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  1. #26
    Spice
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    Forgot to update on this. I ended up in the cast until the 11th Feb, around 5.5/6 months.
    Took a few weeks to get more than 20 degrees of movement back (was completely seized and unable to move for several days!), and a few months later I had a fair bit of movement, and was getting some muscle back (although I still had to take it easy). 14 months after breaking it (10 months after surgery) it feels pretty much normal, it's felt good for the past 2/3 months really.

    I would emphasise that the deep tissue massage really is necessary. I felt quite queasy doing it at first with it being on my inner wrist, but you get used to it, and after having another small injury which ended up with my finger tendon joined to my skin by scar tissue I can safely say I'm glad nothing like this has happened with the wrist!

    I didnt really listen to the physio for the strength exercises, and instead just made sure that I was using it in a suitable way to build the muscle- no complaints from this.
    Did some rock climbing the other day, and have been xc riding for a few months, just getting back on the dh trails. Happy days!

  2. #27
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    Oh and when the cast was taken off, I still had to use a rigid thermoplastic splint for a month (the sort that makes you look like you have a disability! :/ ), followed by a month in a fabric splint with a metal bar in it, followed by a neoprene support for as long as I wanted.
    I ride with the 661 wrist wrap pro, feels good and luckily I haven't needed to test it falling off yet! It gets a bit achey on cold rides, probably because the screw is still in there (?), but nothing to worry about if you are in the situation I was in a while back- it's just a niggling pain

  3. #28
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    I had a fairly severe compact fracture and my scaphoid was totally displaced, externally from my wrist. With cannulated screw and k-wires, I was off the bike for approximately 7 months and only then I did very light bike paths. It is only now, into the 8th month that I am starting to mtb on kinder trails. You must give it time and respect the bone.

    ...also using a 661 wrist wrap, so far its been excellent!

  4. #29
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    This is a pretty good thread on the much troubled scaphoid fracture and subsequent non-union for us mountain bikers. I'll share a story since I have a lot of free time on my hands right now. I originally fractured my scaphoid in August of 2012. The doc presented me with either casting it or surgery and a screw, the difference between the 2 options being only 4 weeks recovery time. I made a BAD call right there and opted for the cast (well, splint), 16 weeks immobilization and was riding off road immediately, strength training in the gym- it broke again (docs call it a non-union) 7 months after original break with a minor fall skiing. Was diagnosed by a doc for 3 months as a sprain which I treated with manual PT, etc. A second opinion and MRI revealed non-union fracture. Had surgery June, 2013 which was a distal radius bone graft and percutaneous screw. 3-hour surgery and the doc ditched the screw and installed k-wires b/c he felt the bone was not supporting the screw well. The unfortunate outcome of that surgery was another surgery would be required to remove the k-wires. Also, k-wires don't provide any compression to the grafted bones which makes them less likely to grow back together. 7 months after the surgery, riding bikes, weight training and it broke again! Found a new doc who gave me one last chance a couple of days ago: regular bone graft from hip, plus vascular bone graft from radius, 5 screws.

    Needless to say, I'm taking this go-around quite a bit more seriously. Apparently, relying on a doctor to understand what I was doing with weights and mountain biking did not serve me well. I think I broke it both times in the gym trying to get my strength back too soon.

    So, I'm 3 days into my final chance at recovering from this saga of an injury and an end to a way of life that made me happy for so many years. I'm now prepared to put the sport and lifestyle I love so much aside for as long as it takes which by my estimate is closer to a year from now. Kind of like the love of your life that you decide to let go in hopes she'll come back some day if it was meant to be.

    I have lots of advice on deciding what procedure to do, what to eat, imaging, supplements. And a whole lot on what not to do. Bottom line- this injury has the potential to bring the strongest to their knees, take what you love and leave you wondering how it all went so terribly wrong!!

  5. #30
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    That's a shocking continuation issue, I really feel for you.

    So, are you to decide to go ahead with the "regular bone graft from hip, plus vascular bone graft from radius, 5 screws.", or it's already happened?

    Have the scaphoid breaks been only at the distal pole? Or are the recent ones, waist or proximal?

  6. #31
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    The original fracture and 2 non-unions have all been through the waist of the scaphoid and non-displaced. I had that surgery Wednesday (2 days ago). There really wasn't much of a decision to make only to find a doctor I trusted. If this doesn't work wrist fusion would be next. I'm pretty sure I wouldn't have fun riding with a fused wrist. So this is truly a last chance, hail mary at getting the sport back which got me so far in this life. I've seen a lot of amazing places, made great friends and created a way of life around mountain biking. Without riding I'll be pretty lost in this world..

  7. #32
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    I totally hear you, I felt like I was being punished when I had mine and the time off it necessitated. Strange way to put it, but that's how it felt, and I caused it myself! So your thinking is totally understandable.

