I messaged the account and was told it was Elba, a tiny island off the west coast of Italy. I’ve realised the biggest blessings in the universe are faith and patience. Every day showed a little more movement, with my index finger taking the longest to start wriggling. I woke up at one point and there were bright lights above me. Sleep well, but make sure you don’t roll over in the night onto your arm. DISCLAIMER: I’m not a medical professional, nor do I have any medical knowledge whatsoever. In some cases the doctor may have the patient wear a knee brace. Once the swelling decreases, the next goal is to help the patient straighten their knee completely and begin exercising with a physical therapist. Some forums shed some hope on the situation, although they were mixed between ‘I have full motion back!’ and ‘I never felt my arm move again’, which was a bit disheartening. Techniques in Hand and Upper Extremity Surgery, 15 (4), 198–208. I was given some pretty strong painkillers, which helped quite a lot with the general day-to-day pain. These results worked really well for me and I want to share them, but everyone’s case is unique. He owned a shop called ‘saltymanelba’ because he loved fishing, and he was a really cool guy to chat with. It was busy when we went, but the staff were friendly and supportive. Some of the most common injury classification systems cited in t… Finally, my name was called and I was taken into a room for an MRI scan. Here’s the playdo my sister bought for me: Play-Doh 2-Lb. 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. Epidemiology. Please consult with your orthopedic surgeon before you begin to lift anything. I shook his hand and asked what the x-rays had shown. Introduction: Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. I’m guessing it was adrenaline. Epidemiology. We went to the hospital for an appointment, where they cut off my cast from Elba. She sounded concerned, but I told her it was just a scrape, and that I would be home soon. Luckily, the cars round this end were going pretty slowly, otherwise I might have been roadkill. Now I know everyone complains about the NHS, but I personally think they’re amazing. So I had landed squarely on my left hand, and I was pretty sure I had cracked a few ribs, too, as well as cut my face. In some cases, patients can begin light activity on their own at this point. Tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex. Surgery is the treatment of choice as closed reduction is usually insufficient, as seen in this case. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.. 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,’. Google+ My colleagues sent ‘get well soon’ gifts and a card, and my assistant Amelia came over later that day to see how I was. This may ... operative recovery it is best to discuss it with the treating surgeon and ‘Operation has proven to be fully successful, and patient should make a good recovery within 12-18 months.’. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). I was sweating profusely as I jumped on the ferry, people moving out of the way when they saw my cast. I took a deep breath and thanked God that I was still alive. Those 2 weeks were the slowest 2 weeks of my life. ‘I promise, thank you doc. My legs were perfectly fine- not even a scraped knee! ‘Oh, sounds good,’ I said. On a personal level, I’ve truly realised those who care by the people who asked about my arm, and were concerned when I was in pain. And since when were medical names so damn dramatic? I realised that it was faith and patience that got me through the healing process…I remember walking outside in my cast and just muttering ‘faith and patience’ to myself, so if you have broken your elbow, please remember that your healing journey is a combination of patient days, not one miraculous breakthrough moment. Please consult with your orthopedic surgeon before you begin to lift anything. He then called another guy, and the 3 members of staff all started debating whether I should have been allowed on the flight, as I may have been carrying ‘unknown substances’. So 1 week later I went back to the hospital, where they did another X-ray. 1–6 Difficulty in treating patients with this injury is compounded by the lack of information available regarding techniques, results, and complications. Drink it. Within a few minutes my colleagues from work were calling and texting, and although I was in quite a bit of pain, I felt blessed to work in such a brilliant company as VBD. 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. I couldn’t string a sentence together so I just smiled to show I was okay, which probably looked really weird. If you’re reading this and you’ve broken your elbow, I’m sorry you’ve hurt yourself. The thing that disturbed me most was that because my wrist had been in a cast for so long, it had totally locked in place, so I couldn’t rotate it at all. Your doctor may recommend that you don't lift anything heavier than a cup of coffee for the first four to six weeks. !’…I’ve been asking myself the same question since, but the fact is, the side of the road was dusty and it was totally my fault for walking so close to the edge, anyway. The journey back wasn’t as difficult as I had imagined. Within a week, I had a bit more rotation back in my arm! 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. Trust you to nearly die on holiday, honestly!’ She said, shaking her head in disbelief. He was great, and even gave me access to his bike to explore the island. 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. Dr. Ebraheim’s educational animated video describes fracture dislocation of the elbow also know as the "terrible triad". 4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow. ‘Yes, it was successful, you’re okay.’