What is open reduction and internal fixation for a broken collarbone. How does ORIF surgery treat clavicle fractures. When is surgical intervention necessary for a fractured clavicle. What are the risks and benefits of clavicle ORIF surgery. How to prepare for and recover from collarbone fracture surgery.

Understanding Clavicle Fractures and Their Treatment Options

A clavicle fracture, commonly known as a broken collarbone, is a significant injury that can occur due to various causes, including direct blows to the shoulder, falls on outstretched arms, or even during childbirth. While many clavicle fractures can heal with conservative treatments, some cases require surgical intervention. Open reduction and internal fixation (ORIF) is a surgical procedure used to treat severe clavicle fractures.

Types of Clavicle Fractures

Clavicle fractures can be categorized into two main types:

• Non-displaced fractures: The bone pieces remain aligned
• Displaced fractures: The bone fragments are out of alignment

The location of the fracture also plays a role in determining the appropriate treatment. Fractures can occur in the middle of the bone, near the ribcage attachment, or close to the shoulder blade attachment.

What is Open Reduction and Internal Fixation (ORIF) for Clavicle Fractures?

ORIF is a surgical procedure used to stabilize and heal a broken collarbone. It involves two main steps:

1. Open reduction: Surgeons reposition the bone fragments into their proper alignment
2. Internal fixation: Special hardware (screws, plates, wires, or nails) is used to hold the bones in place during healing

The procedure is typically performed under general anesthesia, ensuring the patient remains unconscious and pain-free throughout the surgery.

When is ORIF Necessary for a Clavicle Fracture?

Not all clavicle fractures require ORIF. This surgical intervention is usually reserved for cases where conservative treatments are unlikely to result in proper healing. ORIF may be necessary if:

• The bone fragments are significantly misaligned
• The fracture is compound (bone has broken through the skin)
• The clavicle has broken into multiple pieces

In these situations, ORIF can greatly improve the chances of proper bone healing and restore normal shoulder function.

Preparing for Clavicle Fracture ORIF Surgery

ORIF for a clavicle fracture may be performed as an emergency procedure or as a planned surgery. In either case, proper preparation is crucial for a successful outcome.

Emergency ORIF Preparation

If ORIF is performed as an emergency procedure, healthcare providers will:

• Take your medical history
• Perform a physical examination
• Obtain X-rays of your clavicle
• Inquire about your current medications and when you last ate

Planned ORIF Preparation

For a planned ORIF procedure, your doctor may advise you to:

• Stop taking certain medications, such as blood thinners
• Avoid food and drink after midnight the night before surgery
• Discuss any concerns or questions you may have about the procedure

Is there anything specific you should do to prepare mentally for the surgery? Educating yourself about the procedure, discussing your concerns with your surgeon, and arranging for post-operative care can help alleviate anxiety and ensure a smoother recovery process.

The ORIF Surgical Procedure for Clavicle Fractures

While the specific details of your ORIF surgery may vary depending on the nature and location of your fracture, the general procedure typically involves the following steps:

1. Administration of general anesthesia
2. Incision over the fracture site
3. Realignment of bone fragments (open reduction)
4. Placement of internal fixation hardware
5. Closure of the incision

The entire procedure is usually completed within a few hours. Can you expect to go home the same day as your surgery? In many cases, clavicle ORIF is performed as an outpatient procedure, allowing patients to return home on the same day. However, some patients may need to stay overnight for observation, depending on their individual circumstances.

Potential Risks and Complications of Clavicle ORIF Surgery

While ORIF is generally a safe and effective treatment for clavicle fractures, like any surgical procedure, it carries some risks. Potential complications may include:

• Infection at the surgical site
• Hardware issues (broken screws or plates)
• Damage to surrounding blood vessels or nerves
• Improper bone alignment
• Lung injury
• Anesthesia-related complications
• Non-union (failure of the bone to heal properly)

Are certain individuals at higher risk for complications? Factors that may increase the risk of complications include advanced age, low bone density, diabetes, and smoking. It’s crucial to discuss your individual risk factors with your surgeon before the procedure.

