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Does the bone regrow then? or is your leg bone-metal-bone forever?
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Aug 27, 2015 18:56
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I'd assume the bone regrows, though the rod in my leg is permanent either way. I think the main reason they leave the bone shards in is so the surgery is less invasive. I only have two small openings on my leg, one at hip and one just above the knee, instead of a long gash all the way up the outside of my thigh, plus it heals quicker and easier. I'd say the technique is sound, as here is the same leg about a week and a half after that x-ray was taken, with no further work beyond some physical therapy: 
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Aug 27, 2015 20:38
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That sounds way better than how it used to be done, definitely. I had a friend who was in a gnarly car crash in the 90s, and her femur was shattered pretty badly. They did a similar thing (rod in the thighbone) but also opened her leg up from below the knee to the inner thigh area, and it looked like a drat railroad track with all the staples. Seems like a recipe for a horrible infection to me.
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Aug 27, 2015 22:35
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Slightly tangential but it's me trying to effortpost speculation around HCC's operation so I hope interesting to the thread and therefore kosher. This comes with a major disclaimer that I am of course an goddamn stranger from the internet and not your treating physician; I have not read your case notes so I'm talking generally and this is in no shape or form medical advice and potentially I could be completely wrong and none of this applies to you and you can come to huge harm from listening to my half baked ramblings. I just like talking about surgery. With that really huge caveat out of the way, just looking at what you've put on the internet so far It looks like they put in a femoral nail. They can vary depending on the exact flavour of intramedullary nail and the manufacturer, but they look more or less like this out of the box:  There are three main components to it. The nail itself is the main show because it's a hollow rod that temporarily takes over the job of supporting your weight from your thigh bone. The screws that go across at the top and bottom bite into your bone and secure the rod to your bone. It has to be that long because the structural part of your bone is the outside shell and you want to secure the nail into both sides. You do have marrow on the inside but it isn't structural and doesn't matter if you get it out of the way since as an adult, it doesn't do much of anything apart from store a bit of fat. Judging from your dressings and the x-ray I think you had a proximal nail put in (as opposed to than a retrograde nail which I touch on later.) The wound on the top of your thigh comes from where they first get the soft tissue out of the way off the top end of your thigh, then after exposing the bone, they drill an opening at the top of your thigh bone to get access to your bone's insides. Once in, using a guide wire and some manipulating of your leg they get a decent alignment between the main top piece and the main bottom piece of your thigh bone and pass the wire through the marrow of the top part and down into the marrow of the bottom part. The surgeon then progressively reams out the marrow to make the hole in the core match the size of the nail by getting rid of the (relatively unimportant) marrow. The sequence of X rays below show how you have to wrangle the bone to thread the guide wire through and shows how it helps as a bit of a temporary holder for the fragments once down.  They then tap the nail through (Usually with a surgical mallet. It looks exactly what it sounds like.) so it fits snugly into the bottom piece so it can serve as the new structural support for the whole bone. The final step is to pin the bones to the femoral nail on the inside by tapping the bone at the top and bottom end with some holes in the appropriate places and lock them with screws to keep everything from moving relative to each other and to go back and close the soft tissue layer by layer. The process looks something like this: the brassy stuff is the nail itself, the black plastic bit is a jig that helps determine the alignment of the rod on the inside as well as acting as a guide for placing the drill when you want to tap the screwholes to secure the nail into the bone. The silver stuff is just a target for you to slap with the mallet so you don't damage the nail installing it. It also lets you install the nail flush to the bone without getting your mallet too close to the patient.  This kind of operation lets you pin a break in the thigh bone all without having to open up the whole of your thigh to get access to bone. This has the added benefit of the metal rod and very heavy duty screws taking your weight when you stand so you can mobilise fairly quickly without worrying about the state of the mend. It's not infallible but it's a pretty solid piece of metalware. Your surgeon would have given you sensible advice that you should follow that is tailored for your circumstances which depends on you and how you are, how the break was, the hardware they installed and how the operation went. Here are some before and after x-rays that roughly illustrate the process. Essentially you are lining up the major structural bits before pinning it all together into a metal scaffold. The main difference between these x-rays and HCC's are that this break is obviously a lot cleaner than HCC's fracture, and that this is a retrograde nail which gets driven in from the bottom of the thigh bone. It's accomplished by opening up the knee joint and making the insertion hole away from the knee cartilage. The exact choice of hardware to use depends on what fragments you get and whether you can securely install it into what bone you have available to you after the injury.  This sequence of x-rays is again a bit different to your situation HCC - it's a shinbone rather than a thigh bone and the little fragments look less dramatic, but overall most fractures go through a similar healing process. The edges of your break should look something like this on your followup xrays. The numbers at the bottom of each x-ray film are in weeks after the operation, making the final films taken about 6 months after the operation.  