drmark

[drmark]

Some of you may know me from houstonmotocross, thumpertalk, or ktmtalk
I am a rider and an orthopaedic surgeon who specializes in sports medicine and particularly in MX injuries. I am here to answer any questions that my bother and sister riders may have on these subjects. All you have to do is post. I will comment of other posts where I thing that I could bring some important issue to light.

Much useful information is available on my website: [Only registered and activated users can see links. ]

drmark
Mark Sanders MD
Houston, Texas
[Only registered and activated users can see links. ]
cell phone 24/7 713.907.6076

[schwen_108]

Awesome, Welcome to ATM. Should we referr to you as the ATM Medic than?

[Woody_393]

Wow, very cool of you to join us. We, as you know are a crowd that tends to visit your type of doc quite a bit.

Welcome to ATM and we hope to see you often.

[Keetoman393]

Dr. Mark, thank you for signing up and giving advice here! We all look forward to your expertise.

[Aus_Rider_22]

Ditto.

Thanks for taking the time to register here at ATM!
Look forward to learning from your expertise and advice!

[popfuhre393]

Dr. Mark,

Welcome to ATM, it was great meeting you and yes I do have your cell phone number programed on my phone.

Mike

[valverde]

Dr. Mark
It was nice meeting you this weekend and getting to visit Saturday afternoon at the scoring tower. Also, thanks for the offer to drive your car, that just amazed me, I wouldnt let anyone near that thing if it was mine. Enjoyed the visit and hope I see you on the track sometime and NOT your office!

Wes "ValVerde" Lorenz

[911_Racing_Dad]

Wow. An ATM Doc ... we have it all now. I will throw out the first question.

My son broke his right thumb and collar bone in June and was cleared to ride in mid August. In mid Sep he took what looked like a minor highside and broke his shoulder, arm and two bones in his foot. His breaks were bad this time including chipping a piece off his shoulder socket and snapping the tip of his metitarsel. 3 of the 4 breaks were in the growth plate. I have seen him walk away laughing from much worse bails. We did not let him ride before he was medically cleared but I have to wonder if the damage in Sep was due to his bones still being weak from the first accident. He takes vitamins, eats well and we pound calcium supplements but I do not want to let him on the bike again until I know he is strong enough.

We have at elast 4 more weeks in the cast and sling. After that I plan on getting him a trainer to get some meat on his bones. He is 14, weighs 130 pounds and is almost 6 foot tall. He is strong as can be but is very skinny.

Long story simple question ... how long does it take to really heal after multiple broken bones and what can we do to ensure he is ready to go? I have asked the same question to our docs which are great guys but none of them ride and do not understand our sport.

Welcome and good luck becuase you are going to he bombarded!!

[MrsTwister393]

Welcome to ATM Dr. Mark. We are proud to have you in the family

[zoohoot393]

Hey there Dr. Mark! It was great meeting you this weekend at GMBIV, I am glad you were able to stop by and post. It is very kind/generous of you to take our questions.

Here is a photo from the finish line:

[drmark]

911 Racing Dad,
most of these accidents come about because of poor conditioning. The cast and slings he is in add to the conditoning debacle. When is all that junk coming off. I would think that it should now. Then start him of a program to increase cardio fittness and a weight program. Then back on the bike to compete. Much of the work needs to be don off the motorcycle.

Where are you guys from. Please post recent xrays and I will continue to advise you.

[911_Racing_Dad]

We currently live in Springboro Oh but we are AF so we move every 2 years. Here are a few xrays and the reports. I do not have the most recent ones. We have seen three ortho docs on base, a sports shoulder specialist and a sport foot specialist and have a few conflicting results. The AF docs initially said surgery on both the shoulder and foot. Both the private docs do not want to do surgery. The shoulder piece that is separated is still connected to muscle and is so small all they could do is stitch it and they said it wasn’t worth going in. The foot doc said the bone will heal up as strong as ever. Both private docs said he should have no pain after they heal which is opposite what the base docs told me.

I understand medicine is as much art as it is science so there will be differing opinions but I would love to have yours.

I have more angles I can email.

THanks





06 SEPT 05

RIGHT FOOT:

There is overlying splinting material.

There is a comminuted fracture through the proximal metadiaphysis of the
first metatarsal involving its medial cortex and involving the growth plate
consistent with a Salter-Harris Type II fracture. There is slight apex
lateral angulation.

A second fracture is noted through the head of the second metatarsal crossing
the growth plate. There is slight comminution of the medial cortex.
Findings consistent with a comminuted Salter-Harris Type IV fracture. There
is both medial and proximal displacement of the distal fracture fragment by
4-5 mm.

There is overlying soft tissue swelling. No other fractures or dislocations
noted.

IMPRESSION:

1. SALTER-HARRIS TYPE IV FRACTURE OF THE HEAD AND DISTAL METADIAPHYSIS OF
THE SECOND METATARSAL.

2. SALTER-HARRIS TYPE II FRACTURE OF THE PROXIMAL MEDIAL CORTEX OF THE FIRST
METATARSAL WITH SLIGHT APEX LATERAL ANGULATION.









FOOT,(STANDARD) RT AT 0909HOURS:

9

SHOULDER, (ORTHO)RT 4 VIEW;TRUE AP/AXILLARY/OUTLET/INT ROT AT 0909HOURS:

9
06 SEPT 05

RIGHT SHOULDER:

There is a triangular 5-6 mm ossific density arising from the inferior
glenoid which may represent a small fracture fragment. No other fractures or
dislocations are noted.

