From: jobst.brandt@stanfordalumni.org
Subject: Re: "broken hip" club?
Newsgroups: rec.bicycles.racing
Date: Sun, 14 Oct 2001 01:26:46 GMT

Patrick Magnien writes:

> I just joined the broken hip club this past weekend. Rain-slickened,
> diagonally oriented railroad tracks took me down, and it was the
> most painful accident I'd ever had (for anything).

> Anyone else a member of this club? I'd really like to hear some wisdom

I don't think it comes from long narratives such as the one you cite:

://www.crossroads.net/a/index.html?http://www.crossroads.net/a/writing/hipsmash.html

It depends on where the break was and how clean.  Mine broke half way
between the ball and crook of the femur.  The French doctor in Nice
(Hospital St Roc) which is an expert clinic for this, used hardware
that was ultimately simple and temporary (to be removed later).

With the fracture aligned, a bore was made straight into the ball for
a large "wood" type screw anchored in a holder that was screwed to the
side of the femur.  The bracket contained a tensioning spring that held
the ball and neck tightly to the femur stub.  I was back on the bike
just after four weeks and rode my usual 10,000 miles the following
season including another trip in the Alps.  That was about 15 years
ago and it is working like it never happened today.  The hardware was
removed a year or so later and I have the parts in my collection of
bicycle memorabilia.  I took a couple of dives on that side while the
hardware was in and since with no ill effects.

You are lucky if you were close to a clinic that mends lots of bones.
St Roc has scads of motorcycle, and ski and ice fractures.  This is
their daily routine and they are noted as the best in southern France.
I hope you had as good a location.  Speed is important because the
arteries to the joint along the femur atrophy in short time after a
break, and they are the life of the cartilage in the joint.

Jobst Brandt    <jobst.brandt@stanfordalumni.org>

From: jobst.brandt@stanfordalumni.org
Subject: Re: Broken hip club - need advice
Newsgroups: rec.bicycles.misc,rec.bicycles.racing
Message-ID: <xDoU8.58$yP6.434@typhoon.sonic.net>
Date: Tue, 02 Jul 2002 21:08:45 GMT

James P. Smith writes:

> I've looked through the archives of the groups and noticed there's
> no real consensus on what to do after breaking your hip and deciding
> what to do with the hardware a year or so down the road.  On Feb 17
> of this year I went down on my bike and ended up with a fractured
> hip, just below the femoral head (thank goodness).  The ortho reamed
> out the head and put a threaded insert in the head along with a
> plate down the femur, which is attached with more screws/pins.

Sounds familiar.  I have the hardware in a drawer at home where it
belongs after performing its service.

> I've posed the question to my ortho a few times but he's very wishy
> washy.  He says I don't need to have it out, it's my choice, blah
> blah blah.  On the one hand I want it out since I've heard from some
> of you that it's worse to have it in if you fall again, but on the
> other hand I don't relish going under another time.

By all means get another orthopedist!  This guy doesn't sound like the
man for the job.  When the hardware is removed, the bores fill with
bone and you don't have a protrusion under the skin to worry about.  I
had my hardware removed after 18 months.  Make sure the doctor has the
special wrench to remove it and knows what the process entails.

> I was hoping to race starting this year, but the hip ended that
> quick.  Last week, however, I went to a local crit to see how the
> local talent was and there was a huge wreck with one guy going off
> in an ambulance with a neck brace on. During the wreck the first
> thing that popped into my head was that titanium hardware crushing
> the bones if I was in the pileup.  Does anyone have concrete data
> suggesting the rates of reinjury due to falling with the hardware
> still in?

No I don't but I fell on that hip with hardware in place with no
lasting results.  That is, I got back on the bicycle and continued to
ride.

> Also, the injury put my running on hold.  I'm a bit worried about
> running as well.  Titanium is stiffer than bone and the pins are
> fairly small in diameter.  The last thing I'd want is some bearing
> yield about the pins and having the pins loosen up.  Anyone have
> experience with that?

You don't have to race to enjoy bicycling.  The hardware used by
competent orthopedists is well designed and works well.  I rode over
many passes in the Alps one year after the fracture with no problems.

Jobst Brandt  <jobst.brandt@stanfordalumni.org>  Palo Alto CA

From: jobst.brandt@stanfordalumni.org
Subject: Re: Broken hip club - need advice
Newsgroups: rec.bicycles.misc,rec.bicycles.racing
Message-ID: <Z1bV8.348$u%6.1618@typhoon.sonic.net>
Date: Fri, 05 Jul 2002 06:30:17 GMT

Mike Murray writes:

>> "Sounds familiar.  I have the hardware in a drawer at home where it
>> belongs after performing its service."

>> "By all means get another orthopedist!  This guy doesn't sound like
>> the man for the job.  When the hardware is removed, the bores fill
>> with bone and you don't have a protrusion under the skin to worry
>> about."  He further continues: "Make sure the doctor has the
>> special wrench to remove it and knows what the process entails."

> as though there was only one design of hip fracture fixation device
> or that they all need a "special wrench" and that it would EVER be
> acceptable for a surgeon to NOT "know what the process entails".

