Seven months later: re-fractured clavicle

[run it, ride it]

A mountain-bike crash in early May warranted a titanium plate and six screws to piece back together my collarbone. I hope I haven't fallen off the face of the discussion forums long enough that some of you ladies won't remember:

http://forums.teamestrogen.com/showt...=clavicle+ride

Reading these forums tempted me far, far too much to start riding before I was fully healed--I missed this place, believe me! You ladies are so good-natured, driven, empathetic.

Though I went on a few rides in the following weeks and months, other injuries (ankle twist, ouch!) kept me very wary of my fragility and the possibility of hardware failure. My attitude did a 180--I advocated my own safety. I respected my limits. I wasn't afraid to be afraid. Before the break, I had no qualms about crashes. I took risks and accepted the falls and disregarded the ensuing injuries. I've had too many concussions and get a little loopy with the short-term memory. But you don't forget intense pain like broken bones and surgery, or disregard permanent nerve damage. For the first time in my life, I took it easy and respected my body.

I seemed to heal up as expected. I regained flexibility and strength. I was thinking about mountain bikes again--even planned to buy a sexy Trek Fuel from a friend and rock out the snow-riding season. I was excited to get my plate removed, as the corners now protruded alarmingly under my skin. The surgeon had told me from the start that the plate had to come out--I didn't have enough tissue over the protruding hardware and risked it wearing and breaking through the skin. It also had to come out within a few months or the titanium would fuse to the bone.

I had the surgery two weeks ago Thursday and couldn't have felt better--I got to keep the plate (shh), I was given no discharge instructions and didn't wake up with my arm in a sling this time. My clavicle was healed, right? What kind of bone doesn't heal after seven months?

Still, I was careful. My boss insisted I stay home from work the next day, so instead I did some light cleaning at home.

I was pushing a dust bunny in the kitchen with the lightest broom you could imagine when the unthinkable happened: I heard a sickening CRACK and felt my shoulder cave in again. This time, I screamed. The first half of the vocalization was shock, the second half despairing realization.

Back at square one. My significant other had to put my coat over my shoulder, tie my shoes, open the passenger side door, help me in, buckle my seatbelt and cringe along with my moaning over every bump and pothole the van's sad suspension couldn't compensate for. He's used to me being very independent, and he was very worried. There was no doubt in my mind the bone had re-fractured.

Thank God I'd picked up the prescription for the percocets. Those made the five hours in the ER a little easier. I was in intense pain by the time I was near the top of the list. Never a pro at self-advocation (my father, a physician, often manages to convince me that my medical concerns are nothing to worry about... this has stuck with me, often to my detriment), I'd thankfully initiated some friendly conversations hours earlier with the staff and they moved me up the list noticing my worsening condition.

My parents had just arrived when I was called in to see a doctor--we were supposed to go out for dinner on their way home from the airport after a few months sailing down to the Bahamas. Hi mom, hi dad.... um, actually, can you meet me in the ER? Yeah, funny story...

I had my father, the physician, come in with me--he knows what questions to ask and how to translate medical jargon. In retrospect, based on what I've written above, I would have been far better off to bring in my mother--who (more accurately) tends to evaluate the amount of pain I'm in as an indicator of how badly I'm injured. (And further, who would have been a little less shocked by the nurse's innocent but far-too-audible question, "so does your dad know about your piercings?" as she helped me take off my bra with my father on the other side of the curtain.)

We all looked at the X-rays. I thought it looked broken and said as much--it was bridged up in the middle where the previous fracture open fracture had been plated together--but then again, I was the only one in the room without an MD. I let the experts speculate:

"Well... it doesn't -look- broken. The only other X-rays we have are from when the plate was still in, so we don't know what it's supposed to look like underneath. But it's -very- unlikely it would have broken again."

The ER doctor left a note for my orthopaedic surgeon. I figured I'd get a call if he was alarmed by the X-ray.