Recovery and Rehabilitation After Clavicle ORIF Surgery

Recovery from clavicle ORIF surgery is a gradual process that requires patience and dedication. The typical recovery timeline includes:

1. Immediate post-operative period (1-2 weeks): Focus on pain management and wound care
2. Early recovery (2-6 weeks): Gentle range of motion exercises begin
3. Mid-recovery (6-12 weeks): Strengthening exercises are introduced
4. Late recovery (3-6 months): Return to normal activities and sports

How can you promote optimal healing during recovery? Following your surgeon’s instructions, attending physical therapy sessions, maintaining a healthy diet, and avoiding smoking are all crucial for a successful recovery. Additionally, wearing a sling or brace as directed can help protect the healing clavicle.

Physical Therapy and Rehabilitation Exercises

Physical therapy plays a vital role in regaining strength and mobility after clavicle ORIF surgery. Your physical therapist may guide you through exercises such as:

• Pendulum exercises
• Shoulder shrugs and rolls
• Isometric contractions
• Progressive range of motion exercises
• Strengthening exercises for the shoulder and upper arm

Can you expect to regain full function of your shoulder and arm? With proper rehabilitation and adherence to your recovery plan, most patients can regain full or near-full function of their shoulder and arm following clavicle ORIF surgery.

Long-Term Outlook and Potential Complications

The long-term prognosis for patients undergoing clavicle ORIF surgery is generally positive. Most individuals experience successful bone healing and a return to normal activities within 3-6 months. However, it’s important to be aware of potential long-term complications, including:

• Persistent pain or discomfort
• Limited range of motion
• Hardware-related issues requiring removal
• Increased risk of re-fracture at the surgical site

How long does the internal fixation hardware typically remain in place? In many cases, the hardware can be left in place indefinitely without causing problems. However, some patients may require hardware removal after the bone has fully healed, typically 12-18 months after surgery.

Alternatives to ORIF for Clavicle Fractures

While ORIF is an effective treatment for severe clavicle fractures, it’s not always necessary. Alternative treatments for less severe fractures may include:

• Immobilization with a sling or figure-8 bandage
• Pain management with over-the-counter or prescription medications
• Physical therapy to maintain and restore range of motion
• Closed reduction (non-surgical realignment of bone fragments)

How do doctors determine the best treatment approach for a clavicle fracture? The decision between conservative treatment and surgical intervention depends on factors such as fracture severity, patient age, overall health, and activity level. Your orthopedic surgeon will consider these factors and discuss the most appropriate treatment options with you.

Preventing Clavicle Fractures

While not all clavicle fractures can be prevented, certain measures can help reduce the risk:

• Wearing appropriate protective gear during sports and high-risk activities
• Maintaining bone health through proper nutrition and exercise
• Taking steps to prevent falls, especially in older adults
• Using seatbelts and proper car safety measures

By understanding the nature of clavicle fractures, their treatment options, and the recovery process, patients can make informed decisions about their care and actively participate in their rehabilitation. Whether treated conservatively or through ORIF surgery, most clavicle fractures have a good prognosis with proper management and patient compliance.

Clavicle Fracture Open Reduction and Internal Fixation

What is clavicle fracture open reduction and internal fixation?

Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken collarbone (clavicle).

The clavicle is a long thin bone located between your ribcage and the shoulder blade. Different kinds of injury can damage this bone, causing it to fracture into two or more pieces. Most often, this happens along the middle of the bone. Occasionally, the bone breaks near where it attaches to the ribcage, or near where it attaches to the shoulder blade.

In certain types of clavicle fractures, your clavicle has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of alignment.

If you fracture your clavicle, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces surgically back into their proper alignment. In a closed reduction, a doctor physically moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of physically reconnecting the bones. This method uses special screws, plates, wires, or nails to position the bones correctly. This prevents the bones from healing abnormally. The entire operation usually takes place while you are asleep under general anesthesia.

Why might I need a clavicle fracture open reduction and internal fixation?

Certain medical conditions may make fracturing your clavicle more likely. For example, osteoporosis increases the risk of clavicle fracture in many older adults.

