Complications After Multiple Clavicle Surgeries: A Patient's Journey

Open fracture of the clavicle, third surgery?

Hello Doctor,
At the end of March this year, I fractured my right clavicle while skiing in Japan and returned to Taiwan for treatment.
After reviewing the X-rays, the doctor recommended surgery but did not explain how the procedure would be performed.
Ultimately, a Knowles pin was inserted.
After the surgery, I noticed that the pin was too long and could be felt at both ends.
The doctor initially found this strange, and after I mentioned that I had previously fractured it without surgery, he quietly stated that this situation usually requires a plate for stabilization.
He then reassured me that it would still heal.

During follow-up visits, the doctor informed me that the pin could remain for 1 to 2 years without issue, but later changed his mind and insisted it needed to be removed.
Since I had to travel abroad for work, I asked the doctor when the earliest possible removal could be.
In early June, after reviewing the X-rays, he told me to come back at the end of the month for the removal.
No X-rays were taken before the second surgery to confirm anything, and the procedure was carried out.

After the second surgery, the doctor informed me that the bone would still be unstable after the pin removal, so he reinserted another Knowles pin and added some artificial bone grafting.
He then asked me to modify the consent form and mentioned that the direction of the new pin would be weaker, advising me not to move it around.
I followed his advice and kept my arm elevated for over a month.

Later, I began to lower my arm, but I experienced pain in the elbow area upon waking up each day.
Two months later, I still couldn't raise my arm above 90 degrees, and it was difficult to fasten my bra.
The recovery progress was significantly slower compared to the first time, prompting suggestions to change doctors.

The new doctor recommended replacing the pin with a plate and using autologous bone grafting, or we could wait until next March to confirm if the bone would heal properly.
For now, we decided to schedule the surgery.

I would like to ask the following questions:
1.
Is this situation a result of the doctor's misjudgment?
2.
Is it legal to change the surgical plan after the initial surgery?
3.
Will recovery after the third surgery take longer than before?
4.
Can rehabilitation begin immediately after surgery?
5.
What does rehabilitation generally involve?
6.
Is there an estimated timeline for a complete return to normal function?
7.
What level of recovery can I expect after three months?
8.
I currently have noticeable shoulder asymmetry (left higher, right lower, with the injured side lower); is this normal? Can it be corrected later?
9.
Will undergoing multiple surgeries increase the likelihood of future complications?
10.
After spending five months at home recovering without improvement, I have many questions.

Thank you for your assistance!

A-Wen, 30~39 year old female. Ask Date: 2017/08/27

Dr. Li Yongheng reply Orthopedics

Dear Ms.
Awen,
Based on your condition, it appears that you are experiencing poor fracture healing following your clavicle fracture surgery.
Therefore, a revision surgery for internal fixation with a plate and autologous bone grafting is necessary.
After the surgery, rehabilitation should not commence immediately; you will need to use a sling for 4 weeks.
Currently, there is a noticeable asymmetry in the appearance of your shoulders, likely due to improper posture.
Once the pain subsides and the sling is no longer needed, the height discrepancy of your shoulders will typically resolve.

Having undergone multiple surgeries increases the risk of complications, such as nonunion of the fracture or wound infections.
Therefore, it is important not to rush the recovery process and to attend regular follow-up appointments.
Wishing you a speedy recovery.

Reply Date: 2017/08/27

More Info

After undergoing multiple surgeries for a fractured clavicle, it is understandable that you have numerous concerns regarding your recovery and the potential complications that may arise. Let’s address your questions systematically.

1. Surgeon's Judgment and Surgical Decisions
It is not uncommon for surgeons to reassess their approach during a procedure based on what they observe. However, any significant changes to the surgical plan should ideally be communicated clearly to the patient beforehand. If the surgeon initially indicated that a certain method (like using a Knowles pin) was appropriate but later suggested a different approach (like using a plate), it raises questions about the initial assessment. While it is legal for surgeons to modify their surgical approach based on intraoperative findings, they should ensure that patients are informed and consent to any changes.

2. Recovery Time After the Third Surgery
Recovery after a third surgery can vary significantly depending on several factors, including the extent of the surgery, the patient’s overall health, and adherence to rehabilitation protocols. Generally, multiple surgeries can lead to longer recovery times due to increased tissue trauma and potential scarring. It is essential to follow your new surgeon's recommendations closely to optimize healing.

