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 couldn’t move it at all. And, annoyingly, my trainers may have been a little knackered. I felt super thirsty so downed some water, using the rest of it to wipe blood from my face. Click here to Login. I thought the talk would be something business related, but as he said those words, I couldn’t help but concur. My legs were perfectly fine- not even a scraped knee! Operative treatment is often complex and should follow a thorough preoperative clinical and … My ribs were badly cracked, so I rolled over to one side and slowly slid out of bed. ‘From the bloody cliff, I fell!’ I yelled back hoarsely, trying to muster a smile to show I was still alive. After 2 weeks, I went back to the hospital and had my cast removed. It was less about massive breakthroughs every day, and more about exercise little and often, so you just slowly get your motion back and feel the stiffness leave your arm. I’m going to shift some appointments and operate on you within a few days, as it’s rather urgent. Epidemiology. - Critical time period for recovery of range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients. I had a few painful physio sessions with her, and my elbow is all the better for it. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Epidemiology. Well I’ll be back to the gym pretty soon though right?’. She went and got another guy, who proceeded to wipe some weird strip thing on my cast, glaring at me accusingly. They also will be asked to elevate their knee and minimize movement. My fingers were somewhat back, but I still couldn’t open a door or pour myself a glass of milk. . Elbow Terrible Triad ORIF Olecranon Fracture ORIF with Tension Band Olecranon Fracture ORIF with Plate Fixation ... avulsed 2/3 of the time I. ORIF of the Coronoid. ‘Terrible’ triad was a horrible name for an injury! debride fracture site of all soft tissue to allow proper reduction 2. I nearly slipped a few times and that would have been super awkward. 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. ‘I promise, thank you doc. Mean Broberg-Morrey scores ranged from 76 to 90. I asked him if the damage was permanent, and he nodded. Any other angle and you’d be paralysed or dead, so please don’t do anything stupid from now on.’. 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. Active pronation and supination movements were allowed with the elbow placed in 90° of flexion. I popped into the walk-in centre and they put a patch on it, and I went about my normal day. In terms of strength, it is 100% back to where it was. CONCLUSION: Although our patients had better recovery of range of motion than those reported in other studies, the terrible triad of the elbow can lead to joint instability, osteoarthritis, arthrosis, and joint stiffness, and may resort to total elbow arthroplasty in some cases. I took a deep breath and thanked God that I was still alive. Stay away from Ibuprofen- it has this chemical in it that slows down bones when they’re healing. He had opened my elbow up, and thankfully reconstructed the radial head with a few pins, so it would heal properly. Don’t feel sorry for yourself, get off your ass and stay active. It was completely silent when this happened, so as I hurtled towards the edge of this small cliff I realised I might die. Please consult with your orthopedic surgeon before you begin to lift anything. I have the confidence to launch new businesses, create new products and build my companies with passion, courage and focus. 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 now go to the gym, I box, do my push-ups, drive as I used to, randomly punch walls because I’m weird, and generally don’t even notice my injury. I tried to sit up but realised I couldn’t because of my ribs- I was literally forced to lie there until I could roll over onto my side and sit up. I was exhausted. 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. The doctor came back and said ‘torte…VERY torte. Your doctor may recommend that you don't lift anything heavier than a cup of coffee for the first four to six weeks. 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. University of Washington. 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. 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 … In some cases the doctor may have the patient wear a knee brace. Damn. Due to how deep the hole was, healing took absolutely ages, as my body had to ‘pad out the active site’, which i guess means fill the bottom of the wound and then work upwards. This was by far one of the most important aspects in my recovery. I got scared that I couldn’t move my foot, but realised it was probably pins and needles from sitting on it for so long. - Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury - References: I nodded and felt a bit nervous. I messaged the account and was told it was Elba, a tiny island off the west coast of Italy. When I walk however, no one can tell whatsoever. If you’re reading this and you’ve broken your elbow, I’m sorry you’ve hurt yourself. In the end, instinct took over and I landed squarely on my left hand with a loud crunch and thud. Here’s the playdo my sister bought for me: Play-Doh 2-Lb. He was great, and even gave me access to his bike to explore the island. I don’t notice my elbow during the day or night, and my preferred arm has now returned to being my left again. Right after surgery, most elbows are immobilized with a splint for 2 to 3 weeks. My scars looked really shiny, and had mostly healed on both the top and bottom. 