Post-Operative Issues After Distal Clavicle Surgery: What to Expect

Postoperative Issues Following Remote Clavicle Surgery

Hello doctor, I was in a car accident at the end of March, and at that time, I was diagnosed with a distal clavicle fracture (the farthest part from the throat).
After surgery, where the doctor fixed it with a titanium alloy plate, my follow-up X-ray one month post-operation looked normal.
However, after starting rehabilitation about a month later, I lifted objects at home weighing around 10 kilograms, and afterward, my shoulder felt very uncomfortable.
During my second follow-up two months later, an X-ray revealed that the fracture site had shifted downward by 0.5-1 cm.
The doctor mentioned that with the plate in place, it should be relatively safe, but advised me to be more cautious.
I am currently hesitant to lift objects or continue rehabilitation.
Do you think I will need a second surgery? Additionally, since the surgery, I have occasionally experienced sharp pain and numbness below the wound, which has not improved in two months.
I have consulted a neurologist for electromyography treatment and will continue with that.
Aside from this, I have no other discomfort.
Will there be any issues with removing the plate in the future? Thank you.

Mǎxiū, 40~49 year old female. Ask Date: 2023/05/23

Dr. Chen Yongxue reply Orthopedics

Hello, to regain full mobility after a fracture, it typically takes at least three months.
You may have started bearing weight too early, which increases the risk of a second surgery.
Unless there is significant displacement, it is common to experience numbness below the surgical site after the procedure.
This is a normal occurrence following surgery.
Thank you.

Reply Date: 2023/05/23

More Info

After distal clavicle surgery, particularly following a fracture, patients can expect a variety of post-operative symptoms and challenges. Your experience of discomfort and the subsequent displacement of the fracture site is not uncommon, especially after engaging in activities that may strain the healing bone. Here’s a comprehensive overview of what you might expect and some recommendations based on your situation.

Post-Operative Expectations
1. Pain and Discomfort: It is normal to experience pain and discomfort in the shoulder area after surgery. This can be exacerbated by physical activities, especially if they involve lifting or moving heavy objects. The pain you are feeling, particularly after lifting a 10 kg object, suggests that the shoulder may not yet be fully healed or that you may have aggravated the area.

2. Nerve Sensations: The tingling and occasional sharp pain you describe below the surgical site may indicate nerve irritation or damage, which can occur during surgery. This is often temporary, but if it persists, it may require further evaluation by a neurologist or an orthopedic specialist.

3. Bone Healing: The fact that your X-rays showed a downward displacement of 0.5-1 cm after two months is concerning. While the titanium plate provides stability, any movement of the fracture site can complicate healing. The surgeon's reassurance that the plate should keep the bone secure is a positive sign, but it is crucial to follow their advice regarding activity restrictions.

Recommendations
1. Activity Modification: It is essential to avoid lifting heavy objects and to limit activities that could stress the shoulder joint during the healing process. Follow your doctor's advice on rehabilitation exercises, focusing on gentle range-of-motion activities rather than strength training or heavy lifting until you receive clearance.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can guide you through exercises that promote healing without risking further injury. They can also help you strengthen the surrounding muscles, which may alleviate some discomfort.

3. Monitoring Symptoms: Keep a close watch on your symptoms. If the pain worsens, or if you experience significant swelling, bruising, or changes in sensation, it is crucial to contact your healthcare provider. These could be signs of complications that may require intervention.

4. Surgical Considerations: Regarding the possibility of needing a second surgery, this will depend on the stability of the fracture and the healing process. If the bone continues to shift or if there are signs of non-union (where the bone fails to heal properly), your surgeon may recommend surgical intervention to realign the bone or to remove the plate if it is causing issues.

5. Plate Removal: The removal of the titanium plate is a common procedure once the bone has healed sufficiently. Most patients do not experience significant issues post-removal, but it is essential to discuss any concerns with your surgeon. They will assess whether the plate is causing discomfort or if it is necessary for continued stability.

Conclusion
In summary, while some discomfort and nerve sensations are expected after distal clavicle surgery, significant changes in the position of the fracture site warrant careful monitoring. Adhering to your doctor's recommendations, engaging in appropriate rehabilitation, and maintaining open communication with your healthcare team will be vital in ensuring a successful recovery. If you have any doubts or if your symptoms change, do not hesitate to seek further medical advice. Your health and recovery are the top priorities.

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