2nd Surgery for Marc, First Plate Was Damaged

I'm not at all surprised to hear this. Rigid fixation doesn't mean that it can withstand the sort of forces required to hang on to handle bars while quickly decelerating from over 200MPH. The plate fixation construct is only as strong as the screws holding it in place as well as the quality of the bone, i.e., level of comminution etc.

I was shocked to hear he was riding and skeptical about his being passed fit to race!!

He needs to give the humerus time to heal.

You're not selfish wanting him to rest. I'm sure Marc wants the same thing, but he is being impatient and is treating his return as he treated the race in which he injured himself. This is the downside of his incredible determination. Gotta admire the guy.

As impulsive as ever.

misfit said:

I'm not at all surprised to hear this. Rigid fixation doesn't mean that it can withstand the sort of forces required to hang on to handle bars while quickly decelerating from over 200MPH. The plate fixation construct is only as strong as the screws holding it in place as well as the quality of the bone, i.e., level of comminution etc.

I was shocked to hear he was riding and skeptical about his being passed fit to race!!

He needs to give the humerus time to heal.

You're not selfish wanting him to rest. I'm sure Marc wants the same thing, but he is being impatient and is treating his return as he treated the race in which he injured himself. This is the downside of his incredible determination. Gotta admire the guy.

Click to expand...

Yes, obvious in retrospect that when he had his sudden onset of pain on the Saturday was probably when the plate moved. It was a plate rather than a nail I saw before this current report. This is pretty much what happened with Jorge after the plating of his fractured clavicle, he got through the race and finished 4th or 5th then fell next race weekend, bent the plate necessitating re-operation then missed 2 or 3 races, and despite this only narrowly lost the title. MM might have only missed 2 races and now might miss 3 or 4.

You sound as though you know more about orthopaedics than I do, and I am interested in your opinion. They usually have top sports doctors including orthopaedists involved with all this, and presumably Jorge’s own surgeon who would be one of the best in Spain didn’t nix him racing. This is an unusual injury from a direct blow though, and I guess fairly unprecedented particularly in a 6 time and defending world champion. As we both said the humerus is rather important structurally.

Macca said:

Wow, back under the knife again for a new plate to be fitted.

That's at least 2 more races gone for him, he can't be as daft as last time and attempt to ride sooner can he?

Selfishly, I want him to take time to heal up properly as I'd quite like to see him racing for many years to come

Macca

Click to expand...

He's lucky he hasn't done more serious damage to himself...at least not as far as the doctors can tell at the moment..

Hey...HRC how's that basket with all your eggs doing?
Good thing HRC has the other Marquez on their side... ,

misfit said:

I'm not at all surprised to hear this. Rigid fixation doesn't mean that it can withstand the sort of forces required to hang on to handle bars while quickly decelerating from over 200MPH. The plate fixation construct is only as strong as the screws holding it in place as well as the quality of the bone, i.e., level of comminution etc.

I was shocked to hear he was riding and skeptical about his being passed fit to race!!

He needs to give the humerus time to heal.

You're not selfish wanting him to rest. I'm sure Marc wants the same thing, but he is being impatient and is treating his return as he treated the race in which he injured himself. This is the downside of his incredible determination. Gotta admire the guy.

Click to expand...

I have a similar story. I broke a vertibrae years ago. The finals were coming up so there was no way I was taking 6 months off. I did lessen the work load though I played the full GF in the midfield. Took some time off afterwards but wasn't that long until the next season so I just put up with the pain after a few months off and figured that any pain was because of just normal back issues. Now I'm 31 and my body is all kinds of ...... because of the need and drive to compete through injuries. I had to go for a back X-ray a few weeks ago and it turns out not only did my fracture never heal, I also broke the other side at some stage so I have fractures in my back that have never and will never heal. It's also likely the main cause of some of the other injuries I have picked up.

People hanging .... on him don't understand the kind of mindset that is required to be successful in sports (and probably other areas), hindsight is 2020. Doing the kind of things that Jorge and Marc did also work as often as they fail. I recently watched that Bulls Doco and MJ was talking about his injury in the 80s and how he started doing extra loads and training by himself etc.

michaelm said:

Yes, obvious in retrospect that when he had his sudden onset of pain on the Saturday was probably when the plate moved. It was a plate rather than a nail I saw before this current report. This is pretty much what happened with Jorge after the plating of his fractured clavicle, he got through the race and finished 4th or 5th then fell next race weekend, bent the plate necessitating re-operation then missed 2 or 3 races, and despite this only narrowly lost the title. MM might have only missed 2 races and now might miss 3 or 4.