You may fracture your clavicle from a direct blow to the shoulder, such as while playing a sport or if you’re in a car wreck. Falling on an outstretched arm may also fracture a clavicle. In some cases, a newborn baby will fracture the clavicle during the birth process.

Not everyone with a fractured clavicle needs ORIF. In fact, most people don’t. If possible, your doctor will treat your clavicle fracture with more conservative treatments, like pain medicines, splints, and slings.

You probably won’t need ORIF unless there is some reason your fracture might not heal normally with these conservative treatments. You may need ORIF if:

• The pieces of your clavicle are significantly out of alignment
• Your clavicle broke through the skin
• Your clavicle broke into several pieces

In these cases, ORIF can position your bones back into their proper configuration. This significantly increases the chance that your bone will heal properly. In some cases, you might opt not to have ORIF even if your clavicle is significantly out of alignment, because the bone often heals correctly on its own. Your doctor can talk to you about the risks and benefits of ORIF or discuss other, more conservative treatments for your situation.

What are the risks for clavicle fracture open reduction and internal fixation?

Most people do very well with ORIF for their clavicle fracture. However, some rare complications do sometimes occur. Possible complications include:

• Broken screws or plates
• Infection
• Damage to an artery or vein
• Nerve damage
• Bone misalignment
• Injury to the lung
• Complications from anesthesia

There is also a risk that the fracture won’t heal properly, and you’ll need repeat surgery.

Your own risk of complications may vary according to your age, the anatomy of your clavicle fracture, and your other medical conditions. For example, people with low bone mass or diabetes may be at higher risk of complications. Being a smoker may also increase your risk. Ask your doctor about the risks that most apply to you.

How do I prepare for a clavicle fracture open reduction and internal fixation?

ORIF often takes place as an emergency or urgent procedure. Before your procedure, a healthcare professional will take your medical history and do a physical exam. You’ll need an X-ray of your clavicle. Tell your doctor about all the medicines you take, including over-the-counter medicines like aspirin. Also, let your doctor know the last time you ate.

In some cases, your doctors might perform your ORIF as a planned procedure. If this is the case, talk to your doctor about how to prepare for the procedure. Ask whether you should stop taking any medicines ahead of time, like blood thinners. You’ll need to avoid food and drink after midnight the night before your procedure.

What happens during a clavicle fracture open reduction and internal fixation?

Your doctor can help explain the details of your particular surgery. The details of your surgery will depend on the location and severity of your injury. An orthopedic surgeon and a team of specialized healthcare professionals will do the procedure. The whole operation may take a couple of hours. In general, you can expect the following:

• You will receive general anesthesia to make you sleep through the operation so that you won’t feel any pain or discomfort. (Or, you may receive local anesthesia and a medicine to help you relax.)
• A healthcare professional will carefully monitor your vital signs, such as your heart rate and blood pressure, during the operation. You may have a breathing tube placed down your throat during the operation to help you breathe.
• After cleaning the affected area, your surgeon will make an incision through the skin and muscle near your clavicle.
• Your surgeon will bring the pieces of your clavicle back into alignment (reduction).
• Next, your surgeon will secure the pieces of clavicle to each other (fixation). To do this, he or she may use screws, metal plates, wires, and pins. (Ask what the surgeon will use in your case.)
• Your doctor may make other necessary repairs.
• After the team has secured the bone, your surgeon will surgically close the layers of skin and muscle around your clavicle.

What happens after a clavicle fracture open reduction and internal fixation?

Talk to your doctor about what you can expect after your surgery. You may have some pain after your procedure, but pain medicine may help to reduce the pain. You should be able to resume a normal diet fairly quickly. You will probably need an imaging procedure, like an X-ray, to make sure that your surgery was successful. Depending on the extent of your injury and your other medical conditions, you may be able to go home the same day.

For a while after your surgery, you’ll need to keep your arm immobile. Often, this means that you will need to wear your arm in a sling for several weeks. You’ll receive instructions about how you can move your arm.

Your doctor might give you other instructions about caring for your clavicle, like applying ice. Follow all your doctor’s instructions carefully. Your doctor might not want you to take certain over-the-counter medicine for pain, because some of these can interfere with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin D as your bone heals.

