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Multiple broken ribs, collor bone, collapsed lungs. Treatment.

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My friend, 71 yr old female in excellent condition, very active (e.g. horse, rock climbing, running) suffered 11 broken left ribs (some multiple), collapsed lung, broken left collarbone, and many bad bruises 4 weeks ago. Recovery very good thus far: Tylenol, gabapentin (low dose), and advil enough to control pain now, and we walked over an hour yesterday at a good pace. Left arm is working reasonably well, except left thumb still a little numb and less mobile than should be. The question is what to do about the collarbone.

It's a single break about two inches out from the inner end of the bone. At 3 weeks, the end-end overlap was about 3 bone diameters, and the gap a about one bone diam. Definitely looked more overlapped on xray on day 22 than at day 10. She feels it moving around. She is visibly misshapen, with that shoulder down and in, and one end of the bone making skin poke up. Appointment to discuss surgery Tuesday.

What do you think about screwed-on plate vs intermedullary vs skip the surgery? What are the questions she should ask the surgeon? Is this a sufficiently complicated situation that she should get a second opinion from an unrelated surgeon?

Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Thank you for your query at DoctorSpring.com
I understand your concern, however i do need a few more details from you.
- Why exactly was the semen analysis done?
- Any past history of chronic medical problem ( hypertension/ diabetes/ asthma/ tuberculosis )?
- Any past history of hydrocele/ or any other genital infections?
Feel free to discuss further,

Patient replied :

Me and my wife trying to concieve a baby, is already 1 year we trying, we are both active in sex but im thinking that i have problem because im drinking and smoking.
i dont have past history of chronic medical problem
i donthave past history of hydrocele.
Thank you

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Your semen analysis report is fine as well as your sperm count.
The only issue is the abnormal morphology, however your sperm count is adequate and hence conceiving baby should not be a problem.
Smoking and drinking does can lead to infertility, hence you should stop it.
Kindly get your wife evaluated too and consult an infertility expert for the same.
However as far as your semen analysis goes, the report is fine.
Feel free to discuss further,

Patient replied :

what ate the symptoms of infirtily for the woman?

Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

There won't be much of evident symptoms it all depends on the Trans Vaginal Ultrasound, the FSH and LH levels, and ultrasound whole abdomen.
Sometimes inability to conceive is the only symptom warrating investigations.

Patient replied :

What are the cause of abnormal morphology?

Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Abnormal morphology can be due to a lot of factors such as previous testicular infections, viral orchitis, hydrocele, wearing tight fitting shorts, anything that increases the testicular temperature such as varicocele can lead to abnormal formation of sperms.
However you have 45 % normal spermatozoa, and that is adequate to cause pregnancy.
So please get your wife evaluated and treatment can be based on that.

Dr. Deepu Sebin Sebastian
Category: Select Speciality
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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