Operative Treatment for Clavicle Fractures (Broken Collarbone)

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Clavicle fractures are often caused by a direct blow to the shoulder. In sports, it usually occurs when an athlete is tackled in a football game, falls of a bicycle, or gets body-checked into the plexi-glass of an ice rink. It can also happen during a fall onto the shoulder or a car collision, a fall onto an outstretched arm, or in childbirth, when the baby is passing through the birth canal.

The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.

Clavicle_OSS

Symptoms

Clavicle fractures can be very painful and may make it hard to move your arm.

Additional symptoms include:

  • Sagging shoulder (down and forward)
  • Inability to lift the arm because of pain
  • A grinding sensation if an attempt is made to raise the arm
  • A deformity or “bump” over the break
  • Bruising, swelling, and/or tenderness over the collarbone

Evaluation by an OSS physician

In order to pinpoint the location and severity of the break, your OSS physician will order an x-ray. X-rays of the entire shoulder will often be done to check for additional injuries. If other bones are broken, your doctor may order a computed tomography (CT or CAT) scan to see the fractures in better detail.

If your bones are out of place (displaced), your OSS physician may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered, if displacement is significant. A recent large study showed improvement in function with operative repair when the fracture is significantly displaced.

The use of Plates and Screws

During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates to the outer surface of the bone. Newer locking plates are contoured to give significant strength while minimizing the prominence of the plate. Many patients notice immediate improvement in the disturbing bone movement right after surgery.

After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin. It is important to start full range of motion soon after surgery.

Plates and screws are sometimes removed after the bone has healed, but that is up to the patient’s discretion. This is a much smaller procedure with little down time, usually 4-6 months after the original surgery.

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(A) The clavicle is broken in more than one place and the fragments are severely out of alignment. (B)The fractured pieces are held in place by a combination of plates and screws.


Rehabilitation

Specific exercises will help restore movement and strengthen your shoulder. Your OSS physician may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your OSS physician will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Surgical Complications

People who use nicotine, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your OSS physician about the risks and benefits of surgery for your clavicle fracture.

There are risks associated with any surgery, including:

  • Infection
  • Bleeding
  • Pain
  • Blood clots in your leg
  • Damage to blood vessels or nerves
  • Nausea

The risks specific to surgery for collarbone fractures include:

  • Difficulty with bone healing
  • Injury to surrounding vessels/organs (rare)
  • Hardware irritation

Outcome

Whether your treatment involves surgery or non-surgical treatment, it can take several months for your collarbone to heal. It may take longer in diabetics or people who nicotine.

Most people return to regular activities within 3 months of their injury. Your OSS physician will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports and daily activities.

What to discuss with your OSS Surgeon

  1. When will I be able to start using my arm?
  2. When can I return to work?
  3. Do I have any specific risks for not doing well?
  4. If I have surgery, what are the risks and benefits and how long will I be in the hospital?
  5. If I do not have surgery what are the risks and benefits?
  6. Is my bone weak?
  7. Should I be taking calcium and Vitamin D?

If you would like more information about clavicle surgery, call Orthopedic Specialists of Seattle (206) 633-8100 to schedule an appointment with an OSS surgeon.

Common Swimming Injury – Swimmer’s Shoulder

Swimmers shoulderSwimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college.

Although the lack of impact in swimming makes it a perfect choice for avoiding lower-body injuries, the intense involvement of upper-body muscles makes overuse injuries a real possibility.

The most common swimming-related injury is swimmer’s shoulder, shoulder pain usually caused by rotator cuff tendonitis. Many cases of swimmer’s shoulder can be successfully treated through physical therapy.

For competitive athletes, rotator cuff surgery may be recommended if shoulder pain continues after 6 months of guided rest and rehabilitation.

Signs and Symptoms of Swimmer’s Shoulder

  • Shoulder pain while swimming freestyle
  • A forward shoulder slouch while seated
  • Underdeveloped posterior shoulder musculature
  • A mild winging on the affected side’s left scapula
  • Tenderness in the acromioclavicular joint and coracoid process in the impingement area
  • Tenderness in the affected side’s bicep tendon and supraspinatus tendon
  • A full range of motion in all planes
  • Strength is slightly decreased in the supraspinatus and infraspinatus
  • Full strength in the internal rotators, arm extensors, and flexors
  • Moderate posterior and anterior laxity in both shoulders
  • A bilateral sulcus sign
  • Impingement and adduction-compression tests on the affected side were positive
  • An apprehension test on the affected side was negative

Swimming Safety and Injury Prevention

According to Dr. Franklin, “Proper warm up, stretching, technique and conditioning are crucial in preventing tendonitis and overuse injuries in swimmers.”

  • Learning proper technique goes a long way toward preventing injuries; if you’re just starting out, schedule some sessions with a swimming coach.
  • Remember to warm up and stretch before every swim, giving particular attention to your shoulders.
  • A strength-training program can help build up the muscles around the shoulder and upper back; ask a physical therapist or personal trainer if you need help creating a routine.

