws migrate should I have another surgery to repair prior to break. What is you opinion on the quality of the job or did I possibly do to much prior to bone healing ? Do I have any chance of healing w/ the current arrangement.

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A plate is usually good for four to six months. If its not healed by then, then you should have it changed out bone grafted.

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whats with the screw going right into the fracture sight....thru the plate...

By bridging the fracture sight and fdoing a bone graft...the fracture sight continues to get its blood supply and allows for some flex in ht CB...by having screws in every whole right on top of the fracture site makes the CB very stiff...no flexibilty so I believe it tends to put a lot of stress o those screws and since it takes some time to heal the screws work themselves loose...I hope the best for you and maybe it will heal the way it is.....I AM NO DOCTOR and the doc can tell me if I am wrong anything I have said...

Hey doc when becoming an ORTHO is there not standards on HOW to fix bones and such? I mean to sla a plate on top of a fracture works if it is a made out of wood but bones are not wood....I would think that most clavicles repaired should all ,ook close to the same....

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Dr Mark if I have any problem w/ my recovery from here I will be giving your office a call for appointment. I work near your office in Houston. Iam impressed from the positive comments from everyone on how you run your practice. Wish I would have done more research prior to my first surgery.

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