You might have some draining of fluid from your incision. This is normal. Let your doctor know right away if:

• You see an increase in redness, swelling, or draining from your incision
• You have a high fever or chills
• You have severe pain
• You have loss of feeling anywhere in your body

Make sure to keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.

At some point, you may need physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances of a full recovery. Most people are able to return to all their normal activities within a few months.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure

What Do You Do for a Broken Collarbone?

in Collarbone, Orthopedics, Shoulder

November 21, 2019

Tagged With: broken collarbone, Clavicle, Clavicle Fracture, collarbone, Orthopedic, Orthopedic Surgeon, Shoulder, Shoulder Pain, sports medicine, The Bone & Joint Center

The collarbone or clavicle is the long bone located at the top part of the chest. A broken collarbone or a clavicle fracture is a common orthopedic injury, especially among infants and young children. The most frequent cause of a broken clavicle is trauma from a forceful impact to the shoulders. This trauma can be from a sports-related injury, a bad fall, or vehicle collision. In new born infants, it can result from a birth complications.

Symptoms and Diagnosis

You will feel immediate pain and hear a snapping sound when a fracture in the clavicle happens. This pain can become sharp with the slightest movements, and you can expect bruising and swelling to follow. A clavicle fracture can also result in a slumped shoulder. A dislocated collarbone may appear as a bump under the skin. Consult with a doctor immediately for a proper diagnosis and treatment.

Your doctor will review your medical history and conduct a physical examination to evaluate any other injuries. The shoulder will be thoroughly inspected as well as the nerves in the arms to make sure no other damage has occurred. An x-ray of the clavicle will also be taken to determine the location and extent of the fracture.

First Aid Treatment

With a clavicle fracture, any movement of your shoulders should be as little as possible. For immediate first aid, an ice pack wrapped in a towel can be applied directly to the collarbone.

Nonsurgical Treatment

Most cases of clavicle fractures heal without surgical treatment. It is most commonly treated with medical slings or a figure eight splint. Over-the-counter pain relievers and prescription medications are also used to ease pain.

A sling positions the shoulder and supports the arm in a way that will allow the fracture to heal and move back in place. Meanwhile, a figure-eight splint is wrapped around the front of the shoulders and then crosses at the back. This method helps maintain proper posture while the bone heals. To help regain motion and strength following treatment, you can undergo rehabilitation therapy.

Surgery

In cases where surgery for a clavicle fracture is necessary, the bone is secured with surgical hardware, such as screws and plates. The surgeon aligns the bone back to its proper position. The surgeon may or may not remove the surgical device used to secure the bone after it has healed.

Surgery may be performed for broken bones that ripped through the skin and pose a threat to nearby nerves, blood vessels, or joints. It is also necessary for fractures that fail to heal with nonsurgical treatment. Be sure to talk with your doctor about all procedure options for clavicle fractures.

Clavicle Fracture Treatment in North Dakota

At The Bone & Joint Center, we provide treatments for a wide range of bone, muscle, and joint problems, such as a broken collarbone. Together with our team of board-certified and fellowship-trained bone and joint physicians, we practice patient-centered care with state-of-the-art treatments for your bone and joint problems.

If you are suffering from a broken collarbone, make an appointment with one of our bone and joint specialists. Call us at (701) 946-7400 or (866) 900-8650, or you may also request an appointment online. We look forward to serving you!

Osteosynthesis of the clavicle at a bargain price in Moscow

What to do if I broke my bones abroad or how I got hit by a car in Montenegro — Personal experience on vc.ru

Getting into such a story is unpleasant anywhere, but especially in another country.

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The main lesson I’ve learned is: don’t overestimate your abilities when you’re driving. I have been cycling for 20 years, I ride it very well, I can ride without hands, around the city, rough terrain, in a crowd of people and on the road among cars .. And yet it was on a bicycle that I had an accident and broke my collarbone (the first broken bone in my life).

I think that when you do something for a long time (for example, ride a bike), you start to think that you are good at it, that you have this skill honed to automatism. You become self-confident, you can neglect the safety rules or just attentiveness. And then it’s easy to make a mistake. That is exactly what happened to me.