. But for the most part, because my elbow was immobilised, i managed to just about make it back in one piece. Before I couldn’t do my top button up or put my tie on, but now I have no problem with it, and can do things I used to like play badminton, with no issues. It was a bit of a trek to get to, (from Pisa it was a few tube stops, a train south to Piombino, followed by a bus and finally a ferry over to the island) but after nearly a full day of travelling, I reached the island in the dead of night. ‘. Normally during this time the patient will frequently ice their knee to reduce swelling. He looked at me, and looked to the heavens, his eyes wide with disbelief. Terrible Triad Injury of the Elbow: Current Concepts 138 Journal of the American Academy of Orthopaedic Surgeons. I’ve launched an app called Drench, which has proven fun and challenging, too. Mobility of the right elbow was −20° for extension and 100° for flexion; the wrist mobility was respectively 60° and 20° of flexion and extension. 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. I couldn’t move my fingers at all, and when I prodded them, I couldn’t feel a thing. There are very few articles about terrible triad recovery for the elbow. I stayed pretty still after that. Monteggia Fracture Dislocation with Terrible Triad Injury Feat. The nurses gave me a sling, and they performed some more X-rays. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. Your doctor may recommend that you don't lift anything heavier than a cup of coffee for the first four to six weeks. It was a pretty standard procedure, as the operation had the tiniest chance of killing me, which I guess most operations do when you’re unconscious. I could see the beach in the distance as I walked along the dusty, winding road down towards it. I laughed as some sand fell to the floor from Biodola beach, and my arm appeared for the first time in a while, exfoliated from having the sand rub against it. So on the first day of my holiday, I set off for Biodola Beach, which was around 4 miles from where I was. I smiled and decided to focus on the fact that I could have landed on a bollard or broken my neck, in which case things would have been looking very bleak. My phone screen was shattered, but as I dragged it across the concrete, my body shrieking in protest, I realised it was still working. 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. I decided to try my best to get better, so I can share with others how the terrible triad injury isn’t so terrible really, and that with the right physio, diet and mentality, you can make a great recovery and go on with living your life. You moving could cause injury that could paralyse you permanently.’. T. Trumble 16:48. A few more doctors and nurses joined him, and they started debating what to do. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be extrap… During the final phase of recovery from an unhappy triad surgery, the patient continues to increase exercises and activity under the care of their doctor or physical therapist. Turmeric milk is amazing if you’re having an operation. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. ‘Hamzah, you might not know it now, but you could have fractured your neck or back. It was a quick operation, where they made a small incision in the top of my elbow and used a super small screwdriver to unscrew the screw. 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’d never been more terrified in my entire life. I decided I’d still try to enjoy my holiday, considering I was there for a few more days. Here’s my physio routine, which I did twice an hour, unless I felt too tired: helped when massaging it right after physio: I also sat in my car when I could and just put the handbrake up and down, which startled the neighbours, but did wonders for the stiffness in my bicep. He’s a consummate professional, incredibly skilled, and he was integral in getting me back on my feet again. 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. I would push as hard as I could and get no movement at all, or maybe just a degrees or two. Well I’ll be back to the gym pretty soon though right?’. My accident helped me realise this, because when I was falling, and totally out of control of everything, I realised every other seemingly impossible situation in my life had been solvable with a bit of perseverance. I also asked him about the ligament damage, and he said with physio and a good diet, the ligaments would repair. My whole elbow was in a massive white cast, and the doctor was standing over me. Sixteen studies, involving 312 patients, were included in the systematic review. During this phase of treatment, the patient is able to add more physical activity to their routine including light jogging. Dr. Paul Robinson for being such a legend at fixing elbows, Pat my Physio for pushing me harder every week in how far I could move my arm. My feet would drag wherever I went, my eyes weren’t as sharp and my thought process was clunky whereas before it had been razor sharp. As I was walking on the side of the road, something happened that changed everything. My doctor’s name was Dr. Paul Robinson, who was a specialist in upper limb trauma. 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. Recovery from surgery for an unhappy triad can be a long and intensive process due to the severity of the injury and the surgery. I tore my scar tissue and popped some stitches because I was moving too fast- let every day show small steps of progress, and have patience that your body will heal itself. But then he told me something that made me nauseous. I’m going to be doing my physio again and pushing hard to get more motion back while my arm heals again! Obtaining a good outcome after surgery for a terrible triad requires a balance between motion exercises –so that the elbow does not freeze and become stiff–, and protection –so that the fractures and ligaments heal properly. It took time, but my previous strength, flexibility and endurance has pretty much returned. . I was surprised. ‘X marks the spot,’ he said. However the patient must stay away from contact sports or activities where any twisting of the knee may occur. The reason for the extra work was a proliferation of extra circular business activities, including running a digital agency, building an app and publishing a book. They have put me in a custom full arm brace with a hinge to help me recover range of motion. I’m also more open with my heart, because I realised that for all the worldly successes, if I had died and not shared my heart with those who matter, it would all be for shit anyway. Following a fall-on-outstretched-hand injury, this patient presented with elbow dislocation in addition to fractures of both the radial head and coronoid process, consistent with a terrible triad of the elbow injury. 