Old Clavicle Fractures: Surgical Risks and Treatment Options

Q: Old Clavicle Fractures: Surgical Risks and Treatment Options

Dear readers： Whether a clavicle fracture requires surgical treatment can vary among physicians. <br>The benefits of surgery include proper alignment and stabilization of the fracture, which can shorten the duration of pain and allow for earlier rehabilitation. <br>However, there

I have an old fracture issue with my left clavicle?

I was involved in a car accident on April 29 of last year, which resulted in dislocation of the sternum in the left chest area, particularly at the junction of the left neck and the first clavicle, where the ligaments are protruding upwards, causing the first clavicle to also shift outward.
The left neck meridian has also been displaced.
X-rays showed a noticeable height difference between the two clavicles.
I have consulted many orthopedic doctors, and none recommended surgery to reposition the clavicle and the protruding left neck meridian, opting instead for conservative treatment.
However, nearly a year has passed, and while the left neck meridian has become somewhat more relaxed, I still experience a sense of pressure.
Additionally, the ligaments at the junction of the left neck and the first clavicle are still protruding, causing pressure on my neck and occasional pain, along with muscle soreness and weakness in my left arm, which appears to be atrophying.
Recently, I consulted two different orthopedic doctors at the same hospital, and they presented two differing opinions.
The first doctor maintained the same view as previous doctors, recommending conservative treatment with medication and injections, and advised against surgery due to the chronic nature of the clavicle fracture, suggesting that the bone has formed a callus.
The second doctor was more thorough, stating that the displacement of the clavicle ligaments and the uneven height of both sides, along with the significant displacement of the left neck meridian, indicated that surgery should have been performed right after the accident.
He noted that the delay has resulted in the formation of callus around the bone, and given the persistence of my symptoms for nearly a year, surgery is necessary to properly reposition the structures.
I am inclined to follow the second doctor's recommendation for surgical intervention to redo the repositioning.
However, he will be out of the country for over a month for further training, and he advised me to return for a follow-up consultation and surgery upon his return.
Since the doctor is abroad, I have some questions that remain unanswered:
1.
My left neck meridian is displaced due to the chronic clavicle fracture, with the ligaments at the junction of the left neck and the first clavicle protruding and forming a callus around the bone.
This area contains important nerves and blood vessels related to the heart.
Previous doctors have warned that surgery could be very dangerous; if a nerve or blood vessel, especially near the heart, were accidentally severed, it could pose a life-threatening risk.
Therefore, they advised me to adapt to the situation and avoid surgery, suggesting that it might be better not to operate at all.
If successful, surgery could restore the original appearance, but if it fails, it could severely jeopardize my life.
2.
The second doctor briefly addressed my concerns, stating that if the displaced clavicle fracture does not cause pain or a sense of pressure, and if the left neck meridian is not tight and can move naturally, surgery may not be necessary.
However, given my situation, I still experience tightness and pressure, suggesting that surgery might be the better option.
Although it is a chronic clavicle fracture with callus formation, the complexity is higher now, but careful and meticulous surgery could address all dislocations, including the repositioning of the left neck meridian.
Currently, with the doctor out of the country, I have over a month of hesitation.
I am genuinely afraid of undergoing surgery, as previous doctors have indicated that the chronic fracture with callus formation presents a high level of difficulty, especially since the injured area involves critical heart-related nerves and blood vessels.
However, if I do not have surgery, I continue to suffer discomfort, and I am a perfectionist who is distressed by the visible protrusion of the bone and ligaments at the junction of my left neck and shoulder, as well as the displacement of the neck meridian.

Having consulted numerous doctors in various hospitals, I want to understand clearly: is surgery truly very dangerous for me? Yet, given my current condition, is surgery unavoidable due to the discomfort? I kindly request your prompt advice on my situation.

Fanrao de Song, 30~39 year old female. Ask Date: 2006/03/20

Dr. Chen Xingyuan reply Orthopedics

Dear readers: Whether a clavicle fracture requires surgical treatment can vary among physicians.
The benefits of surgery include proper alignment and stabilization of the fracture, which can shorten the duration of pain and allow for earlier rehabilitation.
However, there are risks associated with anesthesia and the surgical procedure itself.
In your case of an old left clavicle fracture, the necessity for surgery depends on the severity of your symptoms and whether the surgery can meet your expectations.
This should be thoroughly discussed with your attending physician.
Any surgery carries significant risks that should not be taken lightly.
Although surgery for an old clavicle fracture can be more challenging and complex, with a higher likelihood of complications, the chances of life-threatening issues are relatively low.
It is the physician's responsibility to inform the patient of any risks associated with anesthesia and surgery, and the necessity of the procedure should be decided after a detailed discussion with your doctor.
Wishing you health and safety! Sincerely, Dr.
Chen

Reply Date: 2006/03/20

More Info

Understanding old clavicle fractures, especially in the context of surgical risks and treatment options, is crucial for making informed decisions about your health. Your situation, following a car accident that resulted in a displaced clavicle fracture, presents a complex clinical picture that requires careful consideration of both conservative and surgical treatment options.

Firstly, it’s important to understand that clavicle fractures, particularly those that are displaced, can lead to complications if not treated appropriately. The clavicle serves as a critical connection between the arm and the body, and its proper alignment is essential for shoulder function. In your case, the displacement and the associated symptoms, such as pressure sensations in the neck and shoulder pain, indicate that the fracture may not be healing correctly.

The two orthopedic opinions you received reflect a common dilemma in managing old fractures. The first physician's recommendation for conservative treatment suggests that they believe the risks of surgery outweigh the potential benefits, especially given the chronic nature of your injury and the presence of surrounding soft tissue changes (like the "meatball" formation you described). Conservative management typically includes physical therapy, pain management, and monitoring for any changes in symptoms.

On the other hand, the second physician’s inclination towards surgical intervention is based on the ongoing symptoms you are experiencing, which suggest that the fracture may still be causing significant functional impairment. Surgery could potentially realign the clavicle and relieve pressure on surrounding structures, including nerves and blood vessels. However, as you noted, surgery carries inherent risks, particularly in the context of your specific anatomy and the proximity of critical structures.

Regarding the surgical risks, the primary concerns include:
1. Infection: Any surgical procedure carries a risk of infection, which can complicate recovery.

2. Nerve and Vascular Injury: Given the location of your injury, there is a risk of damaging nearby nerves or blood vessels during surgery, which could lead to serious complications.

3. Nonunion or Malunion: There is a possibility that the bone may not heal properly after surgery, which could necessitate further interventions.

4. Anesthesia Risks: As with any surgery, there are risks associated with anesthesia, particularly in older patients or those with pre-existing health conditions.

In weighing these risks against the potential benefits of surgery, it’s essential to consider your quality of life. If conservative treatment has not alleviated your symptoms and you continue to experience pain and functional limitations, surgery may be warranted despite the risks.
It’s also worth noting that surgical techniques have advanced significantly, and many orthopedic surgeons are adept at managing complex cases like yours. If you choose to proceed with surgery, ensure that you discuss all your concerns with your surgeon, including the specific risks related to your anatomy and the surgical approach they plan to use.

In conclusion, while the decision to undergo surgery for an old clavicle fracture is complex and fraught with risks, it may ultimately provide relief and restore function if conservative measures have failed. It’s crucial to have open and honest discussions with your healthcare providers, consider seeking a second opinion if you feel uncertain, and weigh the potential benefits against the risks based on your personal circumstances and health goals.

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