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M Marquez off for the rest of the season

misfit

misfit

Joined May 2019
607 Posts | 459+
Where I am.
It's been amazing to read what Marq was going through trying to ride with his humeral fracture healed with 30º of internal rotation. If you were to let your arms fall to your sides, bend an elbow to 90º and then let your hand arc inwards for 30º with your elbow bent at 90º, you get an idea of the degree of rotation his humerus was healed in. For mere mortals like us, this sort of rotation is acceptable since the shoulder joint is ball and socket. However, the muscles aren't able to work optimally. Incredible that he managed like that. The thought of it makes me wince. It was very brave to have the bone broken again and reset. I wish for him a speedy recovery and rehab. Hopefully, he hasn't caused any other problems trying to compensate for the rotation.
 
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It's unbelievable. 30º is a LOT!! I suppose that's why his elbow was sticking up in the air on turns sometimes. It must have been horrendously painful.

I too wish a speedy recovery and rehab.
 
It makes me wonder about the original surgery. I am not a surgeon though, don’t know anything about this. But I wonder why was the original fracture set so far off the “original” spec?

Then there’s the hubris of riding on it at full tilt two weeks later or some such. Marc is growing up quickly these last couple of years. Good luck to him going forward. As said, he is one brave lad.
 
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Bern1 said:
It makes me wonder about the original surgery. I am not a surgeon though, don’t know anything about this. But I wonder why was the original fracture set so far off the “original” spec?

Then there’s the hubris of riding on it at full tilt two weeks later or some such. Marc is growing up quickly these last couple of years. Good luck to him going forward. As said, he is one brave lad.
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I thought about this, and in the last surgeons defense, these are my thoughts: although orthopaedic surgery is not my speciality, during my surgical training, I did spend enough time working with orthopaedic surgeons to have still retained a fundamental understanding of the issues involved. Perfect alignment or an anatomical fixation is possible only if the bone fragments allow this. I can just imagine the surgeons during that final operation having to trim down the infected ends of the unhealed humerus, interposing a bone graft in the gap created and plating the humerus again to achieve fixation while maintaining length and optimising rotation. They can only plate what they are able to plate to in order to achieve fixation that will not fall apart. At the time of that last procedure, they likely had to compromise and plating with some degree of rotation was one of them. The huge success is that they managed to achieve healing. Humeral length is a common compromise since upper limb length discrepancy isn't as detrimental as a lower limb length discrepancy. Allowing for a little rotation is another compromise. Unfortunately for top tier athletes, there is very little room for compromise. The need for a 4th operation, 'IF POSSIBLE' and 'IF REQUESTED' was likely already known about. If Marq had retired he would likely not have needed this 4th operation since he would be able to carry out the daily activities of mere mortals as ourselves without difficulty.

A LONG time was needed to be allow healing of his previous injury to FULLY occur and for there to be reliable evidence that there is no residual infection. Full healing will allow for breaking, realigning and plating the humerus to correct fixation while not causing unwanted injury that could either lead again to non-union or nerve injury. I was wishing his radial nerve well while thinking about him and his operation. Looks like it came out the other side OK.

I think he will be physically fine, but I'm afraid that this has all taken a toll on him and he isn't that young and dare I say, that hungry anymore. I doubt that he will be willing to take the risks he used to take that allowed for his many feats to achieve the success that he did before all of this started.
 
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misfit said:
I thought about this, and in the last surgeons defense, these are my thoughts: although orthopaedic surgery is not my speciality, during my surgical training, I did spend enough time working with orthopaedic surgeons to have still retained a fundamental understanding of the issues involved. Perfect alignment or an anatomical fixation is possible only if the bone fragments allow this. I can just imagine the surgeons during that final operation having to trim down the infected ends of the unhealed humerus, interposing a bone graft in the gap created and plating the humerus again to achieve fixation while maintaining length and optimising rotation. They can only plate what they are able to plate to in order to achieve fixation that will not fall apart. At the time of that last procedure, they likely had to compromise and plating with some degree of rotation was one of them. The huge success is that they managed to achieve healing. Humeral length is a common compromise since upper limb length discrepancy isn't as detrimental as a lower limb length discrepancy. Allowing for a little rotation is another compromise. Unfortunately for top tier athletes, there is very little room for compromise. The need for a 4th operation, 'IF POSSIBLE' and 'IF REQUESTED' was likely already known about. If Marq had retired he would likely not have needed this 4th operation since he would be able to carry out the daily activities of mere mortals as ourselves without difficulty.