Bone is alive so given enough time the bone pieces will find, bridge the gap and remodel and reshape so it can support your weight. Generally speaking bone has a very loose tolerances as long as the overall alignment is right and things don't move relative to each other so as long as your leg is straight and more or less the same length as when it started peoples' bodies will generally find a way to sort itself out. The fuzziness comes from the bone scarring up and the bone cells reabsorbing the not useful bits of calcium and laying down calcium where it's needed to cement up the break between your bones. By that point the heal is pretty solid. The little bone chips aren't really of consequence because when you do fix a bone it's more about setting up the bone to heal rather than trying to cobble the bone together like a jigsaw puzzle. It's not like they'll do any heavy lifting in terms of structural integrity when you have the implants put in anyway. At which point occasionally the implants can be removed if it gives you trouble or breaks, but the bottom line is you have to have a legitimate reason to put someone through another anaesthetic and operation. The X-ray below is a good reason to go back to the operating theatre.  Either way, it sounds like there's still a long road ahead for recovery - so here's wishing the best of luck with your recovery HCC. Many goondolences that you got wiped out so hard on the road. (Edited a bunch of grammatical stuff. I'm a bad proofreader) Trambopaline fucked around with this message at 08:51 on Aug 28, 2015 |
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Aug 28, 2015 07:28
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That was a very interesting and educational yet monstrously horrifying post for someone who's never broken a bone in his life. HCC in your shoes I'd be unable to sleep at night knowing there's a loving metal pole inside my loving legbone.
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Aug 28, 2015 08:00
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Slavvy posted:HCC in your shoes I'd be unable to sleep at night knowing there's a loving metal pole inside my loving legbone. It beats the alternative!
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Aug 28, 2015 09:08
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HotCanadianChick posted:Yes, they're done. Standard procedure these days is to run a rod between both halves of the femur and not bother with moving or aligning the shards remaining (unless it's a compound fracture and they need to be removed because they're poking out your skin). Apparently as you move the limb, your body senses the old fragments of bone as foreign objects since they're no longer connected to anything and just re absorbs them. Dang, that is cool.
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Aug 28, 2015 13:30
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I'm the opposite, I think it'd be kinda rad (not the accident, horrible pain, rehab part, of course) to have a metal rod in my leg. I never cease to be amazed at how far we've come with things like this. Medical progress is just incredible.
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Aug 28, 2015 16:25
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Trambopaline posted:Slightly tangential but it's me trying to effortpost speculation around HCC's operation so I hope interesting to the thread and therefore kosher. This comes with a major disclaimer that I am of course an goddamn stranger from the internet and not your treating physician; I have not read your case notes so I'm talking generally and this is in no shape or form medical advice and potentially I could be completely wrong and none of this applies to you and you can come to huge harm from listening to my half baked ramblings. I just like talking about surgery. i am a lawyer and you are hosed. but thanks for the new boat I guess (this was a very good and interesting post)
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Aug 28, 2015 16:50
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Trambopaline posted:Slightly tangential but it's me trying to effortpost speculation around HCC's operation so I hope interesting to the thread and therefore kosher. This comes with a major disclaimer that I am of course an goddamn stranger from the internet and not your treating physician; I have not read your case notes so I'm talking generally and this is in no shape or form medical advice and potentially I could be completely wrong and none of this applies to you and you can come to huge harm from listening to my half baked ramblings. I just like talking about surgery. This was really interesting but the whole time I'm picturing it happening to me and  I'm glad I'm not HCC right now (heal up dude)
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Aug 28, 2015 17:30
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Trambopaline posted:At which point occasionally the implants can be removed if it gives you trouble or breaks, but the bottom line is you have to have a legitimate reason to put someone through another anaesthetic and operation. The X-ray below is a good reason to go back to the operating theatre. This was a super interesting post, thanks for taking the time. Question: How does something like that happen? It looks like the rod snapped across the screw line, which is odd - obviously, drilling holes in things weakens them, but I would assume that the threads on the screw are carefully matched to the core material, so it shouldn't just snap like that. Plus if it's a rod of titanium, it should be hell for strong. Manufacturing defect? (I'll be over here shuddering at the idea of having your leg re-broken to get that loving rod out after it snapped - not like you can weld it in place, obviously.  )
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Aug 28, 2015 18:55
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I think the rod breaking is scarier than the bone breaking in the first place. Human bones break, we are fragile. Crazy rear end space-age titanium poo poo shouldn't break like that, although that drive extension looks like it's hard to get right. How do they know where the mounting holes are to fixate the structure? Do they drill holes in the nail at the same time they drill the bone? Not sure I'd like to have the job of the guy who has to tap that poo poo into the bone. Do they have different sizes of surgical mallet? Seat Safety Switch fucked around with this message at 05:19 on Aug 29, 2015 |