    Best of luck with this surgery. I can only re-stress the importance of keeping you hand "unloaded". I hardly lifted a cup for 6-7 months with mine. I just did physio I was recommended to do. I was very clinical about it... black and white. You have to give yourself the very best chance possible and unfortunately this is time. I would imagine you have to treat it like its just happened and that is probably 8 months "unloaded" recovery time. But the doctors should advise.

    I think a partial wrist fusion would be a mistake if it came to that, I would only go a full wrist as you say. But even if this were the case, I would expect you could definitely ride a bike/drive a car with a full wrist fusion. Don't get too down about it, you'll be surprised what you can actually achieve.

  8. #33
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    Just on the question of your initial decision that you see as a bad one - my understanding is that whether it's screwed or not makes no difference to the non union rates, hence the surgeons advice that what it changes is time to return back to sport and out of cast.

    What is helpful is good sets of X-rays , but it's hard to know which fracture gave you the non union.... You can't go back, and there's no way of knowing if what you did or what advice you got had any impact - you have just been one of the 5%

    Don't beat yourself up

  9. #34
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    Scaphoid fracture is a lucky dip and luck is not on the side of the owner if things go wrong. I don't think the jury is in on early open reduction internal fixation (screw) versus perfect, early, non-operative intervention (cast).

    Problem with the scaphoid is that it only has one blood supply and unlike everything else in the body, that comes from the finger end (distal) not from the body side (proximal). So the closer to the body the fracture is, the more important it is to get a scaphoid fixed in anatomical position immediately.

    Then comes all the associated injuries to the triangular fibrocartilage complex, the scapholunate ligament, hand and finger tendons as well as thumb ligaments. A lot of that is influenced by whether the injured person has equal length radius and ulna bones (forearm bones). If they are not equal in length, the physics of an injury may favour certain less desirable results throughout the wrist.

    So, if you do hurt your wrist badly you should consider a very early MRI as well as plain XRays. If that means paying for it yourself, refer to paragraph 2 above.

    When I busted my scaphoid, it was 1980. With it I destroyed my distal radius and ulna, plus bisected and opened up my capitate. The surgeon told my parents to expect an amputation. Didn't tell me that. After specialist decisions in the OT decided there was nothing large enough to fix to anything else (think large breadcrumbs), they just pulled it back to basic length (-1cm), shoved it in a cast and wished me well.

    4 and a half weeks later they took the cast off and didn't put it back on because consensus was I would never move my wrist again. They were right; for the next 2 years I couldn't get more than 50% of normal movement. A year after that and since it has been great - deformed a bit, but great. Who'd guess!

    If there is a message it is that your wrists and hands are really important and getting function back after injury is essential whether you have surgery or not. Find out as much as you can from experienced orthopods, or from people in your shoes. Keep your mind's eye on progress and try to think out why things are going the way they are. Is your pain preventing self care (ie - wimp), is there something really wrong, like a blocked joint or do you just need time: there are no written laws.

    Hope this helps all you lot.

  10. #35
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    I believe the current medical practice on treating non-displaced scaphoid fractures is outdated. in 10 years, it will probably change. If the injured person is not a couch potato than ORIF should be recommended. If the injured person participates in high activity sport (like mountain biking), then ORIF should be strongly recommended. The screw does 2 important things: 1) provides compression of the 2 pieces of bone which allows them to rejoin into one, 2) aligns the scaphoid properly to its original position. The latter is very important to the long term success of the injury, the movement of the subsequent carpals and the ROM of a healed wrist. If the wrist has poor extension and radial deviation after healing (as in my case), it is more likely to break again and the stress on the scaphoid from normal things will be higher. Everyone I see who healed a scaphoid without surgery has very poor extension, most likely caused by a humpback deformed scaphoid, just like I did.

    Well, its hard not to beat myself up when I essentially healed my wrist twice and broke it twice 7 months after. I'm not very good at taking it easy. I told my doc I was mountain biking and lifting weights and he told me to let pain be my guide. Some better advice might have saved me from breaking it again twice.

    This doc reconstructed my scaphoid with 5 screws and 2 bone grafts. He said I had 75* of extension in the OP room. That made me pretty happy but honestly I have a long way to go before I can see how this plays out in my wrist. I feel one's success with a scaphoid fracture is highly dependent on having a good doctor that understands how likely someone who is a mountain biker is to have a non-union.
    Attached Thumbnails Attached Thumbnails Injury recovery time - broken Scaphoid and surgery?-photo-4-.jpg  


  11. #36
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    I'll add my recent experience with a broken scaphoid, and it's considerably more positive than those above.