A LONG time was needed to be allow healing of his previous injury to FULLY occur and for there to be reliable evidence that there is no residual infection. Full healing will allow for breaking, realigning and plating the humerus to correct fixation while not causing unwanted injury that could either lead again to non-union or nerve injury. I was wishing his radial nerve well while thinking about him and his operation. Looks like it came out the other side OK.

I think he will be physically fine, but I'm afraid that this has all taken a toll on him and he isn't that young and dare I say, that hungry anymore. I doubt that he will be willing to take the risks he used to take that allowed for his many feats to achieve the success that he did before all of this started.
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Nice read. Thanks. Now I know why Marc went to considerable lengths to defend the surgeon who performed the first operation.

It is interesting that Marc did not use him for a second operation. Maybe the original physician was against it? No idea.
 
mylexicon said:
Nice read. Thanks. Now I know why Marc went to considerable lengths to defend the surgeon who performed the first operation.

It is interesting that Marc did not use him for a second operation. Maybe the original physician was against it? No idea.
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There's a balance of risk to consider.

What if the procedure doesn't go well? I would assume that Marq would be inclined to find a surgeon who is not only willing to perform the procedure, i.e., go along for the journey (thick or thin), but one with the sort of reputation that would have Marq trust that if things don't turn out well, he can be assured that he tried with the best.

So he understandably went wherever on the globe he could find a surgeon considered to be perhaps his best chance for a favourable outcome. I personally don't believe in 'the best' surgeon for a particular task, but I can understand the perceptual importance for patients that need reassurance.
 
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misfit said:
I thought about this, and in the last surgeons defense, these are my thoughts: although orthopaedic surgery is not my speciality, during my surgical training, I did spend enough time working with orthopaedic surgeons to have still retained a fundamental understanding of the issues involved. Perfect alignment or an anatomical fixation is possible only if the bone fragments allow this. I can just imagine the surgeons during that final operation having to trim down the infected ends of the unhealed humerus, interposing a bone graft in the gap created and plating the humerus again to achieve fixation while maintaining length and optimising rotation. They can only plate what they are able to plate to in order to achieve fixation that will not fall apart. At the time of that last procedure, they likely had to compromise and plating with some degree of rotation was one of them. The huge success is that they managed to achieve healing. Humeral length is a common compromise since upper limb length discrepancy isn't as detrimental as a lower limb length discrepancy. Allowing for a little rotation is another compromise. Unfortunately for top tier athletes, there is very little room for compromise. The need for a 4th operation, 'IF POSSIBLE' and 'IF REQUESTED' was likely already known about. If Marq had retired he would likely not have needed this 4th operation since he would be able to carry out the daily activities of mere mortals as ourselves without difficulty.

A LONG time was needed to be allow healing of his previous injury to FULLY occur and for there to be reliable evidence that there is no residual infection. Full healing will allow for breaking, realigning and plating the humerus to correct fixation while not causing unwanted injury that could either lead again to non-union or nerve injury. I was wishing his radial nerve well while thinking about him and his operation. Looks like it came out the other side OK.

I think he will be physically fine, but I'm afraid that this has all taken a toll on him and he isn't that young and dare I say, that hungry anymore. I doubt that he will be willing to take the risks he used to take that allowed for his many feats to achieve the success that he did before all of this started.
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I agree for what it is worth, an adverse outcome in the particular circumstances far from necessarily implies incompetence. The root causes were an unusual fracture not along usual lines of stress due to an unusual injury, and MM's desire to ride straight away afterwards, which may have led to the fixation being performed with that in view; the very long fixation we saw in the images released to the press may have militated against healing as you said at the time, and possibly increased the risk of infection, and him carrying out that desire put unsustainable strain on the fixation although infection may have been a problem all along.