If you believe you are suffering from swimmer’s shoulder or swimming-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Horse Jockeys and the Risk of Broken Bones

horse racing wallpaper

The excitement of the Preakness, the Kentucky Derby and the Belmont Stakes finishing are finished and Triple Crown hopes and dreams look towards next year’s signature races. Horses are vulnerable to injuries and so are the jockeys that ride them through training and high-stakes races.

 

Since 1940, more than 150 jockeys have died from racing accidents. Jockeys may have the most hazardous job of any professional athlete. One misstep in the crowded race can send a jockey, and perhaps his horse, tumbling to the ground, where he can be crushed by his own horse or another animal running behind.

 

There is no official database of jockey injuries and fatalities, but according to a study published in the Orthopedic Journal of Sports Medicine in 2013, a total of 152 jockeys died as a result of both flat and jump racing or training incidents in the U.S. between 1940 and 2012.

 

Take for example, Randy Meier, he was a leading jockey in the Chicago area who won more than 4,000 races before a traumatic brain injury forced him to retire. Over the course of his 38-year-career, Meier broke 56 bones in his body. He once broke both of his legs, he had a total of 10 broken vertebrates, he needed a rod surgically installed in his upper leg after breaking it, and he had screws and plates surgically installed in his neck when he broke it the first time.

 

The second time Meier broke his neck, at age 55, he also suffered a brain injury that left him unable to speak clearly. His short-term memory was affected, and he couldn’t remember his kids. He spent five and half months at a rehab center for speech therapy, all along thinking he would be back racing soon. Jockey’s Guild, which represents the majority of the roughly 900 riders racing today, is working on trying to improve safety on the racetrack to help minimize the injuries. Last year the organization started a database to document jockey injuries and conditions in which they occur, and it’s working to get racetracks across the country to report the injuries. The Guild eventually plans to use the database to spot trends and better understand what changes need to be made on the track as well as to the safety equipment jockeys wear, like vests and helmets.

 

Common jockey injuries include:

The position in which a jockey rides may also contribute to injury. Jockeys do not sit directly on the horse, but rather use their legs for gripping, stability, and balance. This forces them into a forward lean, creating a forced static posture over the horse. Jockeys are subject to dynamic and static joint loading, impact loading, and injuries associated with acceleration and deceleration from racing.

  • The combination of the applied forces, static postures, repetitiveness, and trauma from joint loading may lead to musculoskeletal injury of the lower extremities and spine.
  • Continual acceleration and deceleration from racing, while forced to maintain forward leaning postures, can propel a jockey over the head of the horse in the event of sudden stop or stumble by the horse, or result in contact with the horse’s head.

Contributing factors to any sports activity all have the potential for greater orthopedic injury. Orthopedic Specialists of Seattle specializes in sports medicine and treats a variety of sports-related injuries. If you are suffering from a sports-related injury, contact OSS to schedule an appointment with one of our physicians at (206) 633-8100.

 

 

2014 FIFA World Cup Injuries Affecting Field of Players

fifa-world-cup-2014-UnoTelly

Several prominent figures for this year’s World Cup event have been lost to injuries. The list includes:

  • Franck Ribery – France
  • Radamel Falcao – Columbia
  • Marco Reus – Germany
  • Kevin Strootman – Netherlands
  • Luis Montes – Mexico
  • Riccardo Montolivo – Italy
  • Christian Benteke – Belgium
  • Theo Walcot – England
  • Roman Shirikov – Russia

Leg fractures to rolled ankles have plagued this year’s field of players throughout the world. It’s not unusual for injuries to strike before the World Cup, due in part to the increasing demand on players during the club season and the brief turnaround before reporting to national team duty ahead of the sport’s premier competition.

Sepp Blatter, president of FIFA, which puts on the World Cup, blamed “too long a [club] season and always the same players [from the elite clubs] are always in the same competitions. Now they are tired.”

Fatigue is not responsible for all injuries. Muscular ailments occur at all stages of the season, while missteps and reckless tackles are also to blame. Falcao suffered a knee injury in January.

According to U.S. midfielder, Michael Bradley, “There [are] certain things as players you do to try to prevent injuries, to try to stay fit, but at the end of the day, you step on the field, you play, you leave everything out on the field and unfortunately things happen at times.” He goes on to say, “No player ever wants to see anybody else get hurt and have to miss a big game, a big tournament.”

