Post ORIF Surgery Concerns

[GingerDives]

Not looking for medical advise but wondering if anyone else has returned to diving after ORIF surgery? What was your experience? How long until you returned to diving after your surgery?

For background…..I am 3 months post ORIF surgery for a fractured proximal humerus. Essentially, my left arm (non-dominant) is now a mess of plates, screws, wire and cadaver bones. Just had a check up and the fracture site is healing “beyond expectations.” I am also able to demonstrate full mobility and have about 95% of the strength I did pre-fracture. No nerve or blood vessel damage. I have not been on pain meds of any kind and have not been experiencing any pain or soreness.

Ortho is not versed in dive medicine but “thinks” it would be okay to go on a planned dive trip in December. I do plan on consulting DAN.

 

[grantctobin]

Seconded on consulting DAN. If you want a best case scenario anecdote, I had a collarbone ORIF May 11, full return to water six weeks later with no concerns / had medical clearance. I did avoid extreme amounts of deco until three ish months after the surgery, but that was more of a healthy skepticism and wasn’t something I consulted with DAN about.

 

[GingerDives]

Seconded on consulting DAN. If you want a best case scenario anecdote, I had a collarbone ORIF May 11, full return to water six weeks later with no concerns / had medical clearance. I did avoid extreme amounts of deco until three ish months after the surgery, but that was more of a healthy skepticism and wasn’t something I consulted with DAN about.

Ouch…..a collarbone, yikes! Thanks for the info. I do want to do a deep wreck dive, but am happy to just putter around on some shallow reefs if the deeper dive is frowned upon by DAN.

 

[rsingler]

Concur with a DAN consult.
Prox. humeral fractures are tough recoveries, as you have doubtless discovered.
Presence of plates/wires/screws is not a contraindication to diving this far post-op, with regard to descent/ambient pressure related issues.
One potential issue I can see is related to circulation to the proximal humerus, depending upon what happened to you during your original fracture. Was it a fracture/dislocation? You need your orthopod's opinion on circulatory compromise to the humeral head. That may be a factor during offgassing on ascent. But if he/she hasn't said, "You may need a total shoulder replacement down the line...", you may be okay.
Second potential relates to refracture. Four months is not a huge amount of time for re-calcification of the fracture line. Plates/screws are stress points. Proximal humerus undergoes a lot of leverage during certain weight-bearing activity with your arm. Beware of slinging tanks and/or pulling hard on an anchor line or reef hook in current.

Most important, beware of internet advice.

Diving Doc

 

[GingerDives]

Concur with a DAN consult.
Prox. humeral fractures are tough recoveries, as you have doubtless discovered.
Presence of plates/wires/screws is not a contraindication to diving this far post-op, with regard to descent/ambient pressure related issues.
One potential issue I can see is related to circulation to the proximal humerus, depending upon what happened to you during your original fracture. Was it a fracture/dislocation? You need your orthopod's opinion on circulatory compromise to the humeral head. That may be a factor during offgassing on ascent. But if he/she hasn't said, "You may need a total shoulder replacement down the line...", you may be okay.
Second potential relates to refracture. Four months is not a huge amount of time for re-calcification of the fracture line. Plates/screws are stress points. Proximal humerus undergoes a lot of leverage during certain weight-bearing activity with your arm. Beware of slinging tanks and/or pulling hard on an anchor line or reef hook in current.

Most important, beware of internet advice.

Diving Doc

Thanks for the reply. I am concerned about the offgassing during ascent too. I was told that there was no circulatory compromise, but I wasn’t sure what that would mean at 100’ under water.

The official diagnosis was a 3-part fracture of proximal humerus, left. I also completely tore off the rotator cuffs. It was not dislocated. Before I went into surgery, there was a threat of a complete shoulder replacement depending on what the surgeon found. I wish I had my initial x-ray and my most recent x-ray for reference, but I’ll attach a copy of my x-ray that was taken at my 2-week post op. appointment.

 

[rsingler]

At 100', there is no problem, nor really in ascending to 30 feet from 100 feet.
It's that last 30 feet after a 100 foot dive (or even a long 60' dive) when the N2 starts whooshing out. If you go, do a slowwww final ascent. Nitrox for sure.
That's a bad one - yeah, it's definitely worth comparing calcium deposition now versus that x-ray before you pull the trigger. I'd expect to see a lot more Ca deposition before I'd head out for anything strenuous. As for dives with more N2 accumulation? Better talk to your orthopod again, and then call DAN.

 

[Boarderguy]

Thanks for the reply. I am concerned about the offgassing during ascent too. I was told that there was no circulatory compromise, but I wasn’t sure what that would mean at 100’ under water.

The official diagnosis was a 3-part fracture of proximal humerus, left. I also completely tore off the rotator cuffs. It was not dislocated. Before I went into surgery, there was a threat of a complete shoulder replacement depending on what the surgeon found. I wish I had my initial x-ray and my most recent x-ray for reference, but I’ll attach a copy of my x-ray that was taken at my 2-week post op. appointment. View attachment 753058

There's more metal than bone there! Call DAN and if you don't feel up to something don't push it.

 

[Duke Dive Medicine]

Not looking for medical advise but wondering if anyone else has returned to diving after ORIF surgery? What was your experience? How long until you returned to diving after your surgery?

For background…..I am 3 months post ORIF surgery for a fractured proximal humerus. Essentially, my left arm (non-dominant) is now a mess of plates, screws, wire and cadaver bones. Just had a check up and the fracture site is healing “beyond expectations.” I am also able to demonstrate full mobility and have about 95% of the strength I did pre-fracture. No nerve or blood vessel damage. I have not been on pain meds of any kind and have not been experiencing any pain or soreness.

Ortho is not versed in dive medicine but “thinks” it would be okay to go on a planned dive trip in December. I do plan on consulting DAN.

That's quite an injury. Was there any other trauma that went along with it?

There is a theoretical risk that the bone in this area won't off-gas as well and, over time, could become weakened with repeated decompression from lengthy exposures to high partial pressures of inert gas. If you were a commercial saturation diver this might be more concerning, but even then, a fracture that was repaired with hardware isn't a hard disqualifier. If you're an average recreational diver, as long as you are cleared for full physical activity, including range of motion and lifting heavy weights, and you have no other underlying issues, you should be fine.

Best regards,
DDM

 

[tridacna]

This is me. Surgery in 2018. >300 dives later and all is well.

PS. I no longer dive doubles and no more deco.

PPS I had ORIF on my right medial malleolus in 1984. Never stopped me then either.

 

[GingerDives]

That's quite an injury. Was there any other trauma that went along with it?

There is a theoretical risk that the bone in this area won't off-gas as well and, over time, could become weakened with repeated decompression from lengthy exposures to high partial pressures of inert gas. If you were a commercial saturation diver this might be more concerning, but even then, a fracture that was repaired with hardware isn't a hard disqualifier. If you're an average recreational diver, as long as you are cleared for full physical activity, including range of motion and lifting heavy weights, and you have no other underlying issues, you should be fine.

Best regards,
DDM

Hi! Thank you for the response. Luckily, I did not sustain any other injuries (ATV rollover) and I have no underlying medical conditions. I am just a casual recreational diver who is eager to get back in the water. I appreciate you taking the time share your knowledge and information.