Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know)

Aug 5, 10 19:20

Post #1 of 21 (10914 views)

Remember how earlier today I thought that that little bit of tendonitis in my ankle was something to worry about?

Well, was biking home from work this evening in light rain. About a half mile from home, made the left turn from a green light, not going especially fast, but not slowing a whole lot either. The bike slid out from under me. I don't know - might have hit an oily patch, or maybe I was being sloppy and went over the manhole cover there. Apparently I'm not as good at this sort of crash as all of you guys who do crits. Lost a large amount of skin on my left butt cheek, and also landed on my outstretched left hand.

Got my wife to drive me right back to the hospital. One of my coworkers took a few pictures of my left wrist, and now it appears that I've got an avulsion fracture of the pisiform.

(For those of you who don't know the carpals, that one is in the first of the two rows, out on the pinky side. The mnemonic we learned in x-ray school is "Some lovers try positions that they can't handle." Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate.)

I'm going to see the grouchy Canadian orthopedist tomorrow. (Doctor McCrankypants, as he is sometimes known, and he has been on a one-man crusade to dispel the notion that Canadians are all polite.) Will find out whether I've got any prayer of actually racing Timberman, or whether I'm going to be volunteering instead. BTW, didn't somebody just recently write about racing in a specially made splint? I'm going to do a little searching after I post this.

I'll keep y'all posted on the prognosis, and on the bedside manner of the grouchy Canadian.

-----
Over 4.5 years bike crash free.

Last edited by: xraycharlie: Aug 6, 10 9:10

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 5, 10 19:43

Post #2 of 21 (10904 views)

Sorry to hear about the crash (and to see the crash counter reset, it was doing quite well). Hopefully its not a severe fracture and you can still swim/bike with it in a few weeks.

Get better soon!

---------------------------------------------------------
All we have to decide is what to do with the time that is given to us. ~Gandalf

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 5, 10 19:46

Post #3 of 21 (10901 views)

Damn it! I am afraid it was my fault. I was thinking the other day about how impressive your crash free streak was. Get well soon!!!

Jodi

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [Jodi] [ In reply to ]

Aug 5, 10 20:05

Post #4 of 21 (10896 views)

Crash free streak was, to be precise, 1091 days, 23 hours, and 45 minutes (give or take). The last one was also on a Thursday. Just like Arthur Dent, it would appear that I've never quite gotten the hang of Thursdays.

Call me obstinate, but I'm going to check out my aerobars tomorrow and see what sort of wrist position would work. Not too worried about what position would work for swimming, 'cause I'm a crappy swimmer anyway.

Am also going to convince the doc to let me work my regular weekend shift. I can already drive stretchers one-handed. Maybe I'm overconfident, but I think that with a little extra help from the ED staff (moving patients, mostly), I can work single handed. Hell, I used to sail single-handed.

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 5, 10 20:07

Post #5 of 21 (10892 views)

You can make it work! In my residency we had one resident working the day after surgery for an open radius fracture after rollover MVC and one this week back at work 2 days after a both bone s/p surgical fixation. YOU CAN DO IT! hehehe...

:-)

Jodi

Last edited by: Jodi: Aug 5, 10 20:33

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [Jodi] [ In reply to ]

Aug 5, 10 20:18

Post #6 of 21 (10885 views)

I guess if you've only got one good hand, it'd really suck if it got stuck doing a DRE.

Big doses of Advil seem to be doing the trick so far. I'm holding off on the Vicodin unless I really need to. Just wondering whether the scanner counts as heavy machinery.

I've got no doubt that I'm mentally capable of doing the work under those circumstances. Not only am I capable of doing x-ray in my sleep, but I've actually done it in my sleep on a few occasions.

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 5, 10 20:23

Post #7 of 21 (10878 views)

Hahahaha. We call the DRE the DG (Denver General) handshake. Did 3 today. One on a 400+ pound man. Not fun. But never thought about having to do that 1 handed....

There was some debate in the literature a few years back on the effect of NSAIDs on bone healing after acute fracture. I have lost track of the literature but if you're bored in your newfound single-handed state a pubmed search could be interesting. Some thought the the anti-inflammatory properties actually partially inhibited the inflammatory process that was necessary to begin new bone growth formation.

:-)

Jodi

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [Jodi] [ In reply to ]

Aug 5, 10 20:34

Post #8 of 21 (10875 views)

Well, great. Weird Vicodin dreams for me, then. Hope my wetsuit doesn't start menacing me again, like it did last night. (See earlier thread.)

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Over 4.5 years bike crash free.

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [Jodi] [ In reply to ]

Aug 5, 10 20:35

Post #9 of 21 (10873 views)

x2 Jodi. Was just going to post to charlie this info (NSAIDs re: bone healing).

Better off just taking a narcotic/nothing/synthetic instead if you must. Healing vibes your way.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Re: Fractured Pisiform (that's my wrist, in case you didn't know) [rroof] [ In reply to ]

Aug 6, 10 9:08

Post #10 of 21 (10824 views)

Just back from the orthopod's office. He was actually fairly pleasant. Turns out that he's a sometime cyclist himself, and one time actually broke his neck in a cornering mishap.

Verdict is that the fracture may actually be in the hamate (the carpal just distal to the pisiform, in case y'all care). Tough to tell without a CT, but no need to bother, 'cause treatment is more or less the same. I'm in a splint instead of a cast (woo hoo!). Won't be racing Timberman. I'm not going to argue the point - very little grip strength in my left hand, so I've got no business being on the road on a bike. Followup appointment is in five weeks. Would ordinarily have been six, but the doc was amenable to moving it up a week to evaluate whether I might be able to do Pumpkinman, at least.

