Posts
912
Joined
8/27/2013
Location
Fredericksburg, VA
US
Edited Date/Time
1/24/2021 10:34am
I broke my arm two weeks ago racing at a Tomahawk MX in WV. First bad break, ever.
I’ve now been to the ER and then to my surgeon twice and he still seems very up in the air on how to treat. I don’t want to jump the gun, but if surgery is required I want to get shit moving. From what I can tell, pros and cons are:
Natural healing - less invasive, less money, no radial nerve damage, no scar. Long heal time, a lot of atrophy, significant shoulder and elbow mobility issues and stiffness. Long, long road for recovery.
Surgery W/ plate and screws - money, invasive, big scar (I don’t care), quickly will be able to move my arm and resume non impact activities. Potential to damage radial nerve. It could not happen at all, it could be damaged and go dormant for up to 6 months, or it could be permanently damaged (very, very low probability). This causes wrist drop and I will lose certain functions in my right hand until the nerve “wakes up”.
I’m torn on what to do. Neither option seems great. Who has had a similar break? What did you do? Any info to share?
I’ve now been to the ER and then to my surgeon twice and he still seems very up in the air on how to treat. I don’t want to jump the gun, but if surgery is required I want to get shit moving. From what I can tell, pros and cons are:
Natural healing - less invasive, less money, no radial nerve damage, no scar. Long heal time, a lot of atrophy, significant shoulder and elbow mobility issues and stiffness. Long, long road for recovery.
Surgery W/ plate and screws - money, invasive, big scar (I don’t care), quickly will be able to move my arm and resume non impact activities. Potential to damage radial nerve. It could not happen at all, it could be damaged and go dormant for up to 6 months, or it could be permanently damaged (very, very low probability). This causes wrist drop and I will lose certain functions in my right hand until the nerve “wakes up”.
I’m torn on what to do. Neither option seems great. Who has had a similar break? What did you do? Any info to share?
If theres a real risk to that nerve i wouldnt do the surgery. I broke my tibia right at the knee joint. 2 incisions, 2 plates, probably 14 screws. Its been 2 years and the entire front of my knee and top of my shin is still as numb as when i woke up in recovery. I wouldnt hold my breath on a nerve “waking up”. I have a similar situation on my collarbone i broke at the same time. My entire left chest/left front shoulder is half numb. Feels like tv static when someone touches that area.
I understand your sentiment on the Radial nerve going dormant or not, but it’s common to be affected and EXTREMELY uncommon to not come back. That’s per my doctor and every study shown online. So that doesn’t scare me too bad.
Not having a fully working arm/ shoulder/ elbow for 9-12 months due to atrophy and mobility is super concerning, though.
The Shop
If I said surgery, he’d do it tomorrow. If I demand to wait, he will wait. I personally like a surgeon to have more conviction and guidance than what I’ve had. I see a second doctor today at 3.
I set up a follow up second opinion at VCU in Richmond today with a sports doctor that works with all the college athletes. We’ll see what he says!
Spagina767, 2 friends of mine broke their humerus and plate them. One was very young, had a break like yours and in no time was back to his regular live, the other one was in his forties and was hesitant but the pain and discomfort decided for him (was worst than a clean cut break maybe shattered, can't recall), it took him a while but he resumed normal live and was happy with the outcome.
You're doing the right thing by checking with a second doctor, I'd even go for a third opinion if needed. I'd suggest check and decide more based on doctors feedback, your age, health, pain/discomfort, needs and preference than based on studies.
At the end, all these studies are scary but the % of things going south is often less than 1 and decent-to-good doctors most of the time aren't part of the statistics, that being said the further away from the operating room the better.
Given that brake is right in the middle of the bone & one nice big break, I’d leave it without doubt.
You’ll get through it.
Clean break, 2 pieces.
I was 20 years old, I got it rodded.
I wanted the rod out though, for no other reason that I was still young and worried about long term effects.
A little over a year later I tried to get it out. Surgery was unsuccessful though, as the bone fused around the rod.
Surgeon said he was afraid to re-break the bone if he had pounded on the extractor any harder.
I thought "meh wimpy doctor, I'll go to a different guy"
Another year later I went to a different guy, big dude, this guy will surely get it out, right? Wrong, same results. I wake up from surgery and they're like, sorry we couldn't get this thing out.
They did take all the retaining screws out and shaved the end of the rod I think.
Almost 20 years later I really have no major side effects. I did have some shoulder issues just recently though but I don't think it was related to the rod.
Pit Row
The main study for non-operative treatment in these fractures was done by a bunch of British guys back in the 1960s if I remember correctly. Because of that, older surgeons are going to be more likely to treat it non operatively. The younger surgeons are not as willing to accept a possible 20 degree varus/valgus angulation or 30 degree anterior angulation deformity in your arm, which the Brits deemed acceptable more than 50 years ago. As a moto rider, I wouldn't want that deformity either.
Find a Trauma or Upper Extremity fellowship trained orthopedist to evaluate you. Sports trained docs may only do these cases every few years depending on the attending and their practice environment. Some of them, depending on where they practice, may do quite a few of these cases (level 1/2 trauma center/ski town/etc), but most will not. You should ask your doc how many of these they do a year. Remember, the ED referred you to whatever doctor was on call that day, not the best doctor for this fracture pattern.
To fix this, you will have to completely expose the radial nerve, which is crossing over the spiral groove right about where your fracture is. It looks like your current doc has you well informed of the risks and benefits of that.
After reading about nerve palsy the function in the hand take months to years to function correctly again.
He's still a teen so I hope they figure it out.
Best of luck in your decision.
The doc I used is the one that did my knee surgery. He’s a sports doctor and I like him, I just do not feel very well informed. Currently in the office at another doctor who works at Virginia Commonwealth University sports medicine.
I’m extremely active. Weightlifting, moto, hunting, wakeboarding, snowboarding, surfing, mountain biking, etc. I have 5 acres I need to take care of and a job where I need both arms. I hate to say it like this, but damn I want to be back to normal ASAP because that’s what life demands of me! I want to make the correct decision though, so we will see what the doc has to say in a minute.
Son in law spiralled his arm wrestling ( its on the internet apparently) , no surgery , did it 3 weeks before Xmas , plaster for 8 weeks, really light use for 3 months, just got the all clear that he can use it as normal.
They didn't give me an option of surgery.
I still only have limited movement, although most of that may be due to lack of rehab.
45 years later arthritis limits range of motion.
I have a professional job so, I was more embarrassed and frustrated by the situation, than the actual injury.
My advice, make sure to take control of your care. The system is set up to get you in and get you out. I had the surgery and the injury got infected.
Had to go in for a second surgery to clean the infection out. After that, told them that the infection was still there and they called me crazy.
Two years later I had a surgery to remove the screws and plate and guess what? The infection was still there. I kinda wonder what would have happened if I hadn’t forced the 3rd surgery
Listen to your body and ask your physician to respect your decisions. I recovered with no significant residual effects. Wishing you the best. Good luck.
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