All things considered if I were the previous surgeon (I hasten to add I am not even a surgeon in the first place) I wouldn't be keen to perform a 4th operation given the incomplete success of even the 3rd operation, although whether the bone would heal at all was doubtless a strong consideration at the time as you imply, and if I were MM I would look for someone different as well, if for no reason other than a hope for a change in luck.

(EDIT I also recall something about a novel technique involving a carbon fiber device, so maybe there is limited availability and expertise as well).
 
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michaelm said:
I agree for what it is worth, an adverse outcome in the particular circumstances far from necessarily implies incompetence. The root causes were an unusual fracture not along usual lines of stress due to an unusual injury, and MM's desire to ride straight away afterwards, which may have led to the fixation being performed with that in view; the very long fixation we saw in the images released to the press may have militated against healing as you said at the time, and possibly increased the risk of infection, and him carrying out that desire put unsustainable strain on the fixation although infection may have been a problem all along.

All things considered if I were the previous surgeon (I hasten to add I am not even a surgeon in the first place) I wouldn't be keen to perform a 4th operation given the incomplete success of even the 3rd operation, although whether the bone would heal at all was doubtless a strong consideration at the time as you imply, and if I were MM I would look for someone different as well, if for no reason other than a hope for a change in luck.

(EDIT I also recall something about a novel technique involving a carbon fiber device, so maybe there is limited availability and expertise as well).
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I don't think the last of the initial series of operations was performed by the surgeon who did the first operation. The possibility of infection shot up once they had to re-operate soon after the initial procedure.
 
misfit said:
I thought about this, and in the last surgeons defense, these are my thoughts: although orthopaedic surgery is not my speciality, during my surgical training, I did spend enough time working with orthopaedic surgeons to have still retained a fundamental understanding of the issues involved. Perfect alignment or an anatomical fixation is possible only if the bone fragments allow this. I can just imagine the surgeons during that final operation having to trim down the infected ends of the unhealed humerus, interposing a bone graft in the gap created and plating the humerus again to achieve fixation while maintaining length and optimising rotation. They can only plate what they are able to plate to in order to achieve fixation that will not fall apart. At the time of that last procedure, they likely had to compromise and plating with some degree of rotation was one of them. The huge success is that they managed to achieve healing. Humeral length is a common compromise since upper limb length discrepancy isn't as detrimental as a lower limb length discrepancy. Allowing for a little rotation is another compromise. Unfortunately for top tier athletes, there is very little room for compromise. The need for a 4th operation, 'IF POSSIBLE' and 'IF REQUESTED' was likely already known about. If Marq had retired he would likely not have needed this 4th operation since he would be able to carry out the daily activities of mere mortals as ourselves without difficulty.

A LONG time was needed to be allow healing of his previous injury to FULLY occur and for there to be reliable evidence that there is no residual infection. Full healing will allow for breaking, realigning and plating the humerus to correct fixation while not causing unwanted injury that could either lead again to non-union or nerve injury. I was wishing his radial nerve well while thinking about him and his operation. Looks like it came out the other side OK.

I think he will be physically fine, but I'm afraid that this has all taken a toll on him and he isn't that young and dare I say, that hungry anymore. I doubt that he will be willing to take the risks he used to take that allowed for his many feats to achieve the success that he did before all of this started.
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Thanks for the insight as usual Misfit.

The only bit I disagree with is that he won't be as hungry after the injury. I'm not sure that he will take the same risks again, or that any rider should. You can only get away with it for so long, as Marc has proven. But he comes back with something to prove and knowing another championship realistically makes him the GOAT.
 
p4p1 said:
Thanks for the insight as usual Misfit.