No osseous destructive lesions seen.

IMPRESSION:

POSSIBLE FRACTURE OF THE INFERIOR LIP OF THE GLENOID WITHOUT SIGNIFICANT
DISPLACEMENT OR STEPOFF.

CT,EXT SHOULDER RT W/O CONTRAST (GROUP) AT 1341HOURS:

5

6 SEPTEMBER 05

CT OF THE RIGHT SHOULDER

PROCEDURE: 2 mm slice at 1 mm interval axial images obtained through right
shoulder with sagittal and coronal reformats utilizing edge enhanced
protocol.

FINDINGS:

CT images confirm bony Bankart fracture off of the anterior inferior bony
glenoid with anterior and inferior displacement of fracture fragment. There
is cortical irregularity and fracture lucency also seen through the anterior
and lateral aspect of the skeletally immature humeral head. Fracture lucency
appears to extend into the physeal plate of the lateral growth center of
humeral head. No significant displacement or fracture fragments is
appreciated. Bone mineralization appears normal for patients age.
Visualized apex of right thorax is unremarkable.

IMPRESSION:

1. POST TRAUMATIC CHANGES STATUS POST DISLOCATION/FRACTURE OF RIGHT SHOULDER
WITH RESULTING BONY BANKART FRACTURE OFF OF ANTERIOR INFERIOR BONY GLENOID
WITH MINIMAL DISPLACEMENT OF FRACTURE FRAGMENT. ADDITIONAL FRACTURE IS SEEN
AT ANTERIOR LATERAL ASPECT OF HUMERAL HEAD WITH FRACTURE LUCENCY EXTENDING
INTO PHYSIS OF LATERAL OSSIFICATION CENTER OF SKELETALLY IMMATURE RIGHT
HUMERAL HEAD. NO SIGNIFICANT DISPLACEMENT APPRECIATED OF FRACTURE FRAGMENTS.

2. ORTHOPEDIC STAFF AWARE OF EXAM FINDINGS AT TIME OF EXAM COMPLETION.

[kwmotocrosspunk]

welcome aboard dr mark

[drmark]

To Racing Dad 911

There could be some controversey about whether or not it would have best to fix the broken foot bones. There is none now, as by four weeks, those bones have healed for better or worse. The cast needs to come off and he needs to start on a rehab and conditoning program.

The shoulder issues are very clear. That shoulder is unstable and requires operative treatment to repair the glenohumeral ligaments back to the glenoid.

In our hands that is an outpatient surgery that is done throught a small incision in the armpit, so no scar is ever evident. The sucess rate approaches 100 percent. I have done well of 400 of these and the only guy who ever redislocated was in a quad accident, broke his collar bone and eight ribs on that side. Short of such an accident you son will have a normal shoulder afterward.

here is our webpage on shoulder instability:
[Only registered and activated users can see links. ]

Let me know if I can help you further.
Regards,
drmark
Mark Sanders, MD
[Only registered and activated users can see links. ]
713.907.6076

[911_Racing_Dad]

Thanks. I contacted the Chief of Othopedics at our hospital today with my concerns based on your evaluation and he is going to review Nat's case and get back to me. I really appreciate it. I wish we lived in TX!

[MrsTwister393]

Making an appointment now for my wrist

[juglenuts]

First off welcome to ATM,, Im sure your knowledge will be very helpful...
Back in May I broke 5 bones in my right foot: the middle 3 metatarsels, shattered where my big toe connects to my foot and fractured my heal. They pinned the middle metatarsel from the bottom of my foot and did 2 pins by my toe. I had everything removed in July and as of 2 weeks ago I am clear to do all activities. As my doctor is kind of worthless and offers very little help,, what activities would be best to gain strenght in my foot/ leg without causing too much pain?? Should I be doing weights for my legs or will that cause too much stress on the bones? Ive been playing tennis and lifted once (squats, calf raises) and the next day I have to walk with a noticable limp because of pain. Should I be 100% by now?
Any info would be appreciated.

[drmark]

It would not be reasonable to think that you could be free of pain at this point.

You need to work on your cardio. The stationary bike one hour per day, every day will take care of that.

After such an injury, the heel cord is likely to get tight so work on stretching it. Use the calf raise machine in the gym in reverse with weights on your shoulders allowing your foot to dorsiflex with only the toes on the platform. That will help both the MT joints and the heel cord stretch.

Needless to say, hamstring and quad exercise is a must.

Specific exercises for the intrinsics muscles of the foot are best proformed by using the toes to pick up pencils or marbles off the floor. Spend 30 minutes per day on that.

For pain, take 4 Advil, 4 times per day. Thats a perscription dose of motrin.

Nutriceuticals, visit [Only registered and activated users can see links. ] and order Nutriex Sport. It has all the vitamins and the cartlage support stuff (glycosaminoglycans, proteoglycan, chondrotin sulphate, antioxicants, etc) God knows you need them.

Let me know what type of boots were you wearing as this is a pretty uncommon MX injury when the foot is properly protected.

good luck
drmark
Mark Sanders MD
[Only registered and activated users can see links. ]
cell 713.907.6076

[juglenuts]

Good stuff,,,Ill hit the bike and work on picking things up with my toes.
I was wearing Alpinestar Tech 6's and am still amazed on how I could do so much damage with good boots on....
Thanks so much for the info.

[drmark]

Move up to Tech 10s. I wear them and I can't imagine how anything could happen to the foot with those on. BTW, I get nothig of value from Alpinestar for endorsing them.
drmark