I made it to the front of the queue and she took me aside, and asked how long I had been in the cast. The mechanism of injury included fall from height in 9 patients and … Two types of tears include minor, which includes stiffness and swelling within two to three days but usually goes away in two to three weeks. We went to the hospital for an appointment, where they cut off my cast from Elba. Angelo, for running over when I had just fallen splat on the road. Over the next few weeks some motion returned to my arm, and I could even sleep with one arm under the pillow again, which is such a luxury now. My lip was split and quite swollen, and my nose was a little swollen, too. While not working with the physical therapist the patient usually will remain on crutches with the knee stabilized. The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization. You can buy the very same lemongrass oil here: Handcraft Lemongrass Essential Oil – 100% Pure and Natural – Premium Therapeutic Grade with Premium Glass Dropper – Huge 4 fl. A distinguished looking doctor came over and looked at me disapprovingly. Before I got up to leave, I called my sister and told her I’d had a slight accident, downplaying it heavily. I remember thinking that this expression was probably just the way he usually looked. In some cases the doctor may have the patient wear a knee brace. Mean follow up after surgery was typically 25 to 30 months. The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. ‘Ciao,’ he replied disapprovingly, looking at my elbow. ‘Hamzah, it’s pretty serious…all your ligaments from the front and back were shredded off the bone, so I had to use sutures to get them back the best I could. It was the weirdest contrast being in such insane agony, and a calm voice on the phone saying ‘this is totally natural, just ride it out and you’ll be fine,’. I clutched my travel bag, which had my passport in it, and closed my eyes once in the ambulance. I took some strong painkillers and after a few days the pain slowly subsided, although one morning I woke up and realised I’d probably had too many painkillers, as I could open my eyes, but couldn’t move my body much. So I met Dr. Robinson, who came into the room looking very concerned. ‘Hamzah, you might not know it now, but you could have fractured your neck or back. Rehabilitation considerations in the management of terrible triad injury to the elbow. I’d be frustrated and tired many days, and think it was pointless, as my arm seemed to have just ‘stalled’ in its healing process. Before long, the ambulance arrived (they have a different siren noise in Italy than in the UK- it’s more sassy and urgent) and a few paramedics jumped out. ‘Let’s hope you can piece it back together then?’. My appointment wasn’t until 11am, so I waited there for a few hours, and watched a movie on my phone called ‘Snowdon’, which was pretty decent. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. I was sweating profusely as I jumped on the ferry, people moving out of the way when they saw my cast. I was given some pretty strong painkillers, which helped quite a lot with the general day-to-day pain. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. In order for it to ... Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. At 8 months of follow-up and 2 months of physiotherapy, the patient made a good recovery in regard to pain and mobility. I worried that I’d never be able to box again, or perform push-ups, or (for some weird reason this really worried me) play ‘head, shoulders, knees and toes’. How is going the recovery of your elbow? Just personal preference. ‘Yes, it was successful, you’re okay.’. Before long, I was in another hospital room lying on a bed, and was having these sticky things put all over my chest and stomach. I took a deep breath and thanked God that I was still alive. So NOW it has been 3 years since the injury and my eventual recovery from the elbow terrible triad. A lot has changed since then, and I feel like a totally different person, as cliche as that sounds. That night on Instagram, I saw the most beautiful beach I’d ever seen. I checked into my AirBnB, and met Leonardo. I experimented with different foods, and found the following really aided my recovery and helped my ligaments repair themselves: Organic Turmeric Root Powder w/ Curcumin | Lab Tested for Purity | 100% Raw from India | 8oz/226g Resealable Kraft Bag | by FGO. 4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow. and an asset to the medical profession. ‘Um, okay so you may need a metal radial head replacement. Angelo made small talk as we waited, and I told him I was on holiday in Elba, although that had kind of been cut short now. The Elbow Terrible Triad - Surgical Treatment 06:33. Some time has past, so some of these numbers might be off a little bit. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. I realised for the first time how terrified I was- I’d been trying to just push through, but the operation was starting to make me nervous. So that’s about 4/5ft. - Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury Epidemiology. I got a text from my colleagues early that morning and told them the operation was done. I nodded and felt a bit nervous. Dr Robinson had assessed me a few months back and asked if I was happy leaving them in, but I wanted to know there wasn’t any metalwork in me. I made it to Pisa airport after the ferry, bus, train and taxi, and was in the queue when a flight attendant looked at me with concern. In terms of strength, it is 100% back to where it was. The terrible triad of the elbow is a difficult-to manage injury and, even with appropriate treatment, it is only rarely possible to achieve a normal elbow after the treatment(21). ‘Don’t worry, these guys are the best’ I said with a big smile, trying to steady my breathing. I have travel insurance, but how much does this cost?’, ‘Don’t worry about it, we’ll get it sorted with the insurance company. Pat, my physio