You sound as though you know more about orthopaedics than I do, and I am interested in your opinion. They usually have top sports doctors including orthopaedists involved with all this, and presumably Jorge’s own surgeon who would be one of the best in Spain didn’t nix him racing. This is an unusual injury from a direct blow though, and I guess fairly unprecedented particularly in a 6 time and defending world champion. As we both said the humerus is rather important structurally.

Click to expand...

Could you please elaborate. The “plate moved”. Jorge crashed bending the plate, that I understand, but Márquez didn’t so what would possibly cause the plate to move, braking force alone- titanium? That doesn’t make sense to me, unless it’s the weakness in the fracture itself. Does siting out Jerez give him extra time or only prolong the inevitable, the plate was going to bend at some point regardless.

I’m surprised overall with the question what was Márquez’s motivation for riding. A championship. 5 in a row, 7 premier class, 9 overall.

MigsAngel said:

He's lucky he hasn't done more serious damage to himself...at least not as far as the doctors can tell at the moment..

Hey...HRC how's that basket with all your eggs doing?
Good thing HRC has the other Marquez on their side... ,��

Click to expand...

In the 4 stroke era lone HRC have had Rossi, Pedrosa, Stoner, Dovi, Marquez, even Lorenzo sign on the dotted line. Eggs in how many HRC baskets is that.

birdman said:

Could you please elaborate. The “plate moved”. Jorge crashed bending the plate, that I understand, but Márquez didn’t so what would possibly cause the plate to move, braking force alone- titanium? That doesn’t make sense to me, unless it’s the weakness in the fracture itself. Does siting out Jerez give him extra time or only prolong the inevitable, the plate was going to bend at some point regardless.

I’m surprised overall with the question what was Márquez’s motivation for riding. A championship. 5 in a row, 7 premier class, 9 overall.

Click to expand...

I am no orthopaedic surgeon, I was following on from what Misfit said who seemed more knowledgeable than I am. He was postulating that the screws didn’t keep the plate in place under the strain/stress of riding a MotoGP bike competitively, which seemed reasonable, there doesn’t seem to be much other reason for the plate to have moved, and even MM can’t ride a bike one armed, with using the arm involving powerful muscles attached to the humerus. From the reports the fracture was not completely separated but was highly angulated, so the plate had a fair bit to do. Dr Mir or whoever else was his surgeon presumably didn’t forbid him to try however, nor the MotoGP doctors, so what do I know anyway ?.

michaelm said:

I am no orthopaedic surgeon, I was following on from what Misfit said who seemed more knowledgeable than I am. He was postulating that the screws didn’t keep the plate in place under the strain/stress of riding a MotoGP bike competitively, which seemed reasonable, there doesn’t seem to be much other reason for the plate to have moved, and even MM can’t ride a bike one armed, with using the arm involving powerful muscles attached to the humerus. From the reports the fracture was not completely separated but was highly angulated, so the plate had a fair bit to do. Dr Mir or whoever else was his surgeon presumably didn’t forbid him to try however, nor the MotoGP doctors, so what do I know anyway ?.

Click to expand...

A screw in a bone, in terms of mechanical strength, does it make any difference if it’s a day, week, month or year? There is no recovery time as far as I’m can understand, more soft tissue and ability to withstand the pain.

In terms of the latter, Marquez must be something out of this world if titanium bends before he does. The level of pain must of been extremely high, and he does touch on the subject briefly where reported, specifically the mind and the bodies ability to deal with and overcome pain. I found what he had to say on the matter very interesting, something of an insight into what it takes to be successful in this sport, probably would make most of us a little uncomfortable at best.

I'm not a surgeon or engineer. However it stands to reason that any repaired system is as strong as its' weakest link at any given point in time. Titanium plates need to be attached somewhere to bone. Can titanium bend? Or is it going to pull away from the attachment point(s) in the bone? Strong muscles are going to stress the connections for sure.

I hope he now takes the time to heal. I selfishly want him there! He isn't done yet....

