Collar bone or Clavicle fracture

Near the end of the first day of a cycling trip in 2015, my front pannier came off and jammed in the front wheel, the result hurtled me through the air at 40 mph, landing splat on the tarmac (click here to read what happened). The crash broke my collar bone and fractured two ribs at the back. Before continuing documenting successive rides, I thought it may be beneficial to some people to read the diary of how I progressed after the crash, so here it is.

WARNING- The following article contains graphic medical images, which is probably academic as you can see the first two anyway.

“Most broken collarbones are left to heal naturally using a simple triangular sling to support the arm and hold the bones together in their normal positions. Surgery is only needed if the injury is severe – for example, the bone has broken through the skin – or if the bones have failed to line up and are overlapping significantly.” (NHS.uk)

Right clavicle fracture Right clavicle fixed Mine had an overlap of an inch (making the whole structure two inches shorter, I’d call that a significant overlap, wouldn’t you?) even so, the surgeon was reluctant to commit to surgery. I knew from research, with the amount of displacement I had, the bone would never heal properly in respect of its functionality; I still had to push hard for surgical intervention. It took 3 weeks (post crash) for the surgery day (it is recommended having the operation within 3 weeks to aid the recovery process). When the operation was done, the movement was almost back to full mobility, but not without pain, and not without sacrifice. Now, all I needed to do was wait six weeks for it to heel, but add this to the original three weeks prior to the operation and that would have been almost two months off the bike; a calamity, as I was due to do a major ride mid August.

The pain killers (containing codeine) blocked me up and made me feel bloated, and being at home, I just pecked at food all day, putting weight on (and I carry too much anyway) and I seemed to nap several hours during the day. Two weeks after the op things had to change; I went on a diet (1) and set a target of using 500kcal a day/every day during exercise. This involved a lot of walking (there are many web sites where you can tap in your weight, walking speed, and time spent walking, and they will work out your calories burned). It has been proven at certain stages of bone recovery exercise is beneficial (your local physiotherapist will advise you).

Anyvan My bike had to be recovered too. For those who read the thread when I came off, I couldn’t take my bike in the ambulance, and therefore it was stuck 160 miles away from my house. Not a big problem; There are services that will pick up your bike and deliver it back to you. One such service is ‘Anyvan’ ®. Tap in the location of the item, your location and then tick how many traders you want to quote. If you’re not fussy about a specific delivery date and are willing to allow the bidding to continue (we’re only talking a few weeks), the price just keeps on going down, as couriers try to outbid each other for the work. ‘Paisley freight’ ® offer a fixed fee of £22 to move your prized possession, but they can be pricey if there are extras (like all my camping stuff). When I got it home it needed a good clean to access the damage; a slight buckle in the front wheel and a subtle bend in the handlebars. The wheel was straightened and new bars were bought and replaced- ‘simples’.

staples Sternomastoid muscle The biggest issue I had after the operation was a tight Sternomastoid muscle (a big muscle on the side of the neck), with numbness below the scar and some pain in the rear upper ribs. Two weeks after surgery the staples were removed and an x-ray was taken, the image didn’t show any bone growth, but the consultant said this was normal as the new cartilage formed didn’t show up on the image, though he was happy the plate was still in line. The staple holes bled for a day or two, but the wound stayed together and healed well without the need for antibiotics. He advised me, the sling can now be used only as comfort, but above shoulder movements must be strictly avoided, and no lifting heavier than a kettle. I geared the pain killers down and began only taking them at night, after three weeks I stopped taking them altogether. This created another issue; because I could only sleep on my left side (because of the fractured ribs at the back), I was waking up earlier every day, not with shoulder pain, just with the discomfort of sleeping in one position all night.

After a month (and with the consultants permission), I was able to do 30 to 40 minute sessions on the ‘turbo trainer’, but not without discomfort. He advised me there shouldn’t be any rocking of the shoulders from side to side, well; most cyclists (except for Froome) iron this movement out early in their career, so that wasn’t a problem. I just rested the injured limb on the bars, not putting any weight through it, or I sat up and rode. To alleviate the boredom on the turbo trainer, I listened to music and read a book. After a full six weeks, I went outside on the bike a few times, but I took my sling with me and rode with one arm. Only after seven weeks could I actually sleep on the injured side, I wasn’t in pain with the shoulder, but I knew it was there, it was more like a toothache. Eight weeks went by, and I was organising returning to work (pending the okay from the consultant). I was quietly confidant, as the radiographers took two x-rays, I felt cheeky and asked them- Is it okay? They replied, “well, we only take the images; the consultant will let you know about the progress.” I knew from their tone something was wrong, I walked over to the screen, and even for the uninitiated; I could see a crack. The consultant only confirmed what I already knew; there was still a micro-fracture. I could return to work, but on light duties.