I spent the next week drugged up in bed. The pain was worse than that of the initial break. My arm didn't leave the sling. I didn't dare move my shoulder forward lest I endure an awful shifting of my innards. At least I'd already done the life-minus-dominant-arm routine months earlier and could more or less step into my tank tops and clumsily brush my teeth with the wrong hand.

I had an appointment with the surgeon ten days after the ER ordeal. Finally, some possible answers. His first words to me were, "what were you doing sweeping the day after surgery?" I reminded him that he hadn't told me not to, and he KNEW he had to keep a tight rein on my allowed activities based on past experience ("Can I ride my road bike?" "No." "Horse?" "No." "...Mountain bike?" "DEFINITELY not." "Skateboard?" "Okay, just go by this general rule: if it's fun, you shouldn't do it.")

He prodded the incision (ouch!), then looked at my X-ray. I asked, "what do you think it was that gave in there?"

"Oh, probably just some scar tissue..."

"Whatever it was, it made one awful cracking noise."

"....OH... The ER didn't tell me you heard a crack."

He prodded my incision again (ouch!) "Does this hurt?"

"Yep."

He pulled up the X-rays and studied them closer. He did a few double takes before concluding, "it DID re-fracture."

He showed me the radiograph from before surgery. "It looks healed, here. After seven months there's no reason it wouldn't be." It did look healed. "I've taken a lot of plates out of a lot of people and never seen anything like this. I really don't want to put another plate in there..."

I joked, "...I'm sorry I ruined all your careful work..."

"Oh, no, no! This isn't your fault. Had I known it wasn't healed, I wouldn't have taken the plate out!"

So the plan is to keep a close eye on the fracture--I have an appointment next week. It's still in a good position, so I guess if it heals, it heals, albeit with a big bump in the middle, and if it doesn't... more orthopaedic surgery.

The pain is manageable now without medication, but the bone clicks and cracks and shifts around an awful lot no matter how careful I am. Any movement feels like I'm being poked with a blunt pencil from under the skin. One of the tendons in my neck catches in the crack when I turn my head or swallow or sneeze and causes me to gasp in sharp pain.

Years and years of no-holds-barred athletic endeavors with a complete disregard to all injuries, thus amassing a whole slew of chronic conditions.... That fracture in May was the first time I stepped back and really made an effort to look after myself, and my reward? Another fracture! Why must all my life lessons be so painful?

How do you deal with something like this? A friend of mine just found me the PERFECT horse (sound, affectionate, huge jump, lots of GO).... owner forced to sell, and mare is going for a steal. Can't even ride to try the sweet mare out. I guess... Not the time. I'm going to the Carribean next week to visit my parents on their sailboat--as I've been working since age ten, I haven't been on a vacation since then. I guess... No getting on and off the boat without help, no diving, no sitting up on the boom or oaring the dinghy about.

I've been told that my recklessness would come back to haunt me... But I paid my dues. I carefully healed my fracture. Had it re-fractured from some reckless action, or from a real accident, this would be easier to accept. Does it ever mess with one's sense of security to break a bone without provocation!

Aye.. as always, thank you for reading, and I welcome your comments/personal stories! Please tell me I'm not alone and I won't be broken forever!

[crazycanuck]

Owieee.. I'm sorry to hear you're back in pain.
I don't have any advice to offer as I dislocated my clavicle & tore ligaments in my knee in a cycling accident in late october.

Please take things slowly, rest & give your body time to heal. In telling you this, i'm telling myself that it takes time. DON"T try and rush anything this time.

Don't panic if you're not back on your bike/horse etc ASAP.

When you do get the OK FROM YOUR DOC to start moving your arm again, is there a pool near you? Water walking might be an ok thing?What about a pilates studio-they could create a modified movement program.

Being off the bike is but it might just be worth it when you get back on. At least that's what i'm telling meself!


ps-I remember you telling us about getting some hunka hunka burnin love after your surgery and just have to tell you it made an impression on me. Ermm..yeh..

