Bone fracture

Question:
Could you please give me medical advice about waiting time after bone fracture.
One of our dive masters suffered from a fracture of tibia and fibia of right leg three months ago. The medical advice about when he could dive again we got here differs from two months up to six months.

Answer:
Diving after a bone fracture, especially if it is a significantly large one, is usually not indicated for at least 4, better six months after the fracture, provided that it healed satisfactorily, without clinically significant sequelae and with good and complete ossification. If diving is resumed prior to the interval of six months, it is prudent to limit exposure ( depth and time ) to well within the No-D limits ( a suggestion would be not to dive beyond 60% of the limits and not deeper that 30 meters ) to avoid any possible undeserved DCI that may be generated by a locally disrupted and disturbed circulation.

Question:
I recently completed a PADI open water Diving course. Before this course I had a medical examination, which I passed. The examination doctor however later on contacted me with doubts about my medial situation.
February 1997 (at age 29) I broke my lower left leg. It healed slowly, and end 1997 my leg showed a 10 degree angle at the fracture. January 1998 it was operated on. My leg was realigned, and a titanium pin was inserted though the centre of the bone, for the entire length (from the knee down).
It was fixated with screws. This healed excellent, and I have very little complaints.
The examination doctor consulted the medical staff of the Dutch Navy, who stated that Professional divers with Osteosynthetic Material In Situ are banned from diving for having a bigger risk at Dysbaric Osteonecrosis.
Both my specialist at the hospital as well as the PADI instructor agreed that a professional diving career would not be advisable (which is perfectly OK by me), but recreational diving up to 30 meters should be possible.
What is your opinion on my situation?

Answer:
I agree with the opinion expressed by the colleagues of the Dutch Navy regarding professional exposure, but consider recreational diving, even as a dive guide or instructor, not contraindicated, given the clinically and functionally satisfactory healing of your fracture.

Question:
Three days ago, whilst walking around our house in my bare feet, I hit one of my toes against a door. This caused bruising and swelling, the result being that my local GP suspects that I may have fractured it. The injury causes me no discomfort, even whilst swimming and walking. Would it be advisable for me to continue diving in the immediate future (i.e. in the next two days), as I am part of the way through a course?

Answer:
The problem with "fresh" bone or soft tissue lesions and diving is mainly related to the altered circulation and blood perfusion which is typical of repairing (healing) tissue. This may generate an altered uptake and offgassing pattern of the inert gas breathed during a dive, with possible facilitation of localized DCI symptoms and signs.

 

The larger the interested bone, the more likely and serious the potential problem. Obviously this also relates to the imposed decompression stress: i.e. a "heavy" dive could be definitely problematic, while a "light" dive, with limited depth and bottom time and, consequently, limited inert gas uptake, may be perfectly safe from the decompression point of view.

 

If you are considering completing a diving course and if this is not involving "heavy" deep dives, provided that your foot does not cause any mechanical discomfort or pain while swimming underwater, diving can be considered. Remember that, as always and more here, a safe ascent from any dive is a slow ascent, including the surfacing after the safety stop.