I asked, “Can I ride my bike?”

Ultrasound device "You should be okay, but only short distances and no mountain biking.” He advised a daily 'Ultrasound' treatment, a procedure used to treat fractures that are slower to heal than expected (delayed healing), fractures that have failed to unite (non-union), and fresh fractures. “Current evidence on the efficacy of low-intensity pulsed ultrasound to promote fracture healing is adequate to show that this procedure can reduce fracture healing time and gives clinical benefit, particularly in circumstances of delayed healing and fracture non-union." (Nice.org.uk). So, here I am, a daily home treatment of twenty minutes holding the business end of an ultra-sound gadget on my shoulder (it’s supposed to stay in place itself with a weighted belt). The treatment is theoretically painless, but I believe the pain went up after each session, not excruciating, but it felt like a frozen shoulder, this went away after a couple of hours, leaving a slight ache.

Three months later, I was recalled to the hospital for another x-ray, when I saw it on the screen, to the untrained eye; there still looked like there was a gap (indicated by a darker colour). Needless to say I was decimated. When the consultant came, and showed me the difference between the first x-ray and this one. The latest x-ray didn’t have the harsh edges to the fracture; they didn’t seem to be as sharp. The consultant explained that although the gap had not fused fully, the dull edges to the sides of the fracture indicated some growth had taken place. “Cary on with the ultrasound treatment and we don’t need to see you again” was his statement. Before I left I explained to the ‘Doc ‘, when I rotate my arm there is a clicking sound which I later established was the ‘rotator cuff’. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. "After a change to the shoulder geometry it’s not uncommon to have ‘clicking and popping’ in the joint", the Doc explained, he wasn’t alarmed as long as there was not any pain with the clicking, there wasn't.

Lifeguard Six months after surgery, I joined a gym (mainly because the weather was so bad I couldn’t get out on the bike). The gym had a swimming pool and it wasn’t until eight months after the surgery, I was confidently able to do front crawl. Even now (eleven months post surgery), I receive pain when pulling or pushing something heavy. To be honest, I still don’t fully trust the shoulder yet, and going on previous fractures; the pain will continue for a couple of years, and not to put doom and gloom on the scene; then comes arthritis, damaging a joint raises your chances of developing arthritis sevenfold (EverydayHealth.co.uk, 2016).

So how has this event affected me? It’s now eleven months post surgery, and I’m about to go on my first long distance mountain bike ride. I feel fit fit enough (though I still have very mild shoulder pain and numbness below the scar), my only issue is mental; I don’t wish to fall off again. To clarify that statement; pre-accident I didn’t care about coming off, and during my competitive years I had absolutely no fear of falling off (even though I had many crashes, I took it as an occupational hazard). Now I’m scared of falling off, will this mindset increase the risk of injury if I do come off? If you’re relaxed, your body and limbs are able to move naturally with the dynamics of the crash. If you’re tense, they will be forced to move against the dynamics of the crash. It’s kind of like being a jelly hitting the ground (it’s still jelly after hitting the floor), whereas an egg will smash. To find out how I got on, on the Trans-Cambrian mountain bike ride click here.

Bibliography:

Nhs.uk. (2015). Broken collarbone - NHS Choices. [online] Available at: http://www.nhs.uk/conditions/broken-collarbone/Pages/Introduction.aspx [Accessed 19 June. 2015].

Nice.org.uk. (2010). Low-intensity pulsed ultrasound to promote fracture healing/Guidance and guidelines/NICE. [online] Available at: https://www.nice.org.uk/guidance/ipg374 [Accessed 19 Jun. 2015].

EverydayHealth.co.uk. (2016). Post-Traumatic Arthritis: When Old Injuries Come Back to Haunt You. [online] Available at: http://www.everydayhealth.co.uk/news/when-old-injuries-come-back-to-haunt-you/ [Accessed 18 Apr. 2016].

(1) You must provide the body with adequate energy to heal. Fracture healing requires more energy than you might expect. Thus, it’s appropriate to increase your caloric intake to promote healing. In traumatic fractures of the long bones, for example, there is an immediate increase in metabolic demands that can translate into a caloric demand three times that of normal. While a normally active adult may require 2,500 calories a day, a bedridden, injured patient with multiple fractures may need 6,000 calories per day! If this demand is not met, the healing process can be compromised.

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