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. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. My physiotherapist was called Pat, and she was absolutely amazing. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. There’s a veryyy slight loss in rotation, but if I’m carrying something heavy, my wrist does twist all the way round with no pain. Nikki, for letting me borrow some PS4 games to keep me busy whilst I recovered. 4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow. (Big shout out to Amelia Costanzo for being such a brilliant digital marketing assistant). The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. - Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury Up to 6 weeks, maximum extension was limited to 30 or 60° according to the elbow stability assessment performed after reduction, and to prevent the risk of dislocation. He stood in front of me and waved cars to go around. ‘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. I had bought myself some playdo to keep my fingers moving, but my hand was still so weak I could barely make a dent in it, which sucked. Background: While the majority of terrible triad elbow injuries (ulnohumeral dislocation with radial head and coronoid fractures) are managed surgically, nonoperative treatment may be appropriate in selected patients, but results with this approach have been limited by very small studies. The paramedics thanked Angelo, who disappeared before I got a chance to say goodbye. The pain however, was unimaginable. 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. I also got a fresh haircut and shave from a guy in the island’s commercial district. I do have scary flashbacks sometimes, especially when I’m standing somewhere high, or look up at a tall building, but I’ve learned to steady myself and take a deep breath. Even as I approached it on the ferry it looked beautiful, the waves shimmering in the moonlight. Oh, and for those who are fantasy fans, I’ve also published a book! Please consult with a medical professional before trying/implementing anything in this blog, as just because it worked really well for me, it’s best to check with the professionals if it’s the right thing for you. The process also involves frequent follow ups and physical therapy. I was a bit pissed off, but could see the funny side. ‘Um, okay so you may need a metal radial head replacement. I have included links to buy stuff that helped me straight from Amazon in case you’re bed-bound, which you can choose to do, or buy stuff you feel is best for you. The air was humid and people were still milling around in the streets, drinks in hand. I was sweating- it was hotter than I thought it would be. Damn. Eleven patients were available for followup of at least 12 months after the injury (mean, 36 months; range, 12-90 months). A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. The mean duration of immobilisation was 25.5 (range, 17-38) days. 1. The goal of treatment for terrible triad injuries is restoring the bony anatomy and reconstructing the ligamentous restraints of the elbow to provide enough stability for early elbow … 1–6 Difficulty in treating patients with this injury is compounded by the lack of information available regarding techniques, results, and complications. But my extending, pulling back, rotating and overall strength is 100% back. It was like there was a weird rubbery thing just attached to my shoulder. ‘You’re right, I’ll book a holiday. But through doing my exercises every day, it very slowly gave my arm the strength it needed to move again- so if you’re doing physio and getting frustrated, just stick with it. The doctor shook his head. My businesses are more successful than ever, by the Grace of God, and my company now employs 25 people worldwide. This normally involves specific exercises to begin to regain motion in the knee. The mechanism of injury included fall from height in 9 patients and … EmailLinkEmbedCopy and paste this HTML code into your webpage to embed. Just as the words left my mouth, I felt myself go dizzy and I fell asleep. I nearly slipped a few times and that would have been super awkward. One guy looked about my age, and he asked if I spoke any Italian. I glanced over the edge and felt sick instantly, so he sped up and dropped me off right next to a stairway that went down to the beach. ‘Hamzah, don’t shut your eyes,’ the Paramedic warned. I was taken into this well-lit theatre and lied down on a bed. For the next few days I researched the operation on Google, which was a big mistake, and part of the reason I’m writing this blog. 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. It’s not magic, it’s just science. The doctor put a big ‘X’ on the arm that was going to be operated on. You can’t fly for a few days because you’ve had general anaesthetic. Some time has past, so some of these numbers might be off a little bit. Then there is severe, which without treatment, a piece of meniscus may come loose and drift into the joint space. 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. 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. I had the scan, which involved being slid slowly inside this massive smarties tube thing, and listening for about 10 minutes to what can only be described as a less elegant version of heavy metal. Dr. Kate Thompson for changing my wound dressing every week and cleaning it for me. Just when I thought it had all but healed, at work I swivelled in my chair, and the edge of the table collided with the scab, opening it up again. (pins and a suture anchor in my elbow to stabilise it). 