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CX VS 29er
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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/15/13 7:35 PM

Brian

Is that your thinking, or does Linda share that same line of thought?

My thinking goes the opposite direction. I only enjoy pushing the limit when I feel I'm at the best position to handle the consequence... of occasionally exceeding the limit! If I'm worried about falling, I probably wouldn't push myself. And I doubt I would enjoy it. Granted, not everyone think along the same line.

Riding itself obviously is the easier part. It's just the potential of falls that's slightly disconcerting. On road, that's extremelly unlikely to happen but off-road, there's that slightly increased chance...

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/16/13 10:00 AM

I've been through this with her before, so yes.

It's about getting past the initial nervousness and realizing that you can relax. If you're tense and nervous, you're more likely make a mistake or overreact and consequently, more likely to crash. Once you get past that, muscle memory takes over and you start having fun again.

She's backed off a bit today and may just do a few laps around her yard, which has enough elevation change and obstacles (plants, trees, etc.) to make it interesting, but with soft landings everywhere except the driveway. After that, we'll see if she's up for some light dirt road and trail riding.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/16/13 5:18 PM

Sparky wrote:


quote:
How is your clav progressing April ?


Well, it "progressed" from disconnected to connected, at least by a plate!

It's "technically considered healed". Doctor's exact word.

But I don't think he "actually" knows. The x-ray from 2 weeks post-op and 6 weeks post-op look IDENTICAL!!! (yes, I was in the room waiting and the x-ray was on the screen, I put the 2 side by side and there's no difference!)

For the uninitiated, the operation butts the 2 broken piece up against each other, then screwed two plates above and below so they can't pull apart any more. So on the x-ray, you can't even tell where the break was any more. But then, you can't tell if they're actually connected by nature, or just held together by the plate! (unlike in the non-surgical case, where the x-ray would show the bone matter "filling in" the gap between the 2 broken end)

So, counting the days, the doc declares it's "technically healed"! That's ASSUMING the body does the normal thing and the bones grew between the two broken end.

Still lots of pain. In fact, about as bad as the day after the accident! That is actually worse than right after the accident!!! :-(

Had an MRI done yesterday to see if there's other demage besides the clav. That's after I complained a lot about the pain when I started doing weight bearing PT.

Been out riding every weekend, Yea, I can see Lance riding with a broken collarbone. Riding doesn't bother it that much, since it's not even moving. If I weren't worried about further demaging it (and didn't have the intense pain of bruised ribs), I could have kept on riding till the day of my surgery too! (some guy in our club did exactly that!)

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/16/13 5:34 PM

Part of my ongoing pain was the tissue rubbing against the edge of a broken edge. Doc said it would granulate and round over in time. It took like a year before Elaine resting he head on that side did not hurt.
Well, hurt as much. Took quite a while before I got used to the new sensations when leaned against or hit etc.

Maybe some hardware is what it hurting. Ask them to take it out now that it 'IS HEALED', hopefully not just technically.

Elaine sez it is not uncommon for folks to have discomfort from screw if it backs out which can and does happen. Approx 50% rate of removal, especially in areas with low fat/tissue like shoulders, elbows ankles etc.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/16/13 9:15 PM

The MRI will also show whether it's actually healed, over just "technically".

I'm not impressed with the doctor's approach. He maybe a decent surgeon (that's IF the MRI confirms it), he's refusal to even consider if there're other injury besides the clav! Both a PT had seen quite many, and a club-mate of mine had, rotator cuff injury in addition to fractured clavicle. When body meets pavement, anything can happen!

Only when other injuries are ruled out, then hardware removal would be the next option. It's not a small operation (just as invasive as the original operation) So it'll only be done if it turns out to be really neccessary, not before all others factors had been considered.

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/16/13 9:23 PM

It's not a small operation (just as invasive as the original operation)

The longer the hardware is in there, the more chance taking it out will be more serious. Bone growing over it being one example..

If you push for it, they will take it out, probably not this soon... Squeeky wheel, if it hurts and you say it hurts, and they can;t see why it still hurts.. yada.