I hope he will realise that the long term is more important, and I hope he will return at his 100%. On a website https://2laps2go.com there are news, standings, motogp Basics and stuff, so if you find some time, check it out.

Bern1 said:

I'm not a surgeon or engineer. However it stands to reason that any repaired system is as strong as its' weakest link at any given point in time. Titanium plates need to be attached somewhere to bone. Can titanium bend? Or is it going to pull away from the attachment point(s) in the bone? Strong muscles are going to stress the connections for sure.

I hope he now takes the time to heal. I selfishly want him there! He isn't done yet....

Click to expand...

Sorry, I was agreeing with misfit (I still pretty much do) and hadn’t read the report on MotoGP.com. The wording is rather imprecise, they don’t actually say the titanium plate bent, they say the fixation was “insufficient”, the plate was “damaged” due to “stress”. As I said, I am no orthopaedist, or even a surgeon, but I agree With you on general principles about bending a titanium plate without a fall, but for me possibilities from that wording were that the plate was inadequate for the task such as needing to be longer or differently positioned, or a screw or screws broke or came loose which can happen in civilians with internal fixation of fractures, spinal surgery with fusion devices etc in everyday life without significant discrete trauma. Misfit sounded like he knew what he was talking about and wondered before the first surgery whether a plate would work or whether it could be fixed with a surgical nail; I personally don’t know whether that could be used with a humeral fracture of the nature MM sustained. As he said it depends on factors such as the quality of the bone where the screws are inserted, and the stress on the screws themselves, riding a MotoGP bike at hundreds of kph likely to be more severe than most. Misfit questioned whether the fracture was comminuted/fragmented which I don’t think it was, the report I read said it was quite angulated but still had some attachment. There are much more significant muscles attached to the humerus than the clavicle which is more of a strut.

birdman said:

In the 4 stroke era lone HRC have had Rossi, Pedrosa, Stoner, Dovi, Marquez, even Lorenzo sign on the dotted line. Eggs in how many HRC baskets is that.

Click to expand...

That was then, this is now. Hondas back then, could be ridden competitively by a variety of riders. Current iteration of the bike has been a clusterfuck for everyone who isn't MM.

Re: the plate, I too am no surgeon, but it stands to reason these repairs were never designed to withstand the kind of stress experienced
by a GP rider. I would think even if the plate is only shifting the tiniest bit, it would be detrimental to the repair of the break itself.

Keshav said:

That was then, this is now. Hondas back then, could be ridden competitively by a variety of riders. Current iteration of the bike has been a clusterfuck for everyone who isn't MM.

Re: the plate, I too am no surgeon, but it stands to reason these repairs were never designed to withstand the kind of stress experienced
by a GP rider. I would think even if the plate is only shifting the tiniest bit, it would be detrimental to the repair of the break itself.

Click to expand...

Lost in the translation. Let me put this another way. Honda has proven they can build a bike and get a rider. Why should we be worried about Honda unless it’s just sour grapes (2015 Migs). Worry about KTM, Aprilia, Suzuki, not Honda. If they put their eggs in one basket, good for them, but I highly doubt it. Honda will build a rider friendly bike when they need to, at present they have Marquez, who is an animal which challenges not only engineers but also surgeons, screws and titanium apparently. I don’t believe all that is said btw I think there was a stuff up somewhere.

birdman said:

Lost in the translation. Let me put this another way. Honda has proven they can build a bike and get a rider. Why should we be worried about Honda unless it’s just sour grapes (2015 Migs). Worry about KTM, Aprilia, Suzuki, not Honda. If they put their eggs in one basket, good for them, but I highly doubt it. Honda will build a rider friendly bike when they need to, at present they have Marquez, who is an animal which challenges not only engineers but also surgeons, screws and titanium apparently. I don’t believe all that is said btw I think there was a stuff up somewhere.

Click to expand...

I am with you on your last point. I strongly suspect the initial operation and/or the device inserted were not completely satisfactory.

birdman said:

Lost in the translation. Let me put this another way. Honda has proven they can build a bike and get a rider. Why should we be worried about Honda unless it’s just sour grapes (2015 Migs). Worry about KTM, Aprilia, Suzuki, not Honda. If they put their eggs in one basket, good for them, but I highly doubt it. Honda will build a rider friendly bike when they need to, at present they have Marquez, who is an animal which challenges not only engineers but also surgeons, screws and titanium apparently. I don’t believe all that is said btw I think there was a stuff up somewhere.

