Managing clavicle fractures non operatively

ClaviBrace Clavicle Gilet is designed to treat all severity of clavicle fracture, more commonly known as a broken collarbone, providing pain relief and best outcomes without surgery. Within 10-20 minutes spasm in the shoulder girdle muscles is relieved and the fracture begins to reduce i.e. 'open out to length'. Pain significantly reduces often disappearing altogether. The shoulders are fully supported and the fracture is anatomically aligned removing the risk of rotation at the fracture site resulting in a good union, independence with a speedy return to normality and sport. BMI Hospital and Harley Street shoulder consultant Mr Ian Bayley FRCS, "the clavicular gilet is an exciting innovation and we're seeing really good results using it".


Want to know more about the dedicated clavicle fracture care and gilet fitting service offered at BMI The Clementine Churchill Hospital, Harrow, HA1 3RX. Please phone: 0208 8723872 or Email: CCHcallme@bmihealthcare.co.uk

Da Vinci AWARD WINNER

For medical breakthrough in the treatment of a broken collarbone 

 (Nominated by icon of the shoulder world, Professor Angus Wallace)

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Getting you back to sport sooner

Disappointed with only an arm sling after breaking your collarbone? You are right to be, a sling is not a treatment and represents a random hit or miss, benign do-nothing approach.

 Ten years of working with icons of the shoulder world have helped bring about the development of this gilet. Our studies show that it can achieve the same successful outcomes as surgery. 

HOW IT WORKS Using a gilet style design offers an ideal and more comfortable means to apply constant support at the shoulders without slipping upwards Quickly stabilises the fracture by holding it in the best possible position for healing Does not cut in at the underarms or interfere with blood supply to the arms Prevents rotation at the fracture site avoiding malunion (bad joining of the two broken ends) STOPS EXCRUCIATING NERVE PAIN - lifts the broken bone ends away from underlying nerves relieving pain and preventing the risk of nerve damage Reduces disturbance at the fracture site and provides an ideal healing environment to aid faster calcification (bone hardening) * Can also be used to stabilise and treat a broken shoulder blade [Scapula] and where applicable, reduces the pain of broken ribs. The gilet has resolved the problems of the traditionally prescribed 'figure of eight splint'. A Canadian study found that the splint pressed down onto the fracture and places pressure on underlying nerves as well as cuts up at the underarms restricting blood flow to the arms and causing tingling down the arms. And that it also rotates causing pressure at the back of the neck and is uncomfortable to wear. The principle of drawing the shoulders back to bring a broken clavicle out to length in this way was proved to be flawed. 

WHY USE A GILET DESIGN?

Adopting a gilet design has overcome the problems of previous conservative clavicle fracture treatments

 Removes any perceived stigma about wearing a brace

Airflow breathable fabrics have been used for continuous comfortable wear

Bacteria inhibiting properties allow the gilet to be worn 24/7 for several weeks without body odour. 

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A bit from Ian 

Having had first-hand experience of Angel Med’s new ClaviBrace Orthopaedic Gilet, I am very excited by its potential which I believe can hold the answer to managing clavicle fractures non operatively.

For me it obeys the crucial principle of supporting the three pillars, or better stepping stones - namely the pelvis, spine and shoulder blades – upon which effective shoulder function ultimately depends and it delivers this in a way acceptable to the wearer.

This is still a medical brace, but components are cleverly concealed in an everyday-looking gilet and since long-term wear may be necessary, it avoids any feeling of self-consciousness.

Mr Ian Bayley

senior consultant orthopaedic surgeon

WHAT IS A BROKEN COLLARBONE

We have two collarbones each positioned at the front of either shoulder. A sharp blow to the shoulder area can result in one or both collarbones breaking.

Our collarbones connect at the sternum (breast bone) and the shoulder blade via joints and muscles. They are important in stabilising the shoulder during movement and protecting blood vessels and underlying nerves. Their consistancy is comparative to a rib which can heal in around ten days. 

If you break your collarbone, in most cases there will be pain often excruciating pain as the broken bone touches down onto the nerve bed. You can expect to feel uncomfortable for 2-4 weeks. Swelling and tenderness at the collarbone area is a good indication of a break and it is common to feel crunching as the broken ends shift and touch eachother. Purple bruising will appear after several days and may spread across the shoulder to the arm.