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. My fingers were somewhat back, but I still couldn’t open a door or pour myself a glass of milk. After a few days I could feel my fingers again, and ever so slowly, they started moving. A small wave of relief instantly dissipated when I saw my arm. Methods: twenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16-36 months). varus, posteromedial, and postero-lateral rotatory forces.14,15 Larger coronoid fractures have a progres-sively greater influence on elbow sta-bility. ‘Don’t worry about him, he was just new. oz. My mum, dad and sisters (Nayab, Tooba and Masooma) for looking after me so well and tending to my every need, from helping me off the sofa when I had cracked ribs, to making me turmeric milk at 2am when I couldn’t sleep from the pain. I couldn’t help but laugh at how big the scars were…they looked like I’d been mauled by a tiger, which is what I resolved to tell anyone who asked about them. So today I went in to get the final screws removed from my elbow. It was busy when we went, but the staff were friendly and supportive. ‘Let’s hope you can piece it back together then?’. I was worried though, as I seemed to be losing motion in my fingers as I travelled. Medical expenses are either free or low cost in Elba. My elbow though was a different story. This may ... operative recovery it is best to discuss it with the treating surgeon and Mobility of the right elbow was −20° for extension and 100° for flexion; the wrist mobility was respectively 60° and 20° of flexion and extension. And, annoyingly, my trainers may have been a little knackered. The feeling in my elbow came back after a while, although some of it will always feel a bit tingly, due to the invasive nature of the operation. It was around 10PM when I finally settled down in my flat, which was near Portoferraio, the commercial coast of the island. I woke up and the pain wasn’t too bad at all, but I was sent home with a cool cast thing and one of those blue arm support things I’ve become so accustomed to the smell of. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. I called the hospital and they said it was quite natural, as the nerves were making new pathways and getting back into action. I nodded and waited a few minutes as we drove back to the main port. If I got through that, nothing else can break me. 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. ORIF of … Active pronation and supination movements were allowed with the elbow placed in 90° of flexion. He said that they’d put me to sleep for 30 minutes whilst they snapped my elbow back into its socket, but that the pain was going to be severe. So the day of the operation came, I packed my overnight bag and me and my mum left the house at like 5.30am to ensure we checked ourselves into the hospital for 6am. So that’s about 4/5ft. Mean Mayo elbow performance scores ranged from 78 to 95. 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. I then walked a few miles along a dusty road, and was near the beach at around 2PM. ‘You broke your ELBOW, in ELBA!!! It essentially helps the wound heal from the bottom up and just dissolves in your body naturally. !’ he howled, slapping the steering wheel whilst snapping his head back and roaring with laughter. The exercises and activities will help the knee to grow stronger and also help build the support muscles around the knee. I have no pain at all, and my movement and rotation has returned to about 98% of what it was before. I said I’d fallen around the height of Trotsky, which is what I named my Honda Jazz. 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. ‘Not many…I mean you may get arthritis by the time you’re 35, and you may never be able to touch your shoulders again, but most people live pretty normal lives with metal replacements.’. The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. I had a look and there was this tiny hole where one of the stitches had split. He then fetched some papers and asked me to sign at the bottom. 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. ‘Oh…well if I have a metal one, what’s the disadvantages?’ I asked, sighing that it just seemed to be disaster after disaster. The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. I couldn’t move my arm at all, or my wrist, which was quite scary. Now I know everyone complains about the NHS, but I personally think they’re. I glanced over the edge a few feet before my feet left the rocky hill, and saw a 20ft drop onto a concrete road below. There was blood all over the concrete floor, and I could hear a car coming, too. 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’. University of Washington. It was on fire, and even an ice-pack didn’t help. How is going the recovery of your elbow? Don’t feel sorry for yourself, get off your ass and stay active. I couldn’t move it at all. I was asked to change into hospital attire, and I walked down to the operating theatre with a great guy who told me all about how he used to scuba dive in exotic locations, and could have sworn he had once encountered some Godzilla type creature. After a few minutes though, movement returned, which was a relief. 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. I realised blood was pouring from my mouth, and there were shiny shards all around me. I went into hospital on 31st January, and was out by the end of the day. The Elbow Terrible Triad - Surgical Treatment 06:33. debride fracture site of all soft tissue to allow proper reduction 2. Prolonged immobilization in plaster for longer than 4 weeks is detrimental [ 18 ]. ‘OUCH!’. It was really pricey, but I was fine paying it considering what had happened yesterday. Before long, we arrived at the hospital, and I was lowered into another stretcher. 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