As Elaine said, about 50% come back for removal at the surgery centers she has worked at. Only 3 in 15 years FWIW. And her longest stint was at a sports ortho surgery center FWIW.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/16/13 9:38 PM


quote:
about 50% come back for removal at the surgery centers she has worked at

Different surgeon have diffeernt percentage. It ranges from 30 to 50% for clavicle.


quote:
The longer the hardware is in there, the more chance taking it out will be more serious. Bone growing over it being one example..

Never heard of it (the longer the worse part). People had been known to take it out decades later.

Most tend to take it out within a few years because they got tired of the problem associated with it. People who take it out decades later usually because they weren't informed of the option from the original surgeon, till they met another ortho much later.

Bone does grow around it, the screws that is. So it's a serious operation. But not worse than putting the screw in the first place.

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/16/13 10:09 PM

"Different surgeon have diffeernt percentage. It ranges from 30 to 50% for clavicle. "

For clarity, no less than 12 Surgeons in both the Nashville and PDX surgery Centers. Thus 50% is for the Center, not a given surgeon.

"But not worse than putting the screw in the first place."

More risk going in due to chance of embolism etc, just from the broken bone as well as drilling for the screws etc.

Taking out even if chipping bone away had got to be less serious a procedure than the break in the first place.

Another note re removal: the holes left behind puts you back in a recovery state until the holes granulate and heal in et al. A fall at that point not a good thing probably.


Well I hope your pain subsides and the outcome/prognosis realized is that which will minimize discomfort and have the best recovery!

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/17/13 10:52 AM


quote:
the holes left behind puts you back in a recovery state until the holes granulate and heal in et al. A fall at that point not a good thing probably.

It only takes about 6 weeks for a fresh break to knit up. So I would think that's how long it takes to fill the holes. Most people don't mind the time it takes because, unlike the original accident, the timing of the removal is usually chosen by the patient to be at a "convenient time"!

It's the surgury itself that scares me more than anything else. Infection can kill you (unlikely), scar tissue needs to be broken up (10x the pain compare to the accident itself!)

The one positive of removal is, the bone will be back to as good as original, rather than artificially strengthen at a point nature designs to give way, in the event of a future accident!

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/19/13 6:29 AM

I don't know about your situation...

...but one concern I have is that the screws create weak spots in the bone, as there really isn't any bond between them. Also, some of the pain you're feeling could be related the hardware, as it doesn't flex the same as the bone does. That's why I had the screws removed from my hip. I was told to take it easy for the first two weeks and be careful for the first month after having the screws removed. It was a piece of cake to recover from and I'm really glad I did it. BTW, I had the removed 9 months after the accident, so you don't necessarily need to rush.

I worry a lot about Linda's ankle, as she has small bones, one of which has 8 screws through it, each of which seems like a weak spot and potential fracture point to me. However, she doesn't even want to discuss the subject, so I'm not pushing it.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/19/13 8:35 AM


quote:
one concern I have is that the screws create weak spots in the bone, as there really isn't any bond between them.

I don't think that's correct. For most people (90%+), the bone does bound to the titanium screw. (that's how dental implant works, the implanted tooth is as stable as the natural tooth). There're some (limited) research on the subject I found (online), they found no cases of fracture with the screws in, but cases of re-fracture within a few weeks/month of screw removal.

I don't know how clavicle plates compare to hip's. There's a nerve on one end of the clavicle, demage that nerve will paralyze the arm! (though my surgeon said the nerve is "easy to avoid". Nonetheless, cases of such had been reported) On the other end of the clavicle is also a big chunk of muscle that needs to be cut and re-attached. So there're enough things that can go wrong. Plus, the bone looks like swiss cheese for about 6 weeks post removal. An innocent fall could turn really nasty.

On the other hand, those two are part of the motivation for removing the plate: the middle of the clavicle has no nerve no muscle so if there's another fall in the future bad enough to break the clavicle again, one really PREFER it to break in the middle! But if the plate stays there, it won't! Instead, it would break in either end outside the plate, much higher chance of direct demage to the nerve, and much harder to heal (cases of those had also been reported). By artifitially re-enforcing a part of the bone that's designed to give, one runs the risk of demanging other parts that are a lot harder to deal with.

