Monday, 29 October 2012

Scaphoid Fractures

Our physio, Nicole Oh, writes about a common injury across all disciplines of cycling, having learnt the hard way during her season of road racing...
The scaphoid is one of the carpal bones on the thumb side of the wrist and is the most commonly fractured carpal bone. Fractured scaphoids usually occur from a fall on an outstretched hand. There is no obvious deformity and little swelling. It often improves relatively quickly meaning it is commonly mistaken for a simple wrist sprain. To further complicate diagnosis, the fracture is often not visible on x-ray shortly after injury.

Diagnosis

On examination there is likely to be tenderness over the anatomical "snuff box", over the scaphoid tubercle and on the scaphoid compression test. Scaphoid fractures are most commonly diagnosed by x-rays of the wrist, although as mentioned above, they often do not show up for 10-14 days post injury, especially with non-displaced fractures. Also, standard x-ray views may not pick up all scaphoid fractures and a special scaphoid view (wrist in ulnar deviation and extension) may be required. After this time, if a scaphoid fracture is still suspected, a CT or MRI may be ordered to aid diagnosis. CT and MRI should pick up scaphoid fractures immediately after injury.

Treatment

Until a definitive diagnosis is made, the patient may remain splinted to prevent movement of a possible fracture. Once diagnosis is made, it is usually treated by immobilisation in a cast for 6-12 weeks (for non-displaced fractures.) Scaphoid fractures often take a long time to heal due to its uncommon blood supply. Unlike nearly all other bones in the body, the blood supply enters the bone distally (near the hand) rather than proximally (towards the forearm.) The main blood vessel is commonly disrupted by the fracture, which slows the healing process and can even cause death of the proximal fragment of the bone (avascular necrosis.)
Displaced fractures, or fractures in the proximal third of the bone (poor blood supply) are likely to need surgery. A screw or pin is inserted to stabilise the bone, sometimes with a bone graft to help heal the bone.

Complications

Complications include non-union, malunion, avascular necrosis, or post-traumatic arthritis. Many people seek help many months after the initial injury with persistent pain or poor wrist function, often because the fracture is misdiagnosed or neglected in the first instance.

Physios are the Worst Patients!

Read on, if you want to know how NOT to manage a scaphoid fracture...
I crashed in a Devil race on the track back in June. I fell heavily on my left side but got back on and finished the Omnium I was racing in that day. Despite not being able to move my left hand or grip the next morning, I did a 10 mile TT. I went to A&E for an x-ray 4 days later as I had quite a lot of snuff box pain, but it was clear (although a scaphoid view wasn't taken.) With the help of taping and a splint, I continued to ride my bike and work as a physio.
I didn't go back for re-x-ray after two weeks as I should have, but instead completed the Marmotte! The wrist was feeling much better, so I resumed road racing and promptly crashed again, this time falling on my right wrist. This one didn't feel like it was broken so I didn't bother with an x-ray and just continued to ride and work with taping and a splint.
A month later, my right wrist was still very painful, so I got both wrists/scaphoids x-rayed. To my surprise, my left scaphoid had been broken for 8 weeks (across the waist, plus a chip off the end) but the right wrist was clear. Even more surprising was the fact that the scaphoid fracture seemed to be healing just fine, despite pretty much no immobilisation and a lot of use. When asked what should be done, the doctor said just to continue to wear my brace and not to fall on it again. I took two weeks off road racing and then finished off the season, thankfully crash-free!

I've had a lot of bad luck with crashes this year, but extremely good luck with the healing of my scaphoid, especially since I'm a self-employed Physio! I will definitely be booking in for re-xray in a month or so, just to make sure it has healed. My best advice - Do as I say, not as I do!
Written by Nicole Oh

Wednesday, 17 October 2012

Trek Domane Review

Trek Domane 6.2

So let’s get a couple of things straight. I don't like sportive bikes and I don't like compact handlebars (or chain sets for that matter). Anyone who has seen one of my bikes will tell you they are long and low and generally have very few concessions to rider comfort. My beloved Pearson hammerandtongs for example has no spacers under the stem, stiff as you like Ksyriums and a deep drop bar. So why, I hear you say, would I be interested in riding Trek’s all new mile muncher - the Domane?

