Remove arm cast before healed?

Discussion in 'Rider Down' started by jeff^d, Jul 31, 2009.

  1. jeff^d

    jeff^d Active Member

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    I cross-posted this on MTBR, but wanted to bring it here for a little more exposure... sorry to spam but I'm trying to get as much input as I can.

    Back in April I had a high speed OTB crash and broke my left ulna/radius about 1/3 of the way up my arm. The ulna was compound and came out of the skin about 4". Since it was on dirt, the break was filthy. The trauma surgeon ended up removing about 1/4" of the ulna because of the dirt compacted into the shaft. They put steel plates on both bones, but left a 1/4" gap in the ulna so I would retain the original length.

    [​IMG]
    ER x-ray

    [​IMG]
    Arm repaired, notice the ulnar gap

    Fast forward 4 months and my radius has healed, but the ulna has shown no real signs of growth. They call it an atrophic nonunion, and now want to do a bone graft surgery.

    My original surgeon is out of my insurance network (still working on fighting that), so I just saw a local ortho surgeon the other day. He is a team doc for the Ontario Reign hockey team, and has worked with the Red Sox and Houston Astros. He sounds comfortable with the surgery I need, but he suggested that they remove the cast and let me go about daily life without it. Keep in mind that my ulna is held together by a plate and screws only. Obviously, he said, I would need to be gentle with it, but he said it'd be good for my arm to get out of the cast and work on some movement and document what sort of pain I'm having. Plus, he said, there is support there from my radius.

    I'm tempted, because this cast business is no fun. But it was never presented as an option with my original surgeon, and she is on vacation for 2 weeks so I can't run it by her. I guess since I'll be getting more surgery soon, and I definitely won't be lifting anything with it or riding any bikes, there isn't much risk in this? As it is, I'm in very little pain and have been off the pain meds for a couple months. Does this sound like anything people have come across before?

    Also, any advice on switching docs in a situation like this? I really like the original surgeon but primary motives for seeing another doc are distance (2.5 hours away, where I crashed) and insurance issues. It is also a headache to deal with her staff, as she is a trauma surgeon and they work for her part time remotely while working other full time jobs. Plus she has been out of town since early July, can't see her again until mid-August, and I'm tired of sitting in a cast with a bone that's not growing when I could've had surgery a month ago. I'm seeing a third doc next week for yet another opinion.

    Thanks for your input.
     
  2. Zonacat

    Zonacat New Member

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    Let the new doc take the cast off. Wrap your arm in an Ace bandage to remind yourself to be careful. Let other doctor know the reasons for doctor change (distance and insurance), he or she will understand.

    Best, and good luck.
     
  3. denmother

    denmother Gone riding....

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    I recently got a 2nd opinion on my knee and decided to switch to the new Ortho. It's perfectly within your right to switch Doctors and to find the best care that meets your needs. BTW, I didn't end up saying anything to my original Doctor, I just quit going.

    If you are not comfortable taking the cast off, wait until you get your 2nd opinion and then make a decision. If they both recommend the same thing, then you have your answer!!!!

    What ever you decide, I wish you the best!
     
  4. mattmaple

    mattmaple New Member

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    I would stop going to the trauma surgeon for using that many staples to close the wounds. I hope you like scars... Besides an ortho doc only does bones. I'd feel more comfortable going to the bone expert (especially one with a sports medicine background).

    Good luck, get better soon.
     
  5. afgenkuong

    afgenkuong Guest

    Honestly... (If it were me), I'd keep the cast on until you got bone graft surgery at least. I'd rather heal up well and nice than have to start the process all over again. Or have complications that will take even longer to heal than before.
     
  6. jeff^d

    jeff^d Active Member

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    Thanks, this is basically what I've decided to do. I still have moments where I want to call up the 2nd surgeon and tell him to get me out of this cast, stat. But then, what's another couple of weeks when I've already been in it 4 months?
     
  7. jeff^d

    jeff^d Active Member

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    Thank you. Regarding the staples: I cannot emphasize enough how dirty the wound was (some here can attest), the large incisions were necessary to ensure all dirt was removed so there was no infection. The scars will make a good story someday. I think she is a great surgeon, just not thrilled that she allowed me to continue seeing her without insurance approval (or without me knowing that I didn't have approval).

    My original surgeon, this new guy, and the third surgeon next week are all sports orthos. I haven't met an orthopod who will only work on bones. They all seem to focus on bones/muscles/joints, some with specific areas of expertise. Lucky for me I think most orthos have extensive training in fracture repair.

    The cast will be back on 6-8 weeks following bone graft surgery, to ensure immobility and allow the bone graft to take.

    I know what you mean, though. My arm without a cast is so tiny and fragile now, I'd hate to bump it on something or sleep on it wrong and cause problems. I'm thinking they would give me a removable soft cast, hopefully.
     
  8. CA_descender

    CA_descender IamHAZZMATTseeMEgroove

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    If the bone is showing no signs of healing then removing the cast should not do much damage as long as you can remember to be careful with it and since the Docs are recommending SX anyways there really is nothing to loose if you do not over do it.

    The movement will get a bit better blood flow in there, help it from becoming to stiff and may even help it heal because of the increase in blood to the area.
     
  9. Margaritaman

    Margaritaman It's just tequila...

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    Agreed. My hard cast came off my foot after ten days. I've got the inflatable boot for work and moving about but at home it's free and I'm just real careful. Being able to move it absolutely helps it feel better albeit a bit sore at times. I think there is some mental heeling too having it free.

    If you do take it off just do something so you don't forget about it. How about a Sharpie to write on it.;)

    Happy healing and best wishes. And ya, casts suck!
     
