Screws and diving

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endurodog

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Scuba Instructor
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Location
Aurora Colorado
This last week my girlfriend was involved in an accident where a car T-bones her car. Result was a pelvis broken in 8 places, several broken ribs and lots of cuts and bruising which will result in a couple week stay in the hospital and rehab. They did surgery and put in some screws, along with some external fixators that will be removed later. The screws are suppose to stay in. When I asked the doc about future diving he said sure in 6 months or so. Who knows if he understands the diving issues really.

First question I have, and another friend brought this up, I didn't see a problem with it is will the screws cause any risk or trapped gas pockets or any issues? 2nd I will need to ask the doc about but if there is an ortho doc maybe he can advise. Weight on water entry and getting out the water. Is that an issue 6 months down the road, to much for the pelvis?
 
So compassionately speaking, you would like to know how long your girlfriend
will be out of action.

Show her your questions, and it will be far longer than six months.
 
First question I have, and another friend brought this up, I didn't see a problem with it is will the screws cause any risk or trapped gas pockets or any issues? 2nd I will need to ask the doc about but if there is an ortho doc maybe he can advise. Weight on water entry and getting out the water. Is that an issue 6 months down the road, to much for the pelvis?

Endurodog,
There should be no problems with gas pockets around orthopedic hardware unless she develops an infection in the bone, which would be another issue entirely. As far as returning to diving, as soon as her surgeon clears her for full, unlimited activity she should be fine. If she has any residual strength/range of motion deficits at that time, she can discuss them with her surgeon and her physical therapist, and make plans to adjust her diving practices if necessary. She may have to educate them on the physical strain involved in diving, especially moving around and entering the water with extra weight like you mentioned. Please wish her a speedy recovery.
Best,
DDM
 
Sorry to hear about the accident. I had a surgery last year where I had pins and screws put into my lower leg due to an awkward fall and break while shore diving. I was back up and diving in about 5-6 weeks (I suspect hers will be much longer). The point is that once I was skeletally able to dive again I had no issues stemming from the hardware. The trick will be getting structurally sound and regaining the motor skills/mobility to participate.
 
Something to note is that trauma patients at high risk of deep venous thrombosis and/or pulmonary embolism will sometimes have an inferior vena cava filter (IVCF; a.k.a. Greenfield filter) installed. The device might be installed temporarily or left in permanently. I believe that the tendency is to remove them in younger patients who may eventually return to an active lifestyle out of safety concerns for the device over a person's lifetime. In the instance of permanent IVCF (which, from what I know, would be unlikely), I'm really not sure how this affects DCS risk (positive: device breaks up venous bubbles?, negative: bubbles cause migration/blockage of the device?) down the road since the relevant diver population would be rather small. Long-term follow-up studies of patients receiving IVCF installation have shown little to no migration of the device and little to no long-term complications attributable to the device. AFAIK, there have been no case reports of divers with IVCF encountering any long-term complications.

As you already know, from research in the DCS field, there seems to be a vascular/blood component to DCS pathophysiology and venous bubbling has been used as a proxy for decompression stress.

If your girlfriend didn't receive an IVCF or just had one temporarily installed, then I'm not sure if it's even worth worrying about...although I suppose it's possible that the device could induce some vascular scarring in the area in which it was located. :idk:

Another thing to consider is that long-term complications of pelvic fractures can include back pain and/or other related neurological issues. Such complications might limit the kind of physical activity the person can do. Moreover, it's not too difficult to imagine how those kinds of persistent problems might make DCS diagnosis more difficult.

I can understand your concern for your girlfriend being able to enjoy all of her former activities. Scuba diving is fun and can bring a lot of joy into people's lives. It sounds like she has a challenging road to recovery. I hope she gets well soon.
 
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Wow . . . that's a BIG injury. I'm glad she is doing well enough to be thinking about diving!

There are theoretical concerns about increased DCS risk in areas of trauma, due to scar tissue and reduction of blood supply. I am not aware of any studies that confirm that, however, and there are many people (myself included) who have had fractures and dive without issues.

Although the plural of anecdote is not data, none of my five plates or 30-odd screws has ever caused me any discomfort related to diving (except that the one in my collarbone doesn't like the weight of my gear on it).

My guess is that you are probably looking at closer to a year before she's totally recovered and thinking about recreational activities beyond simple PT/rehab.
 
Sorry to hear about the accident.
The big question relates to the body and the addition of metal, and possible impacts to diving.

Personal experience: none what so ever. I have screws, and two artificial knees.

Once her doctor clears her, she should be good to go.
 
All good comments so far. Free gas will usually diffuse completely back into tissue; e.g. laparoscopic surgery. The obvious exception is when gas production/injection exceeds absorption rate; e.g. the gut, injury, or serious infection.

Because the pelvis is the foundation of the skeleton, it's essential that she follow her PT regime. Her doctor seems to think some activity 6mo is possible but I agree that a year would be more usual before return to full activity. I am especially skeptical of trying to tote around a scuba tank, whether over a shoreline or a rocking boat. Ambulation as soon as possible, even at partial weight-bearing, will reduce the risk of thrombosis.


--------------------------------

I got a terrible start from your description of the accident. You both are very very fortunate. It was from just such an accident that I lost one of my nurses and her unborn child -- in my OR, on my table. 'Nuf said.
 
Great info guys! Thank you so much. She did have a IVCF placed but they are saying that is temporary and will be removed in a few months.

Knowone, I wasn't talking about her weight but the additional weight of scuba gear on a rocking boat deck then on the ladder getting out. If I was commenting on the other her hands still work well enough to shoot me :)

This is one the the goals I can use to help motivate her when PT is tough. We have a huge long road ahead.

Thanks guys (and gals).
 
https://www.shearwater.com/products/swift/

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