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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;
Divers with acute bone or joint injury
or inflammations
should not return to diving until:
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:
Finally - you should discuss this with your orthopedist for any comment that he/she might have regarding your return to diving in 5 weeks. 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.
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. 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 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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