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Fractures, Surgery and Acute Conditions

General Considerations

Disqualification of divers with musculoskeletal injuries, surgery and inflammations should be considered during the period of an incompletely healed fracture, sprain, ligamentous injury or inflammatory process for several reasons;
----the loss of mobility and dexterity with a cast
----the possible alteration in the uptake of inert gas at the site of injury resulting in delayed healing and inability to climb into boats
----other aspects of diving requiring mobility and strength.
----the possibility of wound infection from marine organisms
----the possibility of reinjury to a fracture resulting in non-union, or disruption of a surgical repair.

Divers with acute bone or joint injury or inflammations should not return to diving until:
----the injury has healed and there is a full range of motion and strength. ----residual pain should not be present to impair the diver's ability to perform in emergencies.
----in addition, there should be no pain patterns that could be confused with a decompression accident.
----they have the OK to return to diving from their physician.

Consideration should be given to the particular arrangements of diving gear, straps and equipment and what effect this will have on weight-bearing and the possibility of further injury to other underlying structures.


Diving After a Fracture

Healed fractures generally are thought not to impose any restrictions on diving. Generally, a fracture should be properly healed in 4-6 weeks barring complications. However, there is the theoretical caveat that there is an increased risk of bubble formation in regions of bone where there has been some disruption of blood supply - leaving an increased or decreased vascularity. There have been no studies to prove or disprove these cautionaries, however.

There are a couple of other factors that you might consider: 
1. There is significant pressure applied to the arms and legs in exiting the water climbing back into boats from weight-bearing from the heavy scuba gear.  You might want to arrange with the divemaster for assistance in donning and removing your gear in the water. 
2. There is significant loss of muscle strength and sometimes actual muscle atrophy with a fracture and disuse. 

Finally - you should discuss this with your orthopedist for any comment that he/she might have regarding your return to diving in 5 weeks. 


Diving With a Cast

Moisture weakens plaster and damp padding next to the skin can cause irritation. Use two layers of plastic or purchase waterproof shields to keep your splint or cast dry while you shower or bathe.

Waterproof cast construction uses a waterproof cast liner made of Gore-Tex (W. L. Gore and Associates, Inc, Flagstaff, Arizona) to replace the traditional stockinette and cast padding. The Gore-Tex liner repels water and permits evaporation, allowing bathing, swimming, sweating, and hydrotherapy without any special drying of the cast or skin. The liner material is available in rolls of 2-, 3-, and 4-in. width and is applied directly to the patient's skin. Fiberglass casting tape is then wrapped around the waterproof liner.
http://www.physsportsmed.com/issues/1997/09sep/seles.htm

It is the theoretical possibility that there might be an increased risk of bubbling in a fracture site due to the altered blood supply. If this were the case, you might find decreased healing of your fracture after diving. Consequently, it would be wise to heed the advice of your physician before diving at all with an incompletely healed fracture. 

In addition, you will encounter logistical difficulties in gearing up, water entry and exit and locomotion in the water that could be risky to you and others on the dive boat.


Carpal Tunnel Surgery

You should be able to return to diving after complete healing of your incisions and satisfactory rehabilitation as determined by your operating surgeon. We cannot give you specific time intervals as this differs widely between individuals and is highly variable. 

Healed nerve and tendon release operations generally are thought not to impose any restrictions on diving. However, there is the theoretical caveat that there might be an increased risk of bubble formation in regions of surgery where there has been some disruption of blood supply - leaving an increased or decreased vascularity. There have been no studies to prove or disprove these cautionaries, however. 

Careful recording of neurological deficits should be accomplished before diving.


Rib Fractures

Rib fractures can be very painful, decrease respiratory excursions and if severe, can cause lung puncture with the resultant pneumothorax. A diver is also possibly placed at risk for increased decompression effects at the fracture site with slowed healing of the fracture. Best advice is not to dive during the period of healing (four to six weeks).

Rib braces and ACE bandages are the only effective treatment. In rare cases of fractures in severely traumatized people with markedly reduced respiratory reserve - nerve blocks can be done for pain relief and improved respiration. 



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 Ernest Campbell, MD, FACS All Rights Reserved.


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