    I broke my scaphoid (non-displaced) and radial head going over the bars at a bike park. Went from the bike park to the ER because I knew something was not right. The initial xray did not reveal any fractures but I was placed in a slab cast to immobilize my wrist as a precaution and scheduled a follow up for one week later. The followup revealed both the scaphoid and radial head fractures. I received a short arm cast for the scaphoid and told that the radial head should be treated as a bruise.

    I tried getting back on the trainer immediately, but the radial head was causing pain so I stopped for 2 weeks. After 2 weeks the elbow felt much better, range of motion was improved and I was back on the trainer with no discomfort.

    This morning I went for my follow-up, 6 weeks after the accident. Xrays revealed my scaphoid is healed, much to my surprise. The cast is now off, my wrist is stiff and sore at the limits of my range of motion, and I while I will continue riding the trainer, I was advised to stay off the bike outdoors for another 4 weeks, at which point I'll have a follow up xray to confirm everything looks okay.

    After reading all the stories online about months of recovery and surgery I was very relieved with the diagnosis this morning. I attribute my success to immediate immobilization of my wrist, good diet, and quality sleep while recovering. I posted to let others unfortunate enough to break their scaphoid know that it sometimes can heal quickly.

  12. #37
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    I broke this same bone, but while I was riding a four wheeler up in Copper Harbor, MI. Tried to take a turn too fast and tree roots prevented the rear wheels from drifting. Fortunately I was able to ride for another week or so by using a tie strap on my elbow to pull the clutch lever lol. The bone was broken, but still together so I just got a cast for 6 weeks. The doctor should give you guys a electronic device that draws blood to the bone. If not, have your doctor inquire about getting one! I started a new job the day after the cast came off, and was lifting very large amounts of sheet metal for duct forming. No problems at all unless I bumped that wrist hard on something, simply because it was a little weak and sore from the cast.

  13. #38
    cdouble
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    Hoping there is still some life in this thread - I am looking for some advice.

    Fractured distal third of my scaphoid on 1/17, surgeon put in a screw on 1/27. Since then I've been splinted, doing some daily RoM exercises for the last few weeks. Feels pretty good all things considered. Had CT scan this week, seeing surgeon next week, will find out next steps then.

    I want to get back to some easy riding, gravel roads whatever, to start getting some conditioning. I won't go before the doctor recommends, but when I do I expect to be wearing some sort of wrist brace. At a minimum, I'd like one with rigid stays that give strong support to the wrist. But I'm interested in the brace described above by Aizen (10/4/2012) that also immobilizes the thumb. That seems like a good idea, but wondering how that brace worked on the bike in terms of comfort and bike handling.

    These braces are not cheap, and mail order is my only option, so trying to get as much good first-hand advice as possible before pulling the trigger.

    Thanks in advance and let's keep the rubber side down.

    Chris
    cdouble

    http://mo7s.blogspot.com

    "It never gets easier, you just go faster"
    Greg LeMond

  14. #39
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    bump! Landed on my hand and had xray 3 days later and i knew something was broken. Negative xray, dont worry it's just ligament. Got another xray 2 weeks later when it still hurt, negative again so i gave it a few weeks in a thumb splint then went back to riding. Doc booked me an mri months out because canada is stupid and thats normal wait. Had to ask for a bone scan and i even told the gp i had numbness in my thumb. Finally got it today andits definitely cracked 3 months out from the initial injury. Wonder how much additional damage ive done when if i was put in a cast immediately id be better by now. FML

  15. #40
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    I recommend ORIF surgery (a screw) if you're not a couch potato. Relying on only immobilization (cast or splint) is too variable in outcome and often does not work for men who mountain bike. The screw pulls the 2 bone pieces together and really helps the bone remodel and get blood supply. I had 2 occasions where the doc said it's healed but in reality it was not even close to being healed and it re-broke with a super minor load. Apparently it's very difficult to fully know when the bone has healed from looking at x-rays and CTs. Better to take the safer route here or REALLY take it slow on the recovery. Or risk it all and break it again. It's just your wrist- you've got 2 of them...

  16. #41
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    Appreciate the advice. This was my first summer on a mountain bike and i fell in love but sounds like i might not ride at all next summer. Going to stop drinking and all bad habits, hope to hell it ever heals.

  17. #42
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    Good luck with the healing! I would reccommend a screw, mine has been fine since (now almost 2 years since surgery) so long-ish term it feels fine, pretty much normal. Slight loss of movement but nothing bad. I also gave up bad habits, and made a habit of having at least a pint of milk every day for extra calcium!

  18. #43
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    As others have said, there isn't any way of telling how healed the bone is once it's reunited. Best to just take it easy for a good long time, and not risk breaking it again. This is where a road bike (and tri bars!) comes in handy!

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