She certainly is a looker

I've always been an admirer of Trek and the way that they design their products. They were one of the pioneers in carbon technology in bicycles and in recent years have led the way in commercialising and mass producing a cost and time effective "custom" product by way of their Project One program. Plus they promise something a little different with the Domane and different it certainly is.

The model we have here is the 6.2 using the top of the line 6 series frame. It's the frame that Fabian Cancellara used to win the Strade Bianche in March. The Swiss rider has had an active and intimate input into the development of the bike. The 6 series frame is handmade in Waterloo, Wisconsin, USA and is only available via their custom Project One scheme. This allows the rider to fully customise anything on the bike from transmission to handlebars, wheels to paintwork. You can even have your own name or slogan written on the frame! More details on that if you follow the links below. This particular model has come equipped with a Shimano Ultegra transmission and Bontrager (Trek's in house component brand) RL wheels. It's finished off with Bontrager R1 tyres, RL saddle and RL handlebars. If you want one it'll set you back a cool £4000 but the range begins at £1000.

Handmade in Waterloo, Wisconsin, USA

I was a little sceptical when I first saw a Domane (pronounced do-ma-ney for those who care) The "ISOspeed decoupler" seemed a little extravagant, especially in an industry where fashion over function really takes precedence and fads come and go more frequently than the sun rises and sets. I was keen to try one all the same.

The ISOspeed decoupler - one of the more drastic departures from traditional bike design.

The ISOspeed system is essentially a set of cartridge bearings set at the top tube/seatmast/seatstay junction and designed to give the seatmast a degree of movement - aiding the amount of give from the frame and thus dampening vibrations from Britain's notoriously bad roads. In practice this system works extremely well, smoothing out road imperfections easily without destroying that "road feel" that is so commonly lost on this type of bike. The other thing that struck me (or not, so to speak) was how well the bike absorbed large impacts like potholes, it really is very smooth and carries speed exceptionally well.

Remove the cover to find two sealed cartridge bearings. This allows a greater degree of movement in the seatmast, a sort of suspension if you like.

One thing that has always bothered me with this type of bike is the lack of stiffness - particularly at the bottom bracket. This is another area where the Trek really surpasses expectations. Trek claim a 15% boost in stiffness over their current Madone model, now I can’t quote figures and percentages but the power delivery on this bike is nothing short of superb with no discernible flex in the bottom bracket, it really seems to revel in being pushed hard. The same can be said for the front end. The tapered head tube shows no signs of deflection under load and when matched with a slightly slacker 71.9 degree (on a 56cm) head angle creates a very sure-footed and stable bike to ride yet it still manages to retain some of that zing you get from riding a thoroughbred race bike - the comparatively short 100mm stem allowing quick and snappy changes in direction. This is no blend in with the crowd sportive bike. In fact after speaking to Trek it turns out that they don't call it a sportive bike, it's an "endurance race bike" - a very fitting description.

I suppose what I'm getting at here is that this bike stands for everything I tend to dislike in a bike. It's high at the front end with a long wheelbase. It even has a compact bar and chainset but in almost contradictory fashion the Trek is fun and inspiring to ride, it responds with breath taking efficiency when you give it the beans and you can really lay it down flat in a corner. I think what really sets the Domane apart from most of its competitors is its ability to do it all. It's light and stiff enough to race but comfortable and stable enough for even the newest rider. Trek has built a gem here and quite frankly I don't want to give it back.

The Trek Domane range is now available at the Pearson Cycles Pro Shop in Sutton

Tidy cabling is routed internally, entering the headtube
Yup, shes UCI approved, giving a nod to how Trek really expect this bike to be ridden. The mega-wide BB90 bottom bracket. Note the integrated chain watcher bolted to the bottom of the seat tube.
The tapered fork has a wider profile when viewed from the front...
Than it is from the side. This design allows a greater degree of vertical compliance while retaining all important lateral stiffness - one of the keys to the Domane's sure footed ride.
Trek Project One