I guess you missed the description of the hardware but it is the
common modern type used for this operation.  My removal surgeon had no
idea what he was going to find when he got in there and proceeded to
hammer and screw on the thing as I listened to his bewilderment and
that of his assistants.  He did not know how it worked and nearly
advanced the screw into the hip socket, which would have cause serious
damage.

This occurred even though I made sure he got the pin-wrench with which
it was installed.  I even made a mechanical drawing of the piece from
x-ray pictures so there would be no mistake.  The device was installed
in France while the removal took place in Stanford by a macho football
injury orthopedist.  I have the evidence of his hammering the device
in the wrong direction from the dents in the stainless steel.  When I
heard the hammering, I was highly worried.  What a klutz!

> I think that Jobst has stepped significantly out of his field of
> expertise on this.  There are advantages and risks associated with
> both leaving an internal fixation device in place and with having it
> removed.  In order to make a decision on this subject you need to
> weigh many items such as the type of device, the location, the
> patient's surgical risks, the demand the patient is putting on the
> area and whether the patient is having any symptoms that may be
> related to the presence of the device.

It was on the advice of the surgeon who installed the device that I
had it removed.  He explained why and what the effects would be,
making obvious sense.  I don't understand what you find inappropriate
about removal.  Maybe you can expand on that and for what reasons.

> You also need to consider the risk of fracture during the healing
> period after the device is removed.  The cost of the surgery to
> remove the device is also a consideration, not only monetary but in
> terms of time off work, off the bike, etc.

There is no "healing period" except for the incision, the holes left
in the bone being in the neutral axis (by design) and their absence
only strengthens the bone as it fills in.  The purpose of the hardware
is to pull the ball of the hip joint back into position on the
fracture.  It does not supply support any more than any tension strut
(which it is) within a tubular member.  The main bone screw is under
spring load when tightened to the proper torque.  The small screws
perpendicular to the femur arrest device rotation like safety clips
and have no structural role.

Jobst Brandt  <jobst.brandt@stanfordalumni.org>  Palo Alto CA

From: jobst.brandt@stanfordalumni.org
Subject: Re: Avocet fastgrip SL tires...
Newsgroups: rec.bicycles.tech
Message-ID: <5ynQ9.57926$Ik.1930074@typhoon.sonic.net>
Date: Tue, 31 Dec 2002 20:58:41 GMT

Terry Morse writes:

>> I believe the fact that Avocet tires are a true 25mm wide, all
>> carbon black, smooth tread tire is the reason for their great ride.
>> Get the 700x25, you will find it to be a great riding, fantastic
>> handling tire...

> I've been using Avocet Fasgrip tires for a few years, but I've begun
> to question their wet traction.  Three weeks ago, my front wheel
> slid out on a very slow turn on slightly wet pavement, and I'm now
> laid up with a hip fracture for a few months.  Have Avocets ever
> been tested for wet traction?

That's no fun.  That happened to me in the Alps in 1989 down the Tende
Pass (a major truck route) just after it started to rain with white
foam on the road.  A great orthopedist in l'Hopital St Roc (Nice), I
was back in the saddle in a few weeks and back in the Alps the
following summer.

I know it was the slimy road because I have witnessed slip-out tests
on the Avocet tester and have ridden on "clean wet roads" with
excellent cornering.  The Avocet advertising pictures in the rain were
with Dave Mack cornering hard.

I think the subject of patterned tread has been beaten around on
wreck.bike often.  The main effect is rubber composition and true
contact area, both of which are maximized with smooth carbon-black
rubber tread.

With a contact patch as small as that of a road bicycle tire, there is
little averaging of traction over a larger sample of road, so that
small slick spots can initiate an unrecoverable slip.  This is best
demonstrated when riding over a tar stripe "crack patch".  I've seen
riders fall riding uphill over these stripes.

Jobst Brandt
jobst.brandt@stanfordalumni.org
Palo Alto CA

From: jobst.brandt@stanfordalumni.org
Subject: Re: Avocet fastgrip SL tires...
Newsgroups: rec.bicycles.tech
Message-ID: <8y5R9.58786$Ik.1975880@typhoon.sonic.net>
Date: Fri, 03 Jan 2003 01:19:00 GMT

Terry Morse writes:

> Your rapid recovery sounds encouraging. About how many weeks was it
> before you were back in the saddle? My doctor has told me 12 weeks
> with no weight bearing, which seems awfully conservative. Did you have
> the screws removed at a later date, or did you decide to leave them
> in?

I had a French device with a lag screw that pulled the ball (trailer
hitch) back into its proper position with a stiff spring load and the
anchor tab of the fixture arrested by two "wood screws" normal to the
shank of the femur.  I don't recall now but I think I was fully on
that leg in eight weeks and had the hardware removed about a year
later.  The stuff is in my collection drawer today, the Xrays of it in
a folder.

The summer following the break I fell on that hip on a hairpin turn
passing cars but wasn't delayed enough to lose position in traffic on
the Gerlos Pass above the Zillertal.  It was pouring.

Jobst Brandt
jobst.brandt@stanfordalumni.org
Palo Alto CA