Most people with this injury will not be able to lift their arm. It is important to keep the injured side elbow close-in to the body to avoid rotation at the fracture site. Any rotation can prolong healing leading to non-union [failure of the bone to join together], it may also result in the bone knitting together in a contorted fashion (malunion). The latter leading to muscle malfunction and future shoulder complications.

Pain can be excruciating. If you need to take pain medication avoid Ibuprofen as this inhibits new bone formation. Use paracetamol instead.

CONSEQUENCES OF IGNORING A COLLARBONE FRACTURE
by surgeon Mr Ian Bayley

A broken collarbone conservatively managed using the routinely prescribed collar and cuff or shoulder arm sling or a figure of eight splint is not a treatment and can only be described as benign neglect of the broken bone. They do nothing to elongate the bone to its original length or encourage union of the two ends.

In many cases the bone heals shortened or fails to unite, or mal unites (malunion where the bone rotates and heals at a bad angle) all resulting in shoulder instability further down the line. 

Those scenarios are a frequent cause of a condition called Scapular Dyskinesis (or winging scapula or shoulder blade malfunction). 

Shortening of as little as one millimetre can throw additional strain on the shoulder blade and other elements in the kinetic chain such as spine and pelvis and predispose the patient to future discomfort and even injury.

The relationship between muscles and bone framework is altered with devastating effect. Muscles contrive to work abnormally, shoulder blades can 'wing' unnaturally outward and shoulders fall forward; all adversely affecting pelvic and spinal alignment. Posture is weakened and, if left unchecked, cause the stronger muscles to reverse roles and deploy weaker sets. Chronic or intense pain ensues with a life left compromised by an altogether avoidable condition.

Our understanding of shoulder problems has increased in the forty years of my involvement in the field. We have come to understand the importance of the shoulder blade, how commonly it is compromised, and how resistant to surgery it can be.

So how do we tackle such an important and potentially life-changing condition?

Scapula dyskinesia comes in varying degrees and can often go undiagnosed. It is a debilitating but not untreatable condition and we need to be able to treat all degrees of severity, not just the critical cases that come into my clinic.

One of the complications in treating the condition is the lack in the scapular (shoulder blade) of good mechanoreceptors - sensory receptors that rapidly transmit sensory information to the brain and the means by which the brain senses the position of shoulder joints/scapula.

Patients simply don't know if their scapula is winging, added to which the brain readily accepts the abnormal movement as normal.

For the vast majority of patients, physiotherapy is the first line of combat. In many cases, again for the majority, corrective exercise alone does not solve the problem. With surgery very much a last resort and no promise of success, patients are often left disappointed and in despair. 

We need new ways to tackle this condition. Having had first-hand experience of Angel Med’s new ClaviBrace Orthopaedic Gilet, I am very excited by its potential which I believe can hold the answer.

For me it obeys the crucial principle of supporting the three pillars, or better stepping stones - namely the pelvis, spine and shoulder blades – upon which effective shoulder function ultimately depends and it delivers this in a way acceptable to the wearer. 

This is still a medical brace, but components are cleverly concealed in an everyday-looking gilet and since long-term wear may be necessary, it avoids any feeling of self-consciousness.

Mr Ian Bayley is a senior consultant orthopaedic surgeon with a busy clinical practice in shoulder surgery on Harley Street and has worked within BMI and The Circle Health Group.

He was appointed to open and direct the Spinal Injuries Unit at the Royal National Orthopaedic Hospital Stanmore in 1980 and to direct and develop the complex Shoulder Surgery Unit.

He also took on the role of National Clinical Chair of the NHS Orthopaedic Services collaborative and various subsequent service redevelopment roles on the national stage. His experience is therefore based firmly at “the coal face” of clinical practice and spans the whole medical spectrum from acute care through rehabilitation to community reintegration, combined with service redesign and delivery.

He is a member of the British Elbow & Shoulder Surgeons, British Orthopaedic Association and the European Shoulder & Elbow Society. 

His clinical interest is in complex pain states, instability, rotator cuff pathology, primary and revision shoulder replacement.