C

[Tuckervill]

I'm so sorry! Cringing on your behalf.

I'm somewhat appalled that it doesn't seem obviously broken to anyone but you! I hope this is the short path to an ending for this pain.

Karen

[lph]

ooooohhhh! There's not much I can say since I've never really broken something, except OUCH!

My mother broke her clavicle as an adult, and I remember her being in a LOT of pain, chomping down painkillers like they were candy and basically sitting semi-paralyzed in a chair doing crosswords til it healed. I've also noticed that even not breaking anything - spills and tumbles I've taken since about the age of 30 just seem to HURT so much more. Either my pain threshold is lower or I just heal slower and less efficiently. I fell off a horse every other week when I was a teenager, and I was up bouncing off the walls the day after.

Such a shame this had to happen when you really had made an effort to be careful. Still - the final result has got to be better because of you taking care. Keep us posted!

[singletrackmind]

Hope you're feeling better quick as possible, thank you sooo much for your story-the hubby read it over my shoulder, now maybe he'll get off my back for not getting a plate either the first or second time I broke mine (and it never properly healed either time so I'm not saying I -or you- shouldn't have gone with it....just that he bothers me about it every time I do just the wrong thing and accidentally let out a yelp)....Danged collarbones!

See, housework is hazardous to your health!

[smilingcat]

Hi RR,

Oh dear, so bizzare that you would fracture it again. Your first round 7 month ago and just getting the plate out 2 weeks ago says to me that your first time around must have been really serious (big nasty one).
I've broken both of mine...

Well, please take it easy and keep your arm in a sling. Drink lots of calcium fortified OJ. What little I know says your body can't absorb the calicum without the vitamin-C...

lots of healing thoughts,
smilingcat

[silver]

Ohhhh, I'm so sorry that you are going through this. I do remember your story very clearly.

from reading your words, it sounds like you have a pretty good perspective on this. your words show your strength and courage and resolution to get through this. Your words also show your frustration.

Please come here whenever you need to vent or just talk through things.

I haven't had the exact same situation as you, but I've had lots of injuries because of my desire to be active. The situation that is most similar to yours is breaking my right foot about a year and a half after breaking the left because of running marathons. After the first stress fracture I thought I was doing everything right, being so careful and then the second break happened when doing "all the right things" The doctors acted like they hadn't seen anything like it and treated me as if I was just being whiney.

Here's some of what I've found.....You WILL get through this. you WILL a lot about yourself...your strength and your fragility, you WILL find ways to be active again as you heal. You'll do things differently and you will make mistakes. but you will carry on.

Now tell us about the SO!!!!!!!

[Velobambina]

I broke my clav in '96. Running up a hill, tripped on a manhole cover, then ran 10 miles w/it broken. I remember the sensation of things readusting & moving around. My fracture didn't need surgery, thank goodness, but I spent about six weeks wearing a sling. Healed up fine. Even worse than the fracture was restoring range of motion to my joint--on my own (no PT)--after the bone healed. Be prepared for that--make sure that you get physical therapy and get the muscles in your shoulder joint STRONG so you won't have any lingering problems from the fracture.

Broke my elbow, ice skating, in '03. No cast, sling was optional, I rarely used the latter as I wanted to ensure that I kept the range of motion, despite the intense pain every time I moved the arm or my wrist/hand (the break was minor--more a crack--but it hurt like the devil). I could do the marcerena arms after a couple weeks, which impressed my ortho. I've got a high tolerance for pain/discomfort.

My advice--lots of good healing food, good thought, much patience. Think of the long-term reward of fully restored use of the joint and return to activity. In the short-term, a six week layoff and the subsequent rehab is never easy. This time of the year, it will be easier since the weather isn't that conducive to outdoor activity. You can always get your fitness back, so long as the bone heals strong. Lots of calcium. I upped my milk/dairy & my protein intake when my bones were healing.