also helped tremendously, using massage milk on my arm to loosen it up and helping me move my wrist so it gained more motion. Most patients find their recovery time to be anywhere between 6-9 months depending on how quickly they heal and the extent of their injuries. I glanced at the contract and signed at the bottom, barely legible as I’m naturally left handed. Sleep well, but make sure you don’t roll over in the night onto your arm. The two nurses who plastered my cast both times, and the nurse who chased me down at full speed before I left the hospital because I had forgotten to get the cast properly secured. Pathology Drink it. Prepare fracture . As ridiculous as that sounds, I think it probably stemmed from the fear of not being able to defend myself properly for the first time in my life. The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. ANYWAY, my elbow is 100% healed…it hasn’t caused me any inconvenience or pain in the longest time. They wanted to let the broken bones heal, but they also didn’t want something called ‘muscular atrophy’ to set in, which means your muscles start deteriorating because you haven’t used them in so long. It was busy when we went, but the staff were friendly and supportive. It was busy when we went, but the staff were friendly and supportive. A wonderful nurse came to check on me every 30 minutes or so, and she made the best tea ever. The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . Together they can defeat any barrier. For a while I didn’t trust it not to give way when I exercised with weights, but now I treat it just like I used to, and it never lets me down. And listen Hamzah,’ he said, looking me directly in the eyes, ‘you were incredibly lucky, you need to know that. Sling use will vary depending upon the situation, but your doctor may request that you wear the sling every night for at least the first month. It’s not magic, it’s just science. Here’s a link above to the squishy ball I used, that really helped me improve my grip. These results worked really well for me and I want to share them, but everyone’s case is unique. In the end, instinct took over and I landed squarely on my left hand with a loud crunch and thud. My medical experience starts and ends with a game of ‘Operation’ I lost about 15 years ago. Three weeks ago, I sustained terrible triad elbow while studying abroad. The MRI hadn’t picked up the ligament damage, and what he had found had been quite a mess. He shook his head. You had a bit of ulnar bone floating around in your arm which we removed, so that bone will begin healing, but to be honest, it was quite a mess.’. I haven’t had one in a long time.’. He’d called me in for a quick word, and he looked concerned. A complex elbow dislocation with associated radial head and coronoid process fractures was named the terrible triad by Hotchkiss 1 because of historically poor outcomes. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. I asked how much extension I’d end up having in my arm, and he said I’d never ever extend it fully again, and that it would never be as strong as it used to be, but I’d be able to live a normal life otherwise. My personal and professional life is incredibly different, and I’m working harder than ever to achieve my goals. I floated back into a deep sleep, and the next time I woke up I remember being wheeled through some corridors, and saw my mum and dad. It turned out that I had been delayed a bit, so I waited another 2 hours or so, pretty much memorising the news being played on the TV (something about the £ losing its value…). I couldn’t move my arm at all, or my wrist, which was quite scary. The next day I explored the island, checked out the touristy side and walked through Napoleon’s summer house, which was fascinating. You can’t fly for a few days because you’ve had general anaesthetic. It was beautiful, and I found a sunny spot and lay there for hours, my cast drawing lots of weird stares. However the patient must stay away from contact sports or activities where any twisting of the knee may occur. At the beginning my arm didn’t move past 90 degrees, and my wrist didn’t rotate at all, so I got to work straight away. ‘Was it successful? Materials and Methods: Between 2010 and 2014, 15 terrible triad injury of elbow with nine males and six females of mean age of 35 years were included. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). But then he told me something that made me nauseous. Oh, and I totally binged on Brooklyn 99, which is the BEST COMEDY SHOW EVER. debride fracture site of all soft tissue to allow proper reduction 2. I then walked a few miles along a dusty road, and was near the beach at around 2PM. I popped into the walk-in centre and they put a patch on it, and I went about my normal day. He’s a consummate professional, incredibly skilled, and he was integral in getting me back on my feet again. In the experimental group, postoperation, according to the Mayo elbow performance score, patients were assigned into the effective group (72 cases) and ineffective group (14 cases). ‘I promise, thank you doc. I went to the walk-in centre again and they packed it with this weird woolly material made of seaweed. There was blood all over the concrete floor, and I could hear a car coming, too. It was sore as hell and kind of tender, but I could rotate my arm a few more degrees than I could before. It was by the main coast, so I bought myself an ice-cream (which was amazing, ice-cream here just tastes like sugary ice now) and sat by the sea, people glancing at my massive cast and bust up face as they walked by. I’m doing pull ups, push ups, playing badminton, boxing and giving presentations with zero difficulty, and for many days at a time, I forget I even have a scar. To evaluate the results from surgical treatment of the terrible triad of the elbow, with a minimum of six months of follow-up, taking elbow function into consideration. Promise?’ He said, in a mock stern voice. I thought the talk would be something business related, but as he said those words, I couldn’t help but concur. varus, posteromedial, and postero-lateral rotatory forces.14,15 Larger coronoid fractures have a progres-sively greater influence on elbow sta-bility. I also asked him about the ligament damage, and he said with physio and a good diet, the ligaments would repair. I’ve also since built my business, a digital marketing agency called Regent Branding and we’re now a team of 32 people worldwide, which I’m super proud of. It was really pricey, but I was fine paying it considering what had happened yesterday. I’d also been told I wasn’t out of the woods yet, as the X-ray could show my bone hadn’t been set properly, or the screws were causing some issues. I could feel the liquid paracetamol they’d given me wearing off, and a dull, engulfing pain was spreading like wildfire down my arm. Sixteen studies, involving 312 patients, were included in the systematic review. So I woke up the next day and groaned when I tried to sit up. The goal of the first few days after surgery is to reduce swelling and pain. I said I’d fallen around the height of Trotsky, which is what I named my Honda Jazz. But my extending, pulling back, rotating and overall strength is 100% back. As the name suggests, there are three types of injuries involved here – an injury to the medial collateral ligament, the meniscus (a cartilage in the joint), and the cruciate ligament. I stopped to speak to someone who asked about my cast, and they laughed whilst telling me the crime rate in Elba was practically 0%, which left me stunned. ‘X marks the spot,’ he said. Then there is severe, which without treatment, a piece of meniscus may come loose and drift into the joint space. I’m also utterly unfazed by investors, big clients and fellow entrepreneurs…not because I don’t respect them, but because when anyone tries to intimidate me, I just think back to the feeling I had when I was splattered on the bottom of a cliffside in Italy, utterly alone. One massive inconvenience though was showering- I had to wrap my arm up in a bag and shower at a weird angle, which was super annoying. As I was walking on the side of the road, something happened that changed everything. I’ve realised the biggest blessings in the universe are faith and patience. I’m not sure about the ligaments, but there seems to be some damage there, too. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. Skip to my daily physio routine that helped me make an amazing recovery. When showering, be super careful stepping in and out of the bath/cubicle. I asked him if the damage was permanent, and he nodded. He ran back to his car and got me some water. She was an amazing physiotherapist, as she had this blend of being between empathetic and reassuring, but could also be very frank and no-nonsense. Having thought about it, the fall was nearer 15/20 ft, as I remember the weird silence in the air as I fell, which lasted a good few seconds. I remember telling her she was an amazing person, half asleep and half awake, and she laughed. Suddenly, the taxi driver burst out laughing. And to be honest, I’ve been lazy in updating this blog, so I was kind of at this stage 18 months after the operation, just to give rough timelines. How I Broke my Elbow in Elba By Falling off a Cliff. I was taken into this well-lit theatre and lied down on a bed. I went into hospital on 31st January, and was out by the end of the day. Click here to skip to read about the wonderful JointCare fish oil supplement that helped me get rotation and flexibility back, Dr. Robinson (Consultant Trauma & Orthopaedic Surgeon), Diet (If you’re recovering PLEASE take this seriously), a digital marketing agency called Regent Branding. Oh, and whenever I’m waiting for someone to get off a machine in the gym, I just very casually run my hand through my hair and they glance at my scars and nervously walk away, which is pretty convenient, because I genuinely wouldn’t stand a chance against most the massive lads I work out with. The random American couple from Colorado who helped me with my bags and even paid for my bus fare when I struggled to find loose change in my pocket. My arm throbbed, but the doctor had immobilised it pretty well in the cast. My legs were perfectly fine- not even a scraped knee! Operative treatment is often complex and should follow a thorough preoperative clinical and … After 2 weeks, I went back to the hospital and had my cast removed. ‘Shit, they’ve gone and bloody killed me’ I thought, but then Dr. Robinson floated into view, and a nurse dabbed my forehead, which was covered in sweat. Please consult with your orthopedic surgeon before you begin to lift anything. I’m going to shift some appointments and operate on you within a few days, as it’s rather urgent. The first time I saw my family at the airport, I felt relieved, as I had tried to ignore how difficult it had been to fly home with a big cast to lug around and only one working arm. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. Damn. What you’ve sustained is called the terrible triad injury, because you’ve broken your ulnar, radial head and also dislocated your entire elbow.’ A picture of this is below, and while I kinda just shrug my shoulders at it, anyone in the medical field just looks a bit uncomfortable and says ‘ouch’ when they see it, so I guess the gap in the bone is where I broke it. Some time has past, so some of these numbers might be off a little bit. This leads to new injuries. It was like my bones had inflated and were going to tear through my skin at any second. I nearly slipped a few times and that would have been super awkward. ‘OUCH!’. The main symbol of the operation are the two massive scars, which I’ve been told can be sorted with some bio-oil, but the immature part of me just wants to keep them so I can make up stories about how I got them when random people ask. 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