Looks like I'll be getting in some quality time on the trainer. Any good TV/movie recommendations for this sort of thing?

I'm still thinking I'll make my way to Timberman, but will be volunteering or tailgating or something. You'll be able to spot me by the blue splint on my left wrist.

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 6, 10 9:55

Post #11 of 21 (10818 views)

I used to think fractures were no biggey. Then in '08 I fractured my lunate. Later developed Keinbock's. Just had surgery a month ago and have my fingers crossed for a solid recovery.

Sorry about your fall and fracture. When you heal up, take some Judo or Jiu jitsu classs for a month or two. You won't extend your hands anymore when you bust!

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [triguy98] [ In reply to ]

Aug 6, 10 11:57

Post #12 of 21 (10796 views)

Had to Google Keinbock's. Sounds unpleasant. How did you fracture the lunate?

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 6, 10 13:13

Post #13 of 21 (10787 views)

Work. I was team lifting a heavy desk by the handles. We has to step up and turn the desk. Apparently weight+ torque= bad for wrist.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [triguy98] [ In reply to ]

Aug 6, 10 15:00

Post #14 of 21 (10773 views)

In Reply To:

Work. I was team lifting a heavy desk by the handles. We has to step up and turn the desk. Apparently weight+ torque= bad for wrist.

Woah. Damn.

Also had to google Keinbock's - one of my friends warned me of avascular necrosis, which sounds to be very, very similar.

In fact, I get to add my name to the list of people who have broken their wrist recently. Mine's technically a broken arm, because I hairline'd the ulna. Yours must've been much worse than mine, because I raced on it two weeks later (duathlon), and have done two more dus since.

Heaving vibes, bro.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [persondude27] [ In reply to ]

Aug 7, 10 5:38

Post #15 of 21 (10748 views)

It hurt when happened and was sore. Weight bearing stuff hurt. But I could run and ride my tri bike. MTB and roadie haven't been fun. Doc told me no MTB for a long time. Too much a risk of reinjury.
When swimming bothered I decided to return to the doc. Took a year and half for Keinbocks to show on a MRI. So don't anyone rush a return from a wrist fracture and don't ignore any persistant soreness.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [triguy98] [ In reply to ]

Aug 7, 10 5:59

Post #16 of 21 (10745 views)

How's swimming?

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 7, 10 6:48

Post #17 of 21 (10734 views)

Before surgery it was just uncomfortable. Didn't hurt enough to quit a workout, but enough that I wasn't terribly motivated to hit the pool.
Four weeks post surgery and the PT said I am a ways away from being good for laps. The doc had told me I could, but since my initial injury, this PT has been right when the doc was wrong, so her word is law for me. I really cant imagine swimming right now anyway. I can't tie my own shoe laces or was my back, so I'm focusing on that first

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [triguy98] [ In reply to ]

Aug 7, 10 7:43

Post #18 of 21 (10724 views)

In Reply To:

I can't tie my own shoe laces . . .

That's bad enough - but I'm at work right now, and am having trouble tying the drawstrings on my scrub pants tightly. I sucked in my gut as far as I could, and they seem to be holding for now. Wondering what the odds are that I going to accidentally drop trou today and show everyone my nicely road-rashed ass.

-----
Over 4.5 years bike crash free.

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 7, 10 8:11

Post #19 of 21 (10720 views)

That sucks. I'm fortunate that my work place is laid back enough that I've been wearing basketball shorts and soccer sandles. I can't imagine putting scrubs on. They dont make elastic ones? Maybe have a tailor stitch some elastic into you current ones?

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [xraycharlie] [ In reply to ]

Aug 7, 10 8:19

Post #20 of 21 (10717 views)

Should I give you the lecture on appropriate calcium intake?

Sucks about the fx and the race. Will you post your x rays? :-)

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Re: Fractured Pisiform and/or Hamate (that's my wrist, in case you didn't know) [tigerchik] [ In reply to ]

Aug 7, 10 8:59

Post #21 of 21 (10714 views)

I could try to post the films, but the fracture(s) are pretty subtle. I didn't see anything when I looked at them originally, and the orthopod said that he didn't really see the hamate fracture until he'd done the physical exam and knew right where to look, using magnification and a high-resolution monitor.

Calcium intake: Not a problem. Lots o' cheese in my diet, and cream in my coffee.

And yeah, it sorta sucks about not being able to race, and missing out on a lot of biking this summer. But whenever I start feeling sorry for myself, I think about the guy I xrayed in the trauma room here earlier this week. He was the bike part of a car vs. bike MVA - from what I heard, he accidentally pulled out right into the path of a car. Open fractures of the left tibia and femur (as in, bones were sticking out of his leg). Pelvis was separated at the symphysis pubis, and probably dislocated at the right SI joint. He got sent out by helicopter.

The reason why he was out biking distracted, though, was that his son had been in a bad MTB crash out of state earlier in the day. Skull and C1/C2 fracture - no word on the condition of the cord. Scheduled for surgery the following day. So his dad went out for a ride to try to "clear his mind . . ."

I talked to his wife briefly as he was being loaded onto the helicopter. She was being pretty damn stoic, given the circumstances.

It's a dangerous hobby we have. No telling what a bad roll of the dice will get you. I'm glad that I'm still able to work, and might just possibly salvage something of this race season. Given the various bullets that I've dodged, that's not too bad.

-----
Over 4.5 years bike crash free.

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