It's not easy but you'll get through it. Like all bad things, it will come to an end.

[sgtiger]

((((((RiRi))))))

I'm so sorry to hear that your clavicle is re-injured. I'm sending you many healing wishes that this time around it will quickly and completely heal.

My 7 y.o. son broke his last spring falling out of bed and it definitely was not fun. He had to have his arm in a sling for six weeks to let his clavicle heal. After a couple of weeks the pain subsided, so it was very difficult for him to remember that he wasn't to move his arm else his clavicle wouldn't have a chance of healing properly. It took many motherly reminders and just plain nagging (and a few threats with taping his arm to his side! ) to keep him from moving it too much. I received many a harry eyeballs during that time but we survived through it.

The day we let him take off his sling, he hooped and hollered, then jumped on his bike and rode around as fast as he could. It was very difficult to get him to go inside that day.

[run it, ride it]

Goodness, thank you all for the replies.

Okay, onto the good stuff: I ended up quitting my job in my hometown after six weeks because I was being pressured into tasks that were dangerous for my clavicle and tendonitis (carrying mop buckets, scrubbing showers overhead). Thank goodness I did--given how weak the fracture apparently was, it would not have taken much for hardware failure.

I arranged a sublet at a good friend's house, signed up for a personal training course, landed a job at a local gym, and moved back to the town the Nice Young Gentleman I mentioned in the first post was from--and where I was still boarding my horse.

I had two amazing housemates for the remainder of the summer--a beautiful husky who snuggled with me every night, and a very cute guy with whom I had a lot in common--including, of course, that we both had significant others.

Well, except that his had gone to Africa for two months and never called him; and mine, the aforementioned Nice Young Gentleman, was just vocal enough about that fact that he had commitment issues (when I was getting just attached enough that his dating someone else would have devastated me) that I had to keep a careful distance.

My housemate and I would talk late into the night... we were absolutely respectful of one another, and of one another's relationships, flawed though they both were. We liked the same books and would spend hours reading outside in the yard, walking the dog, watching meteor showers in the park....

Well (and I'm sure you all see where this is going), long story short... housemate's relationship and my relationship both petered off (though I am still very close friends with the Nice Young Gentleman), and longer story short, I am still living with, and happily committed to, my housemate.

And the horse... he hasn't thrown me since the fracture in May. We've since jumped our first Cross-Country fences, camped out in the wilderness, rode in three Santa Claus parades... What fractured clavicle? What arthritic horse? While my ideal horse is something with a lot of 'GO,' I can trust my old steed to the ends of the earth, particularly when I'm injured... so I guess I'll hang onto him a little longer.

Nor have I fallen off a bicycle since. My first time out 'the guys,' I kid you not, I creeped down every even slightly scary decline with both hands on the brakes and one foot unclipped. I was terrified but determined. When one of the guys suggested, "try putting both your feet on the pedals and letting go of the brakes" I shot him a "yeah, no kidding, but no way in hell!" look and my friend who had accompanied me to the hospital told him firmly, "she's doing exactly what she should be doing." Before the fracture, I would have been mortified if one of the guys saw me hesitate and followed their every tidbit of advice. After, I had higher priorities.

Once my confidence came back, under the careful guidance of my mountain-bike-mentor/hospital-accompanier, I was flying faster than ever before. SAFER than ever before. Obstacles I might have once thought scary--logs, roots, rocks--were a breeze, but I spooked and slammed the brakes and INCHED, heart pounding, through ANY quick dip in the dirt that reminded me of the jump that sent me flying.

This setback is rough in the moment, but I learned valuable lessons with the first break: how to accept help from others; how to ask for help; how to advocate for my own safety; how to appreciate my limits.

And man oh man--how to fend off all those creepy guys who see the sling and think, "conversation starter, AND she can't get away as quick..."