It is heartening, in this age of formalized education and regulation, to discover that anyone with a spark of curiosity and the will to follow through can come up with something that improves people’s lives and changes the way medicine is practised. This is the first in a series of posts under the title Who Needs a Medical Degree? celebrating individuals not daunted by their lack of clinical experience, training or qualification, who followed a spark, put in many hours of research and hard work, and came up with something amazing in response.
The Clavibrace – for middle third clavicle fractures
I would like to give a plug to the clavibrace (I need to put a little r in a circle here but I can’t find it on my computer, so just be aware that the name is protected.) I saw this at COPA. It is specifically designed for people who break the middle third of their clavicle, 30% of which are displaced and need help to fuse in a good position.
Until a vivacious and inventive Scot called Barbara Thompson broke her own clavicle in 2008, there were two ways of treating these: 1) risky and complication-prone surgery, with resulting ugly scars or 2) conservative treatment with a broad arm sling. A large Canadian study in 2007 (Journal of Bone and Joint Surgery) came down on the side of surgery and plating and has guided clinicians ever since. This is because the broad arm sling tended to increase the likelihood of misaligned fusion, with possible subsequent thoracic outlet syndrome and reduced shoulder rotation. They’re also quite uncomfortable, giving you neck ache after a few days. So the scarring, and risk of infection or damage was deemed to be the better of two poor options.
However Barbara arrived in the consulting rooms of Professor Angus Wallace with her broken collarbone and was advised of the two options. She said she didn’t like either of them. There must be a third way. She was quite assertive about that. Most of us would simply sigh and resign ourselves to putting up with what the esteemed medical profession had decided upon, with its years of wisdom and experimentation. She decided to have a go at designing her own thing. With strapping and tights and whatever else was to hand she experimented on herself, and invented a much more stable brace for the clavicle, which worked so well that it went on to win the Davinci Award for Medical Breakthrough in March 2010. It looks a bit like a classy, bulletproof vest. They key to its success seems to be that it reduces pain during the healing process and it places the local ligaments in sustained traction, enabling the clavicle to fuse in a well aligned position. You keep it on 24 hours a day (birdbath washing only) for anything from four weeks to eight, depending on the individual case. They also do a version for children, most of whom wouldn’t have surgery anyway but would be in a lot of pain with a traditional sling.
Barbara’s doctor, Professor Wallace, who stressed that he has no financial interest in this new device at all, has been so impressed by the brace and its clinical results that he came to COPA to speak on her behalf. They still don’t have funding for an RCT (estimated cost – £300 000 to £1 000 000) but are hopeful that that will happen. However if you or someone you know breaks that middle part of the clavicle, you can contact the company, and pay to buy your own brace and have it fitted. I think it is in the region of £150 to £300 for the brace plus the fitting. I think there might be cheaper options, especially for children. And by the way, they are looking for more people to train as fitters if that is your kind of thing.
I think Barbara is quite remarkable. She refers to her initial injury as a “lucky break” that led her along this path, but it sounds like she has done a great deal of work and research and it has been a demanding path. She has now branched out into a variety of slings, supports and braces. If you look at the website 4dflexisport.com you will see these very smart and superior looking products, whose unique selling point seems to be a new skin friendly type fabric which sets them apart from cheaper supports. The back support looks really good and has a handy pocket for cold or hot packs. I had a good look and feel of them at COPA and though it’s not an area in which I can claim to have huge knowledge, they certainly gave an impression of quality and good design.
I can only reiterate what Professor Wallace said: there’s no RCT yet, and it is not in the NICE guidelines, but if I had a fracture of the middle third of my clavicle, I would buy a clavibrace, And I would add that if a patient had need of a quality support, I would encourage them to check out the 4d flexisport website. I know this sounds like a promotion, but it’s not. I just think this kind of individual ingenuity and drive should be supported.