Knee brace, broken femur

[KX02]

Originally Posted by kdxchar393

Thanks for posting this information Dr Mark.

Like Jedi, I will have to do some more research as I've been looking at dropping the big bucks on a set of knee braces. From what I've read here though, looks like my knee guards will work.

This was a very informative read! I wasn't sure what knee braces if any I might look into in the future. I have taken a number of pretty good shots to my knees, but always use some type of pad or guard, I guess I'll stick with that. I'm using the MSR Comp One knee/shin guards right now. I compared a bunch of others like all the one's from Fox and I think these MSR's are the best.

[mtk]

Originally Posted by drmark

Well, I think that a femur fracture in 100 times worse than a knee ligament injury. Femur fractures have a death rate associated with them. Knee ligament injuries get my athletes riding by three months. Femur fractures need over six months, although I think he will be fine after all the kicking and screaming is over.

Well, I'll have to disagree.

I'll bet dollars to donuts that the death rates from femur fractures are related to heart attacks and strokes due to blood clots. Louvenox (sp?) injections take care of the blood clot problem quite nicely. I should know, as I spent 21 days injecting myself with it when I broke my femur 10 weeks ago.

Mine was a severe break, as in, my leg was folded back behind me (heel touching my back). The next day I got a rod installed and in two weeks I was putting weight on it. It's not 100% yet, but that has as much to do with the damage I did to my foot (two hairline breaks in my big toe and lots of bruising and such) and the chunk of bone they left in my thigh to dissolve (long story, but the bottom line is that it's better that way than removing it) than anything. By next spring, I'll be 100% again, forever.

That is RARELY the case with knee injuries. They're also a LOT harder to rehab, more difficult in surgery, and generally have more down-the-road complications. Best of all, bones heal, while ligaments do not.

Given the choice between breaking my knee or ankle or breaking my upper (femur) or lower leg bones (tibia & fibia), I'll take the bone breaks every time.

I had some SixSixOne knee pads on when I did it, in fact. Since they got cut off in the Trauma Unit, I'll be replacing them with Asterisks.

Another factor to keep in mind is that this isn't an all-or-nothing deal. Every injury isn't blowing out every ligament in your knee or snapping your leg like a twig. For example, the last time I rode with a buddy of mine he tweaked his knee. He got the bike a bit sideways and touched a foot to keep it upright. He fell off in what looked like a very minor lowside get-off (think throttle-happy when in a powerslide). But about 30 minutes later his knee was stiff and swelling and it stayed that way for a week or more. I'm quite confident a knee brace would have prevented that injury with the additional support it provides.

I think it is also beyond debate about them protecting you from injury. A brace is a mechanical joint on your knee, in addition to the biological one, that takes some of the loads that your knee would have to carry otherwise. Reducing the loads on the body have to reduce injury since an injury is, at the bottom line, simply an overload on a body part that results in failure of that part. Of course, this assumes proper fitment and all that, but that should go without saying.

[drmark]

MTK,
good luck with your broken femur. You are one of the lucky ones. But even with your fractured femur healed and you should have some trepidation about riding with the hardware in. If you rebreak the femur with the rod in, I am glad that I won't be the one who has to figure out how to get the old broken rod out and the new one in.

Complicated femur fractures make knee ligament injuries into fun and games.

And BTW, a heart attack, kidney, or respiratory failure leading to death is pretty serious to me, (they are all consequences of long bone fractures) perhaps you will disagree.

[crfjedi393]

I will not dispute drmark's opinion. I am certain it is valid in that knee braces can and do cause femur breaks. However, I am much more willing to drop my foot in a turn while wearing my Asterisks. My wreck today at Noconamx tweaked my knee and it was a nasty looking event. Some of the ATM crew almost beat me to my bike to get it off the track as they were pretty sure I wasn't going to get up. I was able to ride back to the pits but my right knee was tweaked and I have two red marks on the inside of my knee where my brace impacted it. I won't go into the "slo-mo" details as I lived my crash but I didn't break either femur and I am totally convinced that my Asterisk braces saved a knee injury.
This is only one crash and it doesn't prove anything. I may break a femur next weekend. But for now, I am wearing the braces.
There are definitely two schools of thought on this subject. It boils down to a personal decision.

[Rider]

wrist guards are a good idea if you ride with metal bark busters that go right round

[drmark]

I like wrist braces. I think CTI has a good product.

[crfjedi393]

Originally Posted by drmark

I like wrist braces. I think CTI has a good product.

Is there any way you could get my insurance to pay for a couple of these?
I would seriously like to purchase these but $1000! Holy Cow! I broke my navicular or scaphoid into 5 pieces. My thumb doesn't work too well. I can still do everything necessary for my job and riding, I just have to make adjustments. I am in the "saving" mode to purchase a couple of these CTI wrist braces. However, with a teenager that crashes more than I do, I might not be able to get them for awhile.
Thank you for sharing your knowledge here. I truly appreciate it!

[drmark]

See if your doctor can write you a perscription for it. I am not sure if insurance will cover it. but give it a try.

[mtk]

Originally Posted by drmark

MTK,
good luck with your broken femur. You are one of the lucky ones. But even with your fractured femur healed and you should have some trepidation about riding with the hardware in. If you rebreak the femur with the rod in, I am glad that I won't be the one who has to figure out how to get the old broken rod out and the new one in.

Complicated femur fractures make knee ligament injuries into fun and games.

And BTW, a heart attack, kidney, or respiratory failure leading to death is pretty serious to me, (they are all consequences of long bone fractures) perhaps you will disagree.