The only bit I disagree with is that he won't be as hungry after the injury. I'm not sure that he will take the same risks again, or that any rider should. You can only get away with it for so long, as Marc has proven. But he comes back with something to prove and knowing another championship realistically makes him the GOAT.
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He realistically is the best there has been already imo.
Never seen anybody remotely capable as he of regularly catching and saving a front end that is gone for all money.

Yep he has taken a beating doing so, or attempting to do so on so many occasions.
The fact that he has been able to do, what we have seen so regularly, stands him above anyone else I've seen.

Fwiw not interesting in arguing who is best, that is just my opinion and the reason for it.
 
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Warthog, I certainly share your admiration of Marquez. For his record as well as his front end saves.

In the words of Senna, “the results speak for themselves.”

My qualifier in my admiration of Marquez is the fact that it is actually better in my book to go fast and not crash and to go fast smoothly without having to radically save the front end.

Stoner and Lorenzo were able to do this pretty consistently, thus my admiration for them. Now it is Fabio who is able to do this as well as Pecco. It remains to be seen what kind of record these guys will establish over time.

I’ll be watching!
 
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Joan Mir is heavily rumoured to be slated for Repsol Honda.

I don't see him functioning and achieving on a substandard machine, or shutting his mouth if it is a pos.

Could be a good choice for developmental purposes.
 
I'd be curious to know what therapies they might use to keep away infection and to hasten healing. I'm scheduling for spinal fusion and a shoulder re-build in the fall after riding season is over. There are so often post surgery therapies that only get offered to sports figures and the very wealthy, that never get mentioned to the average Joe.
 
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Keshav said:
I'd be curious to know what therapies they might use to keep away infection and to hasten healing. I'm scheduling for spinal fusion and a shoulder re-build in the fall after riding season is over. There are so often post surgery therapies that only get offered to sports figures and the very wealthy, that never get mentioned to the average Joe.
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Hope it all goes well for you. Sounds as if you are looking at a lot of PT. Stay positive.
 
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Keshav said:
I'd be curious to know what therapies they might use to keep away infection and to hasten healing. I'm scheduling for spinal fusion and a shoulder re-build in the fall after riding season is over. There are so often post surgery therapies that only get offered to sports figures and the very wealthy, that never get mentioned to the average Joe.
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“It allows me to rest and follow the doctors’ rules: a healthy diet, drink a lot and try to hang out with our dogs because it is important that the body is not inactive.

Good nutrition, active body parts, and no habits that will or may hamper the body's natural processes (which it's very good at if you allow it), smoking in particular is a common one.

The tendency after injury is the failure to mobilise as needed to prevent painful joint stiffness, muscle atrophy. Factors at play may include one or a combination:
fear of causing further damage,
pain,
lack of support,
lack of motivation.

They're offering Marq passive movement exercises for the shoulder and elbow to prevent joint stiffness. His rehab should be quite easy compared to yours Keshav.

What the people with money are able to obtain is great support from physio's who are with them all the time. The physio's they get will be good at what they do and will be with the individual enough to be able to truly dial in the program of exercises routine that best suits you not only from the point of view of your specific operation, but your personality, limits and motivation. They'll also have their little gizmo's to measure progress.
 
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When I regained consciousness, post operations, from a bike accident in '97 my right leg was on a machine which constantly kept my knee bending (I had lost my kneecap and split my femur like a wishbone up from the knee). Rehab was fantastic. Really the only time in my life that I spent focused time in the gym with a detailed plan. And it 100% worked. I have very little lingering affect now, at 60, from what was a surprisingly devastating list of injuries.
 
Mick D said:
When I regained consciousness, post operations, from a bike accident in '97 my right leg was on a machine which constantly kept my knee bending (I had lost my kneecap and split my femur like a wishbone up from the knee). Rehab was fantastic. Really the only time in my life that I spent focused time in the gym with a detailed plan. And it 100% worked. I have very little lingering affect now, at 60, from what was a surprisingly devastating list of injuries.
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Good to hear. It's all about the rehab programme isn't it. One that you are willing and able to follow and one that works if you do. Focused and with the help of the gizmo's.
 
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