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Aug 29, 2015 05:14
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I took a dive today. Nothing super serious like HCC, but it's my first since I've started riding two wheels almost a year ago (and proper motorcycles for 3 months). It's been raining here for the past week, on my way to work this morning an old lady on a scooter cuts me off to make a right turn. Nothing worth panic breaking, but I'm in the scooter lane and hit the lane markings just as I brake, causing me to lose the front end and go down. Thankfully didn't hit the woman, but all I got out of her was a cursory glance and shrug as she drove off. Low speed, only about 40km/h when it happened. Landed on my hand and right arm, and my glove held up. Looks like there's a nick in my helmet, so I'm guessing I must have hit my head somewhere going down, but I don't recall it. Going to the helmet shop just to be safe. Foot and ankle hurt/sore, I think the bike landed on my leg, doesn't feel broken or sprained, so I think I'm getting off fairly light. Broke my mirror and bent the handle bars a bit, but hopefully nothing that can't be fixed; I don't see any other scrapes or damage to the bike. Scuffed up one of my saddlebags, though. Some nice delivery truck guy helped me get the bike back up and on my way again. As a new rider, I now have learned what it feels like to lose the front end. Also, perhaps, helped my fear of falling off the bike a bit, as my gear soaked up all the damage, and not me. I just hope I won't be too much out of pocket to get everything fixed.
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Aug 29, 2015 08:01
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YF19pilot posted:As a new rider, I now have learned what it feels like to lose the front end. YF19pilot posted:I'm guessing I must have hit my head somewhere going down, but I don't recall it. Sounds about right. "Why am I on the ground? I don't remember taking the ground to work today."
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Aug 29, 2015 12:42
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Hey so this is me starting to get a little bit out of my depth so I'll try my best to explain it. The femoral nail comes with holes built in, so there's no real stress put on to the prosthetic itself. They look like this without the screws .  Like you can see on the intraoperative photo, sometimes you have a jig with what essentially guide rails.  How they work is that there is only one way you can install the jig on to the to be implanted nail, so all of the angles are pre- calculated. All you have to do is put your drill bit into the various holes in the jig you'll drill perfect holes in each time and then again, you can drive in the bone screws. In the picture above the surgeon is using a depth gague but the idea is the same, you just stick a drill into the hole. For the screws down at the bottom, you can see on the xrays how metal is that much more dense than bone so it shows up nicely on an x ray, so again you expose the bone and just take a few test shots with the xray to make sure that the holes line up perpendicular with the x ray machine and go to town with the drill so you'll pass through the holes properly.  Regarding prosthetic fractures themselves, how I understand it is that you could put a wolverine-esque indestructable 2" thick titanium rods through people but it's expensive, redundant and expensive - since for any kind of implant which has a sole purpose of healing a fracture all they have to do is a good enough job for about 3 months at which point the bone should be picking up the slack. Combine that with the fact that with each step you take you are putting (for the average caucasian male, something in the ballpark of) 150-ish pounds (I don't actually work in imperial normally. Does that sound right? I mean to say about 75 kilos) of weight through your leg, combine that with the fact that on the break the two ends of the bone can conspire to act to multiply that force through an unfavorable mechanical advantage, going too fast mobilising on a leg can very well stress out an intramedullary nail beyond its design limits. I'm looking at a synthe's spec sheet for femoral naiils and if I am reading it right, they look something like quarter to half inch titanium alloy, and with their test methodology for prosthetic endurance, it looks like they are rated for something in the ballpark of 10,000 cycles at 1.2kN's of force. (Which i believe is something like 270 lbs of force?) Finally, surgical mallets can vary depend on the set they come with but the idea is the same. A heavy mass to cajole implants into the right place. The (kinda unfair) stereotype is that the orthopaedic surgeons are the meathead jocks of the hospital that love to pound and cut bone with hilariously large instruments.  Also some bonus picture! An intra operative X ray  Clamps to wrangle bone  A flexible reamer bit for surgical drills 
Trambopaline fucked around with this message at 13:07 on Aug 29, 2015 |
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Aug 29, 2015 12:56
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ManicJason posted:Sounds about right. "Why am I on the ground? I don't remember taking the ground to work today." More that I can fully recall the incident in great detail, the exact moment I lost the front end, the entirety of the fall, I was aware of my right hand, elbow, arm, and shoulder making impact, and exactly how I landed on them. I just don't recall/wasn't aware of feeling my head (helmet) hit. I remember pretty much every bit of it, down to watching my poor right side mirror go skidding down the road before me, almost, but not quite, hitting the person who cut me off; as though this one broken piece of my bike was a missile intent on exacting some modicum of revenge for this slight. Then again, I don't really recall how my foot hit the ground and if the motorcycle really did fall on it, just that after the adrenaline wore off, my foot hurt a little to walk on. The cosmetic damage on my helmet is very small, almost easy to miss, so it may have been a very light impact. But, I'm not playing maybe with my head, I'll be getting a new brain bucket soon as I can.