Hey, I agree that death is the #1 thing to avoid. I'll also bring up your concerns with my doctor and see if he rethinks the rod removal plan or not. As for breaking it again, I sideswiped a tree in 4th or 5th gear, i.e. I was flying, and I don't think I'll be doing such antics again. I try not to do the same stupid things twice.

Of those three causes of death you mentioned, my guess is that they're all due to blood clots, correct? If that is the case, would you agree that they are easily preventable with the medications available today, i.e. Lovenox and the like? I know throwing a clot was a very real possibility, but my understanding is that it is exceedingly rare when properly managed with medication. Given that, I lumped the risks of death from a clot about as high as dying from anesthesia or the like. Perhaps I underestimated.

But to get back to knee braces, the contention that there is no research to say they prevent injuries may be true. However, that's not exactly meaningful either. There simply isn't a large enough population of data from which to study. In a typical experiment, we'd run a trial, change something, run another, see what happens, and then repeat it a few times for a reasonable statistical sample. Since getting two identical twins to crash a dirt bike, one with braces and one without, to see who gets hurt worse isn't an option, we're left with a statistical analysis of crash data as our only research options. Unlike auto accidents, where we have hundreds of thousands of data points to study, there just isn't enough data to do the same on knee brace use in motorcycling, particularly given the variable nature of motorcycle crashes. In a car, a crash is a crash. You're in a seat and generally stay there (ejections from lack of seat belt use not withstanding). On a bike, once it goes bad almost anything can happen. So let's just assume that conclusive research is a non-starter and isn't going to happen.

We also have seemed to jump right to the far end of the injury spectrum by discussing broken femurs or blown-out knees. This neglects a whole lot of potential injury scenarios one is likely to see. Remember, you've got everything from a hit that causes a bit a momentary pain, but no physical damage, through bone-crushing impacts. Considering just a lateral impact to the knee area, a very small blow might cause a bit of pain for a few minutes and nothing more. At some point, we reach a load that stretches ligaments. More load and they break. At even higher loads, the femur will snap. The brace allows the knee to absorb those smaller loads, which would cause knee damage on their own, and transfer that load to the bone, which the bone is strong enough to take without failing. So many of those smaller injuries can be avoided completely. For many, they may never see an impact large enough to break the femur, but rather impacts large enough to cause pain, sprains, and the like.

The other contention is that ligament damage is preferred to long bone fractures. You've got valid reasons why you think that way, but none of the medical professionals I've ever queried on the subject agree. The point they all made is that bones heal and afterwards are as good as new. Ligaments, on the other hand, do not heal and are never the same again. Stretch them once and they're stretched forever. Snap one and it will never, ever heal (or if it does, it will never have near the strength it did before the injury). So given the choice between an injury that is fully repairable and one that is not, I'll take the one I can recover from 100%, even if it means I get to take shots for 21 days to prevent blood clots and the deadly consequences they bring to the table.

Now I will grant you that I've only asked a few doctors and a few physical therapists the question. But I can say that the doctors I did ask are clearly very good at what they do (not saying you're not, Dr. Mark, I'm just saying these guys aren't hacks as I've seen one or two of those in my life as well). So you othopaedic surgeons need to huddle up in the corner and get your story straight.

This also isn't restricted to just knee injuries. They also said the same things about ankle injuries versus lower leg fractures. They all preferred a broken lower leg to any type of ankle injury because the bones would heal and be fine, while the joint would undoubtedly develop problems down the road or be limited in mobility or some other negative consequence. Having had a talus bone injury and now the broken femur, I'd have to agree with them 100%. My right leg (femur) will eventually be fine. My left ankle (talus) isn't 100% right and never will be, ever.

Now for a pragmatic question, do you have any idea how I can get a set of Asterisk braces with my health insurance? CTi2 braces are easy to get since they have a medical device number, but they lack patella protection, not to mention being $1800 per leg. The Asterisks offer more overall protection, at least to me, and are far cheaper at $550 or so per pair, but they lack that medical device number.

[drmark]

Well, you are very wise when it comes to Lovenox. I use it for all lower extremity cases. Unforturnatly it is not in universal usage. At my hospital, I am the only one that uses it all the time. That leads me to conclude that there are many people at risk.

Pulmonary and kidney failure can occur without a blood clot. The syndorme is called fat embolus and comes from bone marrow and fat being absorbed into the blood stream. It get stuck in the lungs and kidneys, sets un an inflamatory reaction and causes temporary failure of those organ systems. It a guy doesn't die from it, then they can recover. (I guess that was obvious)

[mtk]

Hey Doc,

I just got done doing my edit and saw your reply. Please take a gander above when you get a minute.

As for me being wise, not at all. I just choose talented health professionals when I hurt myself. Believe me, I didn't want to inject myself with Lovenox at all, but the alternative was even more unappealing. But getting back to "talented health professionals," that is one lesson I learned with the femur. I ended up getting transported to Allegheny General Hospital in Pittsburgh, rather than a closer local hospital, so I could go to the Trauma Unit. That turned out to be a VERY good thing. AGH is a top-flight trauma center and they took excellent care of me. I would STRONGLY suggest that everyone learn about their local hospitals and find out where the best local trauma center is located. If something happens, instruct the ambulance to take you there and nowhere else, even if it means handing them your Visa to pay for the trip. Good care is worth it.

As for Lovenox, I wonder how widespread your experience is on it? A friend of mine, who is an RN, told me that almost everyone in his hospital was on it (case appropriate, of course, but I think you get what I mean). If nothing else, that reinforces my thoughs on making sure you know where to get good care before you need it. So if you end up at Dr. Mark's hospital, make sure you get The Man himself and not someone else on staff.

Also, thanks for the info on other forms of complications from the break. Blood clots were the only one I was aware of, not the fat embolus issue you mentioned.