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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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I am a high school basketball coach. One of my best players broke the middle of her collar bone into tiny pieces. She's in surgery now. They say they can put a wire in there that gets hard and holds it in place while it heals. What can we expect for the length of time before she can play again? We are headed for divisional playoffs in just a few months.

Severe fractures of the clavicle (collar bone) can be tricky to treat. Advances in digital X-rays, surgical tools, and techniques have made it possible to now treat this problem surgically. As you have described, a flexible intramedullary (IM) device threaded through all the pieces of bone can hold them all together nicely until healing takes place. Open reduction and internal fixation (ORIF) is the full name of the procedure. The label tells us the surgeon makes incisions to open up the area and then uses hardware (such as this flexible wire) to hold everything together until it heals. A special type of 4-D or real-time X-ray called fluoroscopy is used to help the surgeon see as the guide wire moves through the bone. The patient can't just go out and start swinging a golf club or tennis racket. Immobilization in a sling is required for three weeks. The physical therapist shows the patient how to dangle the arm in order to move the shoulder joint without disrupting the healing clavicle. No one is allowed to lift the arm overhead after this surgery for at least three weeks (and sometimes as long as six weeks per the surgeon's discretion). The decision to allow active motion and progress to overhead or functional activities depends on seeing healing bone on X-rays. Intramedullary (IM) fixation has the added benefit for healing by saving blood flow to the bone. This small detail can determine how quickly the bone heals. The timeline for getting back to work and/or play varies depending on what occupation and activities the patient is engaged in before the injury. Most patients can expect a postoperative period of 10 to 12 weeks before working with arms overhead. Sports activities may have to wait longer -- maybe as much as five or six months until the fracture site is completely healed on X-rays. That may not help your stats for the divisional playoffs but it will give your player a chance to play once again into her distant future. As the saying goes, "Expect the worst, hope for the best."


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