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Aug 29, 2015 13:21
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Trambopaline posted:Cool post on medical stuff That makes a lot of sense, even if it crushes my dreams of full replacement titanium bones.
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Aug 29, 2015 17:56
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Yeah I'm a little bummed now that it's not as cool as I originally thought. Friends mode off, medical science.
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Aug 29, 2015 22:25
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Trambopaline posted: Hacksaws, leeches, and whatnot. BRB, going to go vomit, sell my bike and take up stamp collecting.
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Aug 30, 2015 00:44
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Marv Hushman posted:Trambopaline posted: Thats too easy. Going back to the shop to build a T800 body.
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Aug 30, 2015 01:20
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My big safety mods after this are that all my jackets will now be upgraded to a nice CE level 2 back protector insert like a Forcefield since one of those would have possibly prevented me from breaking off a couple of the vertebral processes on my back and cracking a few vertebrae; and making sure whatever gloves I get next will be sure to stay on in a crash - I was wearing Scorpion Klaw II gloves, and mine had the same problem they all seem to do, which is the Velcro that closes them at the wrist wearing out shortly after purchase, resulting in my left glove having come off during the crash, which means the sole point of road rash on my body is the back of my left hand. My right hand, the glove stayed on and did it's job projecting it (as good as it could, considering my right palm hit cement hard enough to shove the entire wrist bone assembly back down the arm nearly an inch, but I suspect no glove would have saved that kind of hit.)
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Aug 30, 2015 03:47
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I've never seen a crash where a shorty glove didn't do that. Buy a full gauntlet and you'll be all set.
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Aug 30, 2015 03:50
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M42 posted:I've never seen a crash where a shorty glove didn't do that. Buy a full gauntlet and you'll be all set. Yeah, that's the plan. I'd been meaning to buy some longer gauntlet style gloves anyways, this just means it will happen before I get back on a bike now.
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Aug 30, 2015 03:51
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M42 posted:I've never seen a crash where a shorty glove didn't do that. Buy a full gauntlet and you'll be all set. I went down twice well over 60mph in the same Alpinestars shorties. Hands were fine, gloves were rashed both times. Still ride in them... but I finally bought real gauntlets for the track.
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Aug 30, 2015 10:46
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So I've finally managed to piece together what happened to cause my accident (I still have amnesia about that day due to a combination of trauma, concussion, and aftereffects of the anaesthesia they used on me for surgery): https://goo.gl/maps/lrDql I hit that concrete curb in the middle of the road while going about 50-55 mph (the roads in that area are marked 45mph, but it's a low traffic industrial area and if you try to go 45 you are obstructing the flow of traffic because everyone does 50+ thru there) headed west down that road just before dawn while it was still a bit dark and I likely did not see or realize there was a raised bump there at the time. This is the road I normally take to work, and on this particular stretch of road, one of the businesses on the north side of the road a bit further down gets a lot of semi trucks arriving, but they are either slow to process them in or the they get too many trucks to fit in their lot, and as a result, there are often one or more trucks parked in the roadway on the side heading west; it is very common for people who work further down that road to just cut around the trucks by pulling over into the center lane and shooting past them, I've been in caravans of 3-4 people doing this at once on their way to clock in at my work before. What must have happened was a longer back up of trucks than normal causing them to be far enough back that cutting into the center lane put me before those raised bumps in the middle, which I hit hard enough to bend the front wheel of my bike, sending me flying way into the air in my own one-man Evil Knievel impression. Moral of the story if you're violating the normal flow of traffic and proceeding to travel down a lane you normally should not, slow down and verify there are no obstacles in the way first. Also my(your) judgment/memory is poo poo when you're riding first thing in the morning and you're not fully awake yet, and you may forget a detail like a raised divider curb that you've ridden past for months. On the plus side, I'm finally home and posting from an actual computer for the first time in nearly a month. 