It was a combination of overconfidence and inattention. I drove into the yard to take a short cut, drove straight at a fairly high speed. And I did not notice how a car was leaving from around the corner. The most amazing thing is that she appeared super suddenly. Here I am driving straight ahead, there is no one on the road, and suddenly, literally in a second, a car appears right in front of my nose.

Now I understand that this could have been avoided if I had driven more slowly. Still, the yard is a rather dangerous place, a car can always unexpectedly turn around there and you simply won’t notice it (which happened in my case). So there you have to go slower. But “I’m good at driving a bike, I notice all the obstacles on the road, I always drive fast everywhere and everything is OK.” Ok, but not ok)

At the time of the collision, we both braked sharply, but the car managed to hit me and I, along with the bike, fell to the asphalt. She fell on her side, hit her head, lost consciousness for a couple of moments. As is usually the case in such situations, it was not scary, just somehow detachedly watched what was happening.

What struck me the most was that at the moment and immediately after the fall, it didn’t hurt that much. I always thought that breaking a bone is wildly painful, IT’S THE SAME BONE. But in reality, it just felt like a normal fall with a bruise. In general, it is logical, there are no nerve endings in the bones, only the soft tissues around suffer. Then I didn’t even think that I had broken something, it seemed to me that I just fell off the bike and hurt myself.

The driver, of course, got scared, called me a taxi to the hospital, gave me 10 euros for a taxi. As I understand it, an ambulance arrives in Montenegro only as a last resort, and if there is no direct threat to life, you have to get to the hospital on your own. the driver did not speak English well, he hardly understood Russian either, so we did not communicate much, we just waited for a taxi. And I was more worried not for myself, but for the bike. It didn’t break, but I didn’t understand how to return it, it was a rental and I had to return it before the end of the day. And I had to be taken away by an ambulance, and on the journey I was alone, there was no one to entrust it to. As a result, somehow, through an interpreter, I agreed with the driver of the car that hit me that he would return the bike to the rental, exchanged contacts.

They loaded me into a taxi, on the way I informed all my friends and my insurance company about what happened to me (fortunately I had mobile Internet). In the hospital they put me on a gurney – I don’t know why, I was quite capable of walking – and they took me to the emergency department. There she waited her turn.

I felt like this: the places of bruises and abrasions hurt, my shoulder, on which I fell, and my big toe ached (part of the blow fell on it), my head was spinning a little. But in general, it was bearable, I could move, including my broken, as it turned out later, shoulder. I felt a slight constraint of movement in this place, but there was no hellish pain – a strong toothache or headache is much, much worse.

I told the doctor about my symptoms, he understood Russian well, they took a picture. It turned out that I had a closed fracture of the clavicle without displacement – I was lucky, one might say. After all, the driver might not have had time to slow down and crush me, and so I just fell. They also found a cracked toe. Well, the little things – abrasions, bruises. I was still worried that I might have a concussion, but the doctor said that the symptoms did not indicate this and CT was not necessary.

After that I was sent to another room where I was given a tetanus shot and a cast on my shoulder. They didn’t put it on the toe, they said there is a very small crack there and this is not necessary. It was the first time I had a cast put on and I didn’t think it would be so uncomfortable. The arm was fixed in a bent position, pressed against the body and began to be wrapped with a bandage. After a couple of minutes, I wildly wanted to straighten my arm. This feeling is crazy when you want to move, but you can’t, you feel claustrophobia in your own body. Just a disgusting feeling, I wanted to scream and convulse.

And the bandage was soaked in some kind of agent, from which it hardens and begins to press right on the skin until it turns red. These hardened bandages almost immediately began to rub the skin at the joints – the neck and chest. It felt like I was wearing very tight armor on my naked body, which fettered my movements and stuck to my skin.

I experienced even greater horror when I asked the doctor how long I should wear a cast, he answered “at least a month”. I just freaked out then – it was simply impossible to endure it for a month. The cast hindered movement very much, it was difficult to change clothes, I could use only one hand. Fortunately, I broke my left collarbone, so my right hand was free, and I’m right-handed. And how to wash with this plaster, I had no idea at all . .. The doctor explained that in order for the bone to heal correctly and quickly, you can’t move your hand, it must be constantly fixed in one position. But it didn’t get any easier.