  10. Impy

    Impy Active Member

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    A friend of mine had a big ol' gap in his tibia for 2 years before it healed up. It was rodded/screwed. He was walking on it/riding on it. As a matter of fact did VQ on it on a SS. Your results may vary.
     
  11. Pain Freak

    Pain Freak Dead or Alive

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    :)
     
  12. DirtymikeTDB

    DirtymikeTDB Guest

    I dont see anytihng wrong with getting the cast removed. Here is the thing to remember. The Plate is holding your arm together, adn the bone screws are already hard healed. Its the two peices of the Ulna that are not coming together that is the problem. I am not a doctor nor expert by any means, But I know this, the longer your in a cast, the longer your in PT. My cast was removed after two weeks when I broke my wrist, Doc wanted me into PT as soon as possible.

    If you do decided to have it removed, just dont forget its still not healed, you will be amazed what you will be able to do, just dont reinjure it.

    I have to ask to make sure, this isnt your first cast right? Just thinking to make sure you dont still have staples in your arm after four months.
     
  13. Keith B

    Keith B Professional Lion Tamer

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    I also snapped both my ulna and radius in a similar manner to yours. Also had 2 metal bars and 10 bolts put it. Didnt quite come through the skin but the break wasnt a 'snap' - the bone shattered into pieces at the point of the break. The surgeon pulled out alot of the small bone pieces and through them away (or fed them to his dog, who knows) but chose to put a large piece of bone back into the gap it came from in the hope it would grow back into the 2 other pieces. Long story short. One both healed very quickly and the one that shattered took almost a year to grow and bond with the piece that they put back in. The surgeon told me that altho riding was not a good idea I could use the arm as the metal bar would be very strong, I was pretty nervous about it but gradually used it a little more each week and I only wore my support cast when doing something strenuous. I'd heed the docs advice but try and build the strength back up in the arm a little. Not sure if you had the physical therapy yet - if not then prepare for war!
     
  14. Shu

    Shu Active Member

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    I'm not a Dr but I stayed at a Holiday Inn Express last nite and based on your X-rays you should be good to remove your cast until you have your surgery....

    I broke my scaffoid and didn't know it...18 months later(when I was getting xray'd for another injury) the discovered the "Open Union"...my scaffoid had healed apart and actually degenerated a little do to riding and working etc....they decided to insert a graft and a screw to solve the problem....let me tell you...the spot they took the graft(hip) from hurt 1000x's worse then the place they put it..long after my hand was healed and I was back to being normal...my hip still had and has moments of pain....my surgery was 9-07

    [​IMG]
     
  15. jeff^d

    jeff^d Active Member

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    This is my third cast. Staples were taken out about 2 weeks after surgery. Honestly I should've had several more cast changes because the thing is quite nasty. Fortunately I really don't notice it anymore (but those around me probably do).

    I really haven't done any therapy other than continuously making my hand into a fist and stretching my fingers. My arm is pretty darn skinny now, and that combined with my last vivid memory of the arm with its bone sticking out has made me a little gunshy to get the cast off.

    Very anxious to start PT though, regardless of pain/struggle. It's one step closer to getting back on the bike.

    Aw, now you tell me. Where were you 4 months ago to talk some sense into me?
     
  16. jeff^d

    jeff^d Active Member

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    Well, I made the decision last week to have the cast removed. So far, it seems to have been the right decision. Cast was cut off Monday and I started physical therapy Wednesday with Mary Rozina in Upland (she is fantastic -- if you are local and ever need PT done look into her practice, Rozina & Smith).

    Both the second doc and physical therapist were surprised/upset that I was left in a cast for 4 months, but what's done is done. PT is going well; supination (rotation to palm up) is the most painful and I still have another 70-80 degrees of movement to get through. Just being out of a cast and being cleared to run/ride a recumbent bike have boosted my spirits tremendously. I'm continually amazed at how little pain I'm in considering my arm is still broken. However, the reality is that steel plates fatigue, and I'll eventually break the plate or need surgery if the bone doesn't start growing on its own. At this point we are leaning towards a graft from my hip to maximize the chances of surgical success.

    Thank you to everyone who provided input. It's really awesome to feel part of a community even though I've never met most of you.

    A few pictures about an hour after the cast was removed. Lots of dead skin still. Soaked the arm for about an hour in the bath then scrubbed it all off. Felt incredible!

    [​IMG]

    [​IMG]

    [​IMG]

    After a week of "normal" living:

    [​IMG]

    [​IMG]

    Never imagined I'd be riding one of these... but it's actually pretty fun, and it gets me to work and back without dealing with freeways:

    [​IMG]
     
  17. DISCO

    DISCO Banned

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    Rad, get a heavy bag, if you want to ride aggro again you'll need to get it used to the impact, worked for mine.
     
  18. gr@sshopper

    gr@sshopper Closet Roadie

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    Dude. A bent. And sandals. We can't talk anymore. You're DEAD to me Jeff! DEAD.

    Seriously, how's the bent going up and down hills? Could we do a GMR run this weekend?
     
  19. XS NOIZ

    XS NOIZ New Member

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    i'll bet you have to beat the women off with a stick when you come pimpin' that thing.
     
  20. jeff^d

    jeff^d Active Member

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    Sunday morning we are thinking GMR. No time set yet, maybe 8ish? It's tough going up hills, even small ones. No leverage, all legs, and lots of spinning. Coming down is a blast. The long wheel base makes it pretty stable. Let me know if you're interested Sunday! Maybe I'll put on the clipless for GMR...
     

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