3. Rehabilitation Post-Surgery
Rehabilitation should ideally begin as soon as the surgeon permits it, which may vary based on the specifics of your surgery. Early rehabilitation can help prevent stiffness and improve range of motion. The rehabilitation program typically includes:
- Range of Motion Exercises: Gentle movements to maintain flexibility.

- Strengthening Exercises: Gradually increasing resistance to rebuild strength in the shoulder and arm.

- Functional Training: Activities that mimic daily tasks to help regain independence.

Your physical therapist will tailor the rehabilitation program to your specific needs and recovery stage.

4. Expected Recovery Progress
Three months post-surgery, many patients can expect to regain some range of motion and strength, but this varies widely. You may not achieve full range of motion or strength immediately, especially after multiple surgeries. It is crucial to have realistic expectations and to communicate regularly with your healthcare team about your progress.

5. Shoulder Asymmetry and Correction
Having a noticeable difference in shoulder height (high-low shoulder) can occur after clavicle surgery, especially if there has been significant trauma or multiple surgeries. While some asymmetry may improve with rehabilitation, persistent differences may require further evaluation. In some cases, corrective procedures can be considered if the asymmetry affects function or causes discomfort.

6. Long-term Effects of Multiple Surgeries
Undergoing multiple surgeries can increase the risk of complications such as chronic pain, stiffness, and potential issues with bone healing. However, many patients can still achieve satisfactory outcomes with proper rehabilitation and care. It is essential to maintain open communication with your healthcare providers about any concerns you have during your recovery.

Conclusion
Navigating recovery after multiple surgeries can be challenging, and it is normal to have questions and concerns. It is advisable to seek a second opinion if you feel uncertain about your current treatment plan. Ensure that you are actively involved in your rehabilitation process and communicate any issues with your healthcare team. With time, patience, and appropriate care, many patients can achieve significant improvements in function and quality of life after such procedures.

Similar Q&A

Complications After Clavicle Surgery: What to Do When Pins Fail?

Hello, I would like to ask a question. My friend had clavicle screws inserted a year ago (or opted for better screws at their own expense). After the surgery, they were only given a sling for support, without a figure-eight bandage. They have been returning for regular check-ups,...

Dr. Shi Guozheng reply Orthopedics
After the fixation of a fracture, there may be instances where, after a period of time, the removal of the bone screws can lead to a re-fracture, which may require another surgical procedure for improvement.

Understanding Clavicle Issues: Pain After Multiple Surgeries Explained

Last March, I had surgery for a distal clavicle fracture due to a car accident. In June, I underwent a second surgery for ligament displacement, and this February, I had a third surgery because of an allergy to the metal plate. Is it normal to still experience tingling at the sur...

Dr. Li Yongheng reply Orthopedics
Last March, you underwent surgery for a distal clavicle fracture due to a car accident. In June, you had a second surgery because of ligament displacement, and this February, you had a third surgery due to an allergy to the metal plate. This indicates that your recovery process h...

Post-Surgery Complications After Clavicle Fracture: What to Expect

Hello Dr. Lee, On July 9, I fell off my bike and fractured my left clavicle. Although it was a comminuted fracture, the doctor recommended conservative treatment with a figure-eight strap for stabilization. Aside from some inconvenience in movement, I experienced no discomfort o...

Dr. Li Wenlin reply Orthopedics
Hello, In response to your question, it is reasonable to still feel some discomfort one week after surgery on September 15th. This is because the procedure involves incising the skin, separating the fascia and muscles, and carefully detaching the scar tissue around the fracture...

Post-Surgery Complications: Persistent Hematoma After Clavicle Fracture Repair

A 20-year-old male sustained a comminuted fracture of the clavicle due to a motorcycle accident. He underwent surgery with a self-paid titanium clavicle plate. Five days post-operation, the wound continued to exhibit serosanguinous drainage (bruising). Since it was outside of reg...

Dr. Shi Guozheng reply Orthopedics
If there is bruising coming from the wound, it is necessary to change the dressing and keep it clean to prevent infection. Typically, the wound will heal within seven to fourteen days.