FACTS ABOUT SURGERY

All surgery poses risk and should be used as a last resort.

Weighing up surgery against a bad natural outcome has led to a surge in surgical procedures with the idea that surgery is best.

PLATING SURGERY

A collarbone shaped piece of metal is fixed over the broken bone and is held in place with up to nine screws
It takes six months for the screws to consolidate and a further year to heal solidly enough to go back to high impact sports.

 OTHER FACTORS TO CONSIDER

Not all plating surgery is successful
You will have a scar
Rejection of metal-ware
Screws may loosen causing the plate to fail
The area of plating can be left numb It takes a full year, from initial plating surgery, to heal and a further year if you decide to have the plate removed
A recent American study has shown that after shoulder surgery, the brain can disconnect from that area, causing the shoulder to malfunction 

THE PROCEDURE TO REMOVE A COLLARBONE [CLAVICLE] PLATE TAKES AROUND 35 MINUTES UNDER GENERAL ANSAESTHETIC. 

After the plate has been removed the screw holes need time to fill-in. Those holes are lined up and can re-fracture like a zipper opening making the collarbone highly unstable for 6-8 weeks.

It takes a good six months for the collarbone to heal properly and during this time, raising your arm above your head or lifting should be avoided. There are no guides on a safe lifting weight and much depends on individual circumstances

It takes a full year to heal completely and it is important during this time, not to fall or knock that shoulder.

There are mixed opinions about removing a plate. The simple rule is, if you want to return to high-impact sports activities, have it removed. 

RISKS OF REMOVAL

The bone re-breaks easily along the line of screw holes causing the bone to arch upwards forming a protrusion just under the skin

RISKS OF KEEPING THE PLATE IN

With impact, the collarbone breaks beyond the plate causing a more serious and difficult-to-treat fracture than the original

Future impact could send the metal plate into the neck
Straps rub at the area of the plate 
Some feel the shoulder constantly cold

Choosing ClaviBrace®, removes surgical plating risks without compromising on best outcome. Healing time is faster and bone union stronger.

Icons of shoulder surgery

In 2010 Professor Angus Wallace nominated ClaviBrace® for a Da Vinci award which it won for Medical Breakthrough in the treatment of collarbone fractures. He had hit the headlines previously for treating a woman on a flight with a coat hanger, and became known as 'Coat hanger Wallace'. He operated on Wayne Rooney in 2006. He went on to developed the brace position after researching injuries in 1989's Kegworth air crash.

Professor Wallace was awarded his Honorary Fellowship at the Royal College of Physicians in London on 28 September 2017 in recognition of his 30 years contribution to the Specialty of Sport & Exercise Medicine.

Professor Wallace and Professor Moran were invited by the England FA to provide an expert medical opinion on the fitness of Wayne Rooney to play in the World Cup. Both consultants work at Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus (QMC), and both are professors appointed by the University of Nottingham. 

QMC is the biggest trauma centre in England and treats over 16,000 fractures per year. 

Professor Wallace was invited because of his extensive knowledge of both orthopaedic surgery and sports medicine - he has been a consultant orthopaedic surgeon for 22 years working as a consultant trauma surgeon from 1984 to 1996. 

 In addition he has been actively involved in sports medicine for over 16 years and has an in-depth understanding of rehabilitation and fitness loss in relation to sportsmen. 

Professor Angus Wallace

Mr Ian Bayley is a senior consultant orthopaedic surgeon with BMI Hospitals and a busy practice at 6 Harley Street, London. 

Mr Bayley was appointed to develop the Spinal Injuries Unit at the Royal National Orthopaedic Hospital Stanmore in 1980 and to direct and develop the Complex Shoulder Surgery Unit.

He also took on the role of National Clinical Chair of the NHS Orthopaedic Services collaborative and various subsequent service redevelopment roles on the national stage. 

His experience is therefore based firmly at “the coal face” of clinical practice and spans the whole medical spectrum from acute care through rehabilitation to community reintegration, combined with service redesign and delivery.

He is a member of the British Elbow & Shoulder Surgeons, British Orthopaedic Association and the European Shoulder & Elbow Society.