Click to expand...

Understood. It's been my contention for some time that HRC because it is a huge operation with so many people involved in the chain of decision makers guiding the design and realization of their bikes, that the final realized machine may just not be as coherent a design as people tend to assume. Over the years I've been following the sport, I've heard it said by various journalists and insiders that the HRC engineering department, tucked away in their labs in Japan, has a history of being more focused on dazzling feats of engineering, than they are on the practicality of the resulting machine. How true or to what degree that is true, is anybody's guess.

birdman said:

Could you please elaborate. The “plate moved”. Jorge crashed bending the plate, that I understand, but Márquez didn’t so what would possibly cause the plate to move, braking force alone- titanium? That doesn’t make sense to me, unless it’s the weakness in the fracture itself. Does siting out Jerez give him extra time or only prolong the inevitable, the plate was going to bend at some point regardless.

I’m surprised overall with the question what was Márquez’s motivation for riding. A championship. 5 in a row, 7 premier class, 9 overall.

Click to expand...

Any form of fixation or repair of that nature amounts to the start of a race. Will healing occur before the fixation gives way. This is a principle that applies to skin/wound closure, hernia repairs and yes, bone fixation. The repair is not intended to hold things indefinitely. It cannot since unlike tissue, the material used for the repair cannot repair itself and what *anchors* the 'glorified splint' to the adjacent bone will eventually give way under repeated stress. Bone, as any other tissue in the body, has the incredible ability to adapt and a bone is far stronger when forces applied to it are along the lines of force it is designed to withstand, rather than from an unusual angle such as a lateral force on the humerus (as MM sustained). This brings me to another limitation of the fixation, in that the screws that hold the plate in pace are anchored to bone that will have forces asked of it that it isn't adapted to.

The fixation is designed to allow for early mobilisation and physio which speeds up healing and reduces the likelihood of muscle atrophy and joint stiffness. However, the fixation isn't at all designed, or I should say, able to withstand the forces which an unbroken bone can while subjected to the forces it's designed to. Marquez, riding and braking at a competitive pace, puts a lot of force on and along the humerus. I am not surprised to hear what happened, i.e., that the plate moved, likely because the anchoring screws reached their limit of purchase within the bone and gave way in part.

There's a LOT at stake here, both for Marquez and Honda. Money and ambition talks. A surgeon may be unhappy to pass someone fit but you know, if one will not, then they will find one who 'will'. I'm not saying that this is what happened, of course, but it's entirely possible under the circumstance.

p4p1 said:

I have a similar story. I broke a vertibrae years ago. The finals were coming up so there was no way I was taking 6 months off. I did lessen the work load though I played the full GF in the midfield. Took some time off afterwards but wasn't that long until the next season so I just put up with the pain after a few months off and figured that any pain was because of just normal back issues. Now I'm 31 and my body is all kinds of ...... because of the need and drive to compete through injuries. I had to go for a back X-ray a few weeks ago and it turns out not only did my fracture never heal, I also broke the other side at some stage so I have fractures in my back that have never and will never heal. It's also likely the main cause of some of the other injuries I have picked up.

People hanging .... on him don't understand the kind of mindset that is required to be successful in sports (and probably other areas), hindsight is 2020. Doing the kind of things that Jorge and Marc did also work as often as they fail. I recently watched that Bulls Doco and MJ was talking about his injury in the 80s and how he started doing extra loads and training by himself etc.

Click to expand...

I'm sorry to hear this. We all have our regrets. It was still difficult reading what has happened to you. The musculoskeletal system has great adaptive and recuperative abilities. Without these characteristics, injuries would abound. Unfortunately, athletes often don't give injured or acutely worn parts enough time to recover and increase in strength. Instead, they end up with stress injuries/fractures or injuries/fractures that will not heal.

Fixation of a fracture is a glorified splint and should be seen and treated as such. It doesn't mean that it's all good and one can go back to athletic business as usual without potential consequences. The problem is that some get away with it for the short term and are not around to tell their stories of woes that haunt them later in life. A few do get away with it because the forces on the repair aren't that demanding; for example, a competitive runner who falls, breaks his humerus, has it fixed with plate and screws, and then goes back to running in 4 days. Unfortunately MM rides a bike at very high speeds and brakes heavily, multiple times per lap.