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/19/13 10:32 AM

"I was told to take it easy for the first two weeks and be careful for the first month after having the screws removed"

Approx the same time it took the bone to heal the first time round make sense. The bone heals in the holes just like they healed to each other [the parts that are meant to be one].

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/20/13 6:05 AM

Ti vs. stainless hardware

You're correct that the bone can grow into the various Ti hardware bits and they're designed to promote that growth. However, my hip screws were polished stainless and bone cannot grow into it. Except for the one the the doc stripped when he took it out, they look absolutely pristine.

I guess the bottom line is that you need to know exactly what was used in order to determine whether having it removed is the most prudent course or not. In my case, it definitely was.

I'm pretty well acquainted with the nerve bundle at the end of the clavicle, as that's where some of the nerve damage I suffered this spring is. There's still a sore/tight spot there that reminds me periodically that things are still not back to normal.


Last edited by Brian Nystrom on 11/21/13 6:27 AM; edited 1 time in total

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/20/13 12:03 PM


quote:
I'm pretty well acquainted with the nerve bundle at the end of the clavicle, as that's where some of the nerve damage I suffered this spring is. There's still a sore/tight spot there

I always thought sore/tightness are associated with muscle/tendon. Nerve with tingling and numbness...

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/21/13 6:30 AM

I thought so, too

However, this issue is definitely due to the nerve damage.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/21/13 8:31 AM


quote:
whether having it removed is the most prudent course or not. In my case, it definitely was.


Was your hardware causing issues?

Or was it because the removal such a piece of cake, you consider it worth doing just for the peace of mind?

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/22/13 6:45 AM

Yes, it was anoying and painful

The difference in flexibility between the bone and the screws caused an uncomfortable feeling under certain circumstances. Remember, there was no bond between the bone and the stainless screws.

More important, once the bone healed, the heads of the screws protruded (which is typical) and rubbed the inside of my IT band. Also, it really hurt if I bumped my hip into anything.

If you've got Ti hardware and you're not experiencing anything like this a few months post-surgery, I wouldn't bother to have it removed.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/22/13 8:09 AM


quote:
If you've got Ti hardware and you're not experiencing anything like this a few months post-surgery, I wouldn't bother to have it removed.

Although I know the plate is Ti for sure, I'll have to ask the doc to confirm what the screws are made of. I wonder why your surgeon used steel screw instead of ti? I mean, given the less than desirable result...

In Linda's case, maybe that's why she doesn't care to have them taken out? Because she's not having any discomfort?

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/22/13 10:26 AM

Screws surgical stainless I'd think, I seriously doubt the plate is TI and not the same SS. FWIW

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/22/13 10:45 AM

these days, plates are almost all ti. Steel is old school.

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/22/13 11:19 AM

They go back and forth it seems as to what can get billed higher, or rather what can get collected @ higher profit...

Your doc probably just gets more props from the supplier [of Ti] for now and that is the basis of why that shop uses one over the other... ;)

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/22/13 11:23 AM

Haven't heard of steel for clavicle. (not lately, not the last 5, or even 10 years)

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Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

11/22/13 3:28 PM

I wonder if they could use METAX cycling tubing, I know my foco top tube is .035" thick in the middle butt. ;)

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Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

11/23/13 8:23 AM

Stainless is used for hip screws...

... for several reasons.

Mine are between 100 and 110mm long, but only 4mm in diameter and they're hollow, with a 2mm hole down the center. Considering the brutal way they install them, Ti may not be strong enough for this application in this size.

Hips screws only have threads on the last 15mm; the rest of the screw shank is smooth and highly polished. The reason for this is to allow the femoral neck to compress (shorten) slightly as it heals. I'm not sure why this is desirable, but it's standard practice, or at least it was 15 years ago. This compression is the reason that the heads stick out after the bone heals.

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April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

11/24/13 5:37 PM


quote:
Mine are between 100 and 110mm long, but only 4mm in diameter

Wow, that's a looong screw!

Clavicle is not a big bone. So the screw is a lot smaller. At most 2 cm long I can tell...

I'm still a bit early to be able to say whether the screws trouble me or not. Right now, the area is still quite painful and I can kind of tell is from scar tissue. So until those quiet down, I won't be able to tell how much the screws bothers me.

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