Common soccer injuries include:

  • Lower extremities – Sprains and strains are the most common lower extremity injuries. The severity of these injuries varies. Cartilage tears and anterior cruciate ligament (ACL) sprains in the knee are some of the more common injuries that may require surgery. Other injuries include fractures and contusions from direct blows to the body.
  • Overuse of lower extremities – Shin splints (soreness in the calf), patellar tendonitis (pain in the knee), and Achilles tendonitis (pain in the back of the ankle) are some of the more common soccer overuse conditions. Soccer players are also prone to groin pulls and thigh and calf muscle strains.
  • Upper extremities – Injuries to the upper extremities usually occur from falling on an outstretched arm or from player-to-player contact. These conditions include wrist sprains, wrist fractures, and shoulder dislocations.
  • Head, neck and face injuries – Injuries to the head, neck, and face include cuts and bruises, fractures, neck sprains, and concussions. A concussion is any alteration in an athlete’s mental state due to head trauma and should always be evaluated by a physician. Not all those who experience a concussion lose consciousness.

Treatment options to soccer injuries include:

  • Stop participation immediately until any injury is evaluated and treated properly.
  • Most injuries are minor and can be treated by a short period of rest, ice, and elevation. Contact the physicians at Orthopedic Specialists of Seattle (OSS) to evaluate an injury.
  • Overuse injuries can be treated with a short period of rest, which means that the athlete can continue to perform or practice some activities with modifications.
  • In many cases, pushing through pain can be harmful, especially for stress fractures, knee ligament injuries, and any injury to the head or neck. Contact the physicians at Orthopedic Specialists of Seattle for proper diagnosis and treatment of any injury that does not improve after a few days of rest.
  • Return to play only when clearance is granted by a physician.

Orthopedic Specialists would like to offer the following tips for preventing soccer injuries:

  • Have a pre-season physical examination and follow your doctor’s recommendations
  • Use well-fitting cleats and shin guards — there is some evidence that molded and multi-studded cleats are safer than screw-in cleats
  • Be aware of poor field conditions that can increase injury rates
  • Use properly sized synthetic balls — leather balls that can become waterlogged and heavy are more dangerous, especially when heading
  • Watch out for mobile goals that can fall on players and request fixed goals whenever possible
  • Maintain proper fitness — injury rates are higher in athletes who have not adequately prepared physically.
  • After a period of inactivity, progress gradually back to full-contact soccer through activities such as aerobic conditioning, strength training, and agility training.
  • Avoid overuse injuries — more is not always better! Sports medicine specialists at Orthopedic Specialists of Seattle believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out”
  • Speak with a sports medicine physician at Orthopedic Specialists of Seattle if you have any concerns about injuries or soccer injury prevention strategies

According to Dr. Peterson, “Two of the challenges the US team will have to face in addition to the “Group of Death” pairings are travel and heat. They will travel over 6000 miles during the preliminaries, and will be playing at least on of their games deep in the Amazon rain forest in the middle of summer! In these situations, it’s very important to work on hydration, proper diet, and sleep. Proper hydration is occurring when one’s urine is fairly clear to clear. Proper diet varies, but usually should include a balance of protein, carbohydrates, and fats. Eat plenty of fruits and vegetables and minimal fried foods and alcohol. Sleep can be tough with airplane travel.

Try to have a standard time to go to bed, and getting at least 8 hours per night is important. If it is hard to fall asleep, natural sleep aids like melatonin can help. Good luck, USA and Sounders players!”

If you believe you are suffering from a soccer-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Avocados vs. UFC Fighter… and the Winner is?

avocado-cut-3aWho knew you would have to watch your back, or should we say hand, when making the family’s homemade guacamole? Avocados; they look innocent enough, but did you know that avocados are the cause of hundreds of hand injuries a year?

Take for example, UFC Tri Star Welterweight contender, Rory MacDonald.  He gave himself a deep cut in his left hand while cutting an avocado at home, prompting a trip to the emergency room and making him worry he’d have to drop out of his UFC 170 fight against Demian Maia.  Fortunately for MacDonald, he received stitches for his hand injury.

The danger is hidden inside the avocado. Avocados have a soft creamy skin, easily sliceable, but inside, the pit also needs to be removed carefully. Often times, this is done by stabbing the end of a knife onto the pit and twisting it off. If not done properly, the knife can glance off the pit and cut your hand. 

You can also injure yourself when slicing the inside of the avocado while it rests in the palm of your hand; the pressure may be too great and accidentally, you slice right through the peel and your palm along with it, hitting an artery, nerve or tendon in the process.

Slicing an artery, nerve or tendon can be serious. It is possible to have a partial injury to a tendon and still move the hand normally, but there is a risk that the tendon could rupture completely. According to Dr. Ruhlman, “Knife injuries from cutting an avocado are among the most common injuries I see, and unfortunately, often cause an injury that needs surgical repair.  Hopefully, awareness of this common injury might prevent a rate of such a devastating injury.”  By using the proper tools and technique, injury can easily be prevented.  If you do cut yourself it might mean surgery and possible months of therapy.

OSS has several providers specializing in hand injuries.  If you are suffering from a hand-related injury, contact OSS to schedule an appointment with one of our physicians at (206) 633-8100.