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.

img2

(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.

Hand Rejuvenation – New Trend with Women and Plastic Surgery

June is the quintessential month for weddings. The phrase “June Bride” is in our vernacular, conjuring up images of a beautiful bride, a handsome groom, family and a spectacular and exotic honeymoon.

Before the wedding takes place however, there is the all-important engagement photo shoot and for that, women throughout the country are acting on a new trend – plastic surgery for their hands, also known as hand rejuvenation or “handlifts” to show-off their beautiful diamond ring.

This new trend is rooted in today’s social media practice called the “selfie”. Newly engaged women are excited to show off the ring on their finger and post it in social media outlets like Facebook and Instagram. “Selfies” have made society more self conscious of their appearance including their hands. “Handlifts” have gone up 40% since the rise of social media.

According to Dr. Weil, “Next to our faces the hands are the most recognizable and exposed parts of the body. The hands are often forgotten when it comes to rejuvenation procedures. However, they are one of the first areas which are noticed by others, especially when there are years between the appearance of your face and hands. Just like our faces, our hands will show the signs of aging. In some cases our hands may even make us look older than we are. As we age our hands lose fat– along with collagen– which decreases the elasticity and leads to thinning of our skin. This can cause the skin to become loose and wrinkled and cause the veins and tendons of our hands to become more prominent. Today, however, Dermal Fillers (Juvederm, Restylane, Perlane, Radiesse, etc.) have become an excellent option for restoring the volume and smoothness that our youthful hands once had.”

Dr. Weil’s dermal filler of choice for hand rejuvenation is Juvederm Ultra XC. Juvederm Ultra XC works by restoring the volume of hyaluronic acid in your skin, helping to reduce wrinkles and smooth out folds. Hyaluronic Acid (HA) is a naturally occurring sugar found in the human body.

Hyaluronic acid creates volume in the skin by delivering nutrients and by holding in water, making sure the skin stays hydrated. Its function is very similar to that of a sponge–it soaks up and absorbs water–which in this case creates volume in the skin of your hands. Dr Weil goes on to say, “Think of hyaluronic acid as the body’s internal moisturizer!”

Hand1
Youthful hands have a fullness of the skin and subcutaneous tissues. The skin is soft and without wrinkles except for the natural lines seen over the finger joints and knuckles. Veins may be visible, but not obvious.
Hand2
Loss of skin thickness and volume in the tissues underneath the skin make the veins easily noticeable and unattractive.

Pigment changes and dark spots occur as a result of sun exposure. The thin skin becomes wrinkled and has far less elasticity.

Hand3
Hand rejuvenation with dermal fillers is an affordable, non-invasive way to treat volume loss and thinning of the skin that occurs with aging.

Using dermal fillers to restore the volume and smooth away wrinkles of the hands is a procedure with little discomfort and no downtime.

If you would like more information about hand rejuvenation, call Orthopedic Specialists of Seattle at (206) 633-8100 to schedule an appointment with Dr. Weil.

Summer Running

As runners, think about the varied terrain and urban obstacles of jogging outdoors versus the treadmill’s regularity. Now apply that same comparison to every gym exercise and the variables of their outdoor equivalents, from biking in the park to soccer on the grass.

Here are three important steps you should take to ensure that getting back into running leaves you free from injury this summer:

  1. Take a moment to set a goal. Setting a goal helps propel yourself towards a specific aim, a simple enough idea which cannot be overstated in its power to focus yourself on a reasonable achievement.
  2. Renew one of your new year’s resolutions or challenge yourself to meet or beat a pace that you haven’t quite kept up with over the past few years.
  3. More importantly, set up a log book to keep track of your times and achievements. Having a physical record of where you started with a means to your ends is paramount to meeting your goal.

Summer Running | Exercise Plan by Dr. ReedSpeaking of physical reminders, the change in season is the perfect opportunity to change your sneakers!

Most dedicated running stores offer in-depth analyses of your feet and gait to make sure that you get the proper equipment.

Think about marking your shoes with the date of purchase so you can keep tabs on when you got them so that you don’t keep using them after their time is up.

Dr. Mark Reed states, “With so many different running styles gaining popularity; selecting the shoe that fits your style is important. A properly fitted shoe will help protect against injury and may also enhance performance. “

You should also set up an appointment with your OSS physician to go over all the requisites, making sure to get the OK for the goals you’ve set for yourself before the start of new routines.

The simple act of updating your equipment and evaluating your physiology are powerful motivators for getting back in shape and keeping you injury-free.

If you believe you are suffering from a running-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provides excellent treatment options available for you. 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.