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Sep 7, 2015 01:18
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All I can picture is an FZ1 ramping off the kerb and your head smacking the crossing signal lights with a comical ding-doing noise.
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Sep 7, 2015 02:18
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Ironically with the ringing in your ears making you think a train was fast approaching.
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Sep 7, 2015 09:05
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This never would have happened if you started on a 250
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Sep 7, 2015 15:10
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nsaP posted:This never would have happened if you started on a 250 A shame then that I started on the old Husky 125 we had on my grandparents' farm as a kid 25 years ago.
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Sep 7, 2015 15:28
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I was making a joke but using your experience on a dirt bike 25 years ago to justify your first-bike-fz1 helps my case
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Sep 7, 2015 15:31
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nsaP posted:This never would have happened if you started on a 250 My pops told me the same thing when I got the herp from my first girlfriend.
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Sep 7, 2015 16:03
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M42 posted:I've never seen a crash where a shorty glove didn't do that. Buy a full gauntlet and you'll be all set. I wonder if this would extend to Knox shorties. Those boa laces don't feel like they'd come undone for anything short of the entire glove being destroyed.
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Sep 7, 2015 20:12
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Renaissance Robot posted:I wonder if this would extend to Knox shorties. Those boa laces don't feel like they'd come undone for anything short of the entire glove being destroyed. If it's the same Boa system as on my snowboard boots: If the knob/ratchet breaks off the whole thing immediately loosens and now you look like a drunk guy who can't keep his board under control.
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Sep 7, 2015 20:49
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Depends if you are sloppy with the wrist strap, the boa lacing is further up on your forearm, not directly on the wrist. If you manage to break the boa slider and not tighten the wrist strap then I can see it coming off, but only if both fails/are loose.
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Sep 8, 2015 12:42
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HotCanadianChick posted:concrete curb holy gently caress that thing so camouflaged is practically invisible. Glad to hear you're up and at 'em. M42 posted:I've never seen a crash where a shorty glove didn't do that. Buy a full gauntlet and you'll be all set. GnarlyCharlie4u fucked around with this message at 18:18 on Sep 8, 2015 |
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Sep 8, 2015 18:15
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HotCanadianChick posted:My big safety mods after this are that all my jackets will now be upgraded to a nice CE level 2 back protector insert like a Forcefield since one of those would have possibly prevented me from breaking off a couple of the vertebral processes on my back and cracking a few vertebrae; and making sure whatever gloves I get next will be sure to stay on in a crash - I was wearing Scorpion Klaw II gloves, and mine had the same problem they all seem to do, which is the Velcro that closes them at the wrist wearing out shortly after purchase, resulting in my left glove having come off during the crash, which means the sole point of road rash on my body is the back of my left hand. My right hand, the glove stayed on and did it's job projecting it (as good as it could, considering my right palm hit cement hard enough to shove the entire wrist bone assembly back down the arm nearly an inch, but I suspect no glove would have saved that kind of hit.) You could look into getting gauntlets with a scaphoid slider. It might have helped your right palm just slide instead of letting your wrist take the hit. Pretty much only come on race style gauntlets though. I have GP Evos from RS Taichi and they held up pretty well in my crash, though it wasn't nearly as bad as yours.
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Sep 8, 2015 18:35
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Yeah, I can't say enough good stuff about having scaphoid protection on a glove. My Rukka lobstergloves (waterproof, warm) have it, and my summer/dry weather gloves have it, and I won't go back. It annoys the poo poo out of me that there's like MASSIVE SUPER KNUCKLE protection when most people are gonna hit on their palm or the side of their hand, not their gd knuckles.
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Sep 8, 2015 20:26
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I'm super happy about my fuckoff knuckle protection because taking a rock to the hand on the freeway would loving blow dicks. Same for knee armor, Shin protection, and helmets.
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Sep 8, 2015 22:02
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Lynza posted:Yeah, I can't say enough good stuff about having scaphoid protection on a glove. Really surprised scaphoid protectors aren't more common. They're pretty widespread for mountainbike gloves, and I'm pretty sure they saved my scaphoid during a bad race crash. Was looking for them when I got my first motorcycle gloves but they're really on there for the really high end stuff.
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Sep 8, 2015 23:28
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Yeah, I don't think there shouldn't be knuckle protection, but it seems like unless you're spending a lot of money on gloves, that's all you're getting. Having been hit in the knuckles/fingers with rocks and such, I like it. But I'd also like protection where I'm likely to land at speed, too.
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Sep 8, 2015 23:40
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