Then the appointment ended and I was billed, in total for the doctor’s appointment, vaccination and hip came out 156 euros, I had to pay right away. And here a problem arose. I don’t have a foreign card, they don’t accept a Russian one, I was on a trip with cash. And I didn’t have that much cash with me, everything was left in the hotel. I asked in my insurance (I took the policy in Tinkoff) if they can immediately pay for the doctor’s services themselves, explained that the situation is hopeless. I had to wait for an answer, it’s good that at least the hospital didn’t rush and didn’t nightmare with payment. As a result, we went to a meeting and made the payment ourselves by bank transfer, called from the assistance service via the Internet, I gave the phone to the employee at the reception and they themselves figured it out.

The doctor also offered to stay in the hospital for a day, but I could only imagine the price tag they would charge me for it. I was afraid that the insurance company would not compensate for these expenses. Yes, and I didn’t want to lie in some incomprehensible hospital, it’s more comfortable in a hotel. So I refused, the doctor did not insist, he said that there was no threat to life and there would be nothing terrible if I went home right away. He also prescribed painkillers, omeprazole, vinpocetine, metoclopramide, betahistine. Then I read about these drugs – apparently I still had some kind of head injury …

I took the taxi back to the hotel and the medicines at my own expense, kept the receipts and a few days later the insurance company compensated these expenses. But here’s another expense not compensated. The fact is that this cast simply drove me crazy and the very next day I decided to remove it (not without the help of the hotel staff))) and replace it with something more convenient. For example, a more comfortable removable bandage so that it does not press on the skin, so that it is soft so that it can be removed and washed. I found (with difficulty) an orthopedic store (there was simply no such bandage in pharmacies) and bought such a bandage there, it cost 30 euros. These expenses were not compensated – they say, they put you in plaster anyway.

Of course, the trip was down the drain, because even in a comfortable bandage, I still couldn’t move my left arm. Or rather, she could, but she couldn’t. It turned out that without one hand a person becomes absolutely helpless) It is difficult to dress, do basic household chores. Walking was also difficult due to a broken toe. So I decided to change tickets and return home earlier. To calmly lie down at home in a comfortable environment, to be observed by your district doctor, to enlist the help of loved ones.

On the whole, specific organizational issues related to the turning point in another country were not as difficult as I thought. The driver who knocked me down helped call a taxi and told me which hospital to go to, the insurance company paid for the treatment, I didn’t lose much money on the ticket exchange and hotel cancellation. It was much more difficult and unpleasant to be alone, with a broken collarbone and only one working arm, to pack things, get to the airport and fly on a plane. It is good that relatives have already met at the airport in Russia.

My vision was not very good, I felt and looked like a victim of domestic violence.

We don’t value our usual healthy state after all. As is usually the case with a cold, you lie with a fever and think “how good it is to be healthy, I don’t need money and fame, just take me back to the time when I was healthy and I didn’t have a temperature.” And with the fracture, this feeling was multiplied many times over. Because the temperature drops in a couple of days, and here for a whole month, as the doctor said, I was limited in mobility. She could not do anything with her left hand and walked with difficulty, limping, it hurt to step on a broken finger and put on that leg.

Being locked up at home and chained to a bed for a month is not a pleasant experience. You can’t go anywhere, you look in the story as friends hang out without you. Obviously, you can’t do sports, creativity / needlework was also difficult with one hand. From entertainment, only social networks, books, films, TV shows (I then watched Evangelion for the first time, by the way). I love all this very much, but in moderation and of my own free will, and not like this.

The mood was below the baseboard, almost a depressive state. But what a buzz I experienced later, when I returned to an active lifestyle – you can’t imagine. I was wildly happy just because I could walk down the street in good weather, not limp and move both hands, I was right in euphoria for the first two weeks.

I got the impression that at the moment a fracture is not painful or scary at all. But the recovery from it is long and unpleasant. After all, when a month had passed and I could remove the bandage, the pain began.