His clinical interest is in complex pain states, shoulder instability, rotator cuff pathology, primary and revision shoulder replacement.

Mr Ian Bayley

Team Members

Victor Ko

Mr Ian Bailey

FRCS


Consultant Orthopaedic Surgeon

K.a Joben

Mr Rupen Dattani

BSc(Hons), MBChB, MRCSEd, MD, FRCSEd(Tr&Orth)


Consultant Orthopaedic Surgeon

Richard Bauer

Mr Tariq Zaman

MBChB, FRCS (Orth)


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Marin Julia

Marin Julia

ART DIRECTOR

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How the service works and treatment plan

Insert clemi video here as a breif overview of care plan included (time frame)

PHONE 0208 8723872 

EMAIL CCHcallme@bmihealthcare.co.uk

ADDRESS OF FITTING CENTRE  BMI The Clementine Churchill Hospital
 Harrow, 
 HA1 3RX

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Tina's Story

Tina chose to have her fracture plated and was advised by her surgeon to stay in an arm sling for eight weeks. With pressure from horse owners to compete and a business to run, she wore ClaviBrace and upperarm gaiter combination and competed three horses safely, four weeks sooner than would normally have been possible. Wearing the combination ensured that her collarbone, not only broken but made fragile, with eight screws inserted to hold the plate, gave Tina the confidence and security to compete sooner.

Stage 5 Performance Coach in Complete Horsemanship, UKCC Level 3, Centre 10 Adv Coach, Challenge Awards Trainer Professional Event Rider & Coach Lecturer Nottingham Trent University Owner of Tinderbox Sport Horses

Tina has run Tinderbox Sport Horses, from her base near Newark for the last 28 years. She is a highly qualified coach (BHSI), eventing up to three-star level. Her role as university lecturer at Nottingham Trent University, has instilled the importance of innovation and the rigorous research needed to back up new design. Her talent in post breaking, training and preparation for young horse classes is matched by her enthusiasm for teaching and is the stimulus behind her involvement in developing innovative products for both horse and rider. 

Clavicular Gilet Testimonials

fitting video and faqs

  1. Can you use for jewlery and resin crafting??
    As long as the pieces are small, yes. I use it for nails and for resin.
  2. Is there a sunuv uv, led & nail blower combined?
    There is something about parenthood that gives us a sense of history and a deeply rooted desire to send on into the next generation the great things we have discovered about life. And part of that is the desire to instill in our children the love of science, of learning.
  3. How will I know that my order was eccepted?
    There is something about parenthood that gives us a sense of history and a deeply rooted desire to send on into the next generation the great things we have discovered about life. And part of that is the desire to instill in our children the love of science, of learning.
  4. How long does shipping take, and how much will it cost me?
    There is something about parenthood that gives us a sense of history and a deeply rooted desire to send on into the next generation the great things we have discovered about life. And part of that is the desire to instill in our children the love of science, of learning.
  5. Where does it come from?
    There is something about parenthood that gives us a sense of history and a deeply rooted desire to send on into the next generation the great things we have discovered about life. And part of that is the desire to instill in our children the love of science, of learning.

Clavicular Gilet Versus Surgery

Clavicular Gilet

Union 

Independence, Carry on training. Return to sport in approx 3-8 weeks.

Naturally lengthens a shortened collarbone to original length

No scar 

Removes pain as soon as fitted - minimal use of pain medication, no antibiotics 

Possibility of resistance to wearing a close contact device

Stronger mending, less chance of complications if broken again


No need for general anaesthetic and potential side effects


No hospital stay - no risk of contracting infection No need for surgery to remove the metal plate 

Ability to get on with life during convalescence

Surgery

Union 

Similar healing time. Return to sport in approx 3-8 weeks. 

Further downtime to remove plate. 

Uses a metal plate to obtain original length 

Scar 

Medication and antibiotics 

Possibility of plate rejection or failure

Risk of future impact causing a more difficult to treat fracture at one or either end of the plate

Potential for rupturing blood vessel and bleed into the chest cavity (minimal risk)

Possible infection into the chest cavity (minimal risk)

Surgery to remove a metal plate and further convalescence 6-8wks convalescence and potentially disrupting the plate