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. I looked at my elbow and it was totally dislocated, and the skin was pulled white to the point where the bone was just about to break the flesh. Some time has past, so some of these numbers might be off a little bit. He nodded. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be extrap… I woke up the next day and saw my arm was in a big plaster. ANYWAY, my elbow is 100% healed…it hasn’t caused me any inconvenience or pain in the longest time. 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. 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. After a few minutes though, movement returned, which was a relief. I went home and informed work that I’d fallen off a small cliff. I saw Dr. Robinson and my physio, and they were both pleased and impressed at the progress I had made, with my physio shrugging her shoulders and saying she isn’t sure how the recovery happened so fast due to the nature of the injury, but it’s testament to a solid physio routine and good diet. The waiting room wasn’t designed for sitting in for 5 hours, so I felt tired and sore by 11am. Terrible Triad Injury of the Elbow: Current Concepts 138 Journal of the American Academy of Orthopaedic Surgeons. Orthopaedics Today Europe | Elbow stiffness following trauma, surgery or due to joint degeneration is a common problem that can significantly impede upper … 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. ‘You fell from…you came from…’ he stammered, looking at the clouds. Related Content AUTOPLAY ON. I remember mum and dad floating into view at some point, both of them discussing something that sounded like listening to someone talk underwater. I made it to the front of the queue and she took me aside, and asked how long I had been in the cast. ‘Let’s hope you can piece it back together then?’. ‘Was it successful? My phone screen was shattered, but as I dragged it across the concrete, my body shrieking in protest, I realised it was still working. I went to the walk-in centre again and they packed it with this weird woolly material made of seaweed. I walked through the city, which was bustling at 11am, and picked up a late breakfast at a wonderful restaurant, with fresh prawn pizza taking my fancy. I’ve launched an app called Drench, which has proven fun and challenging, too. They called the hospital and got a stretcher out, putting a neck brace on me and loading me onto it carefully. One guy looked about my age, and he asked if I spoke any Italian. After this, my arm was put in another solid cast, which would be taken off in 2 weeks. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. I sighed with relief and thanked the doctor when he told me the news again in person. ?’ I croaked, my throat as dry as sandpaper. Okay, so it has officially been 2 years today since I went in for my operation. I packed my bags with great difficulty and lugged my bag to the port, where I was waiting for 30 minutes. You might laugh and think ‘how could you slip down the side of a road? Have you broken your elbow and got a terrible triad? And then, in this colourful and warm blur, it was time to go home. 1–6 Difficulty in treating patients with this injury is compounded by the lack of information available regarding techniques, results, and complications. oz. I did at one point accidentally catch my left arm on my bag, which sent packets of hot pain all over my left side, making me feel sick. Then there is severe, which without treatment, a piece of meniscus may come loose and drift into the joint space. 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. In the mornings when I stretch, I do feel it stretching out, which is kind of satisfying, as the terrible triad was known to cause stiffness, which thank God didn’t happen. I could see the beach in the distance as I walked along the dusty, winding road down towards it. My lip was split and quite swollen, and my nose was a little swollen, too. Maybe terrible triad,’, and I realised by torte he meant ‘broken’, as he was making a snapping motion with his hands. 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). This normally involves specific exercises to begin to regain motion in the knee. I remember thinking that this expression was probably just the way he usually looked. 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’. Small fractures involving 10% (Any squishy stress ball is fine, by the way), IMPRESA Stress Relief Balls (3-Pack) – Tear-Resistant, Non-Toxic, BPA/Phthalate/Latex-Free (Colors as Shown) – Perfect for Kids and Adults – Squishy Relief Toys for Anxiety, ADHD, Autism and More. ‘. The bottom of my palm was green and yellow, but considering I’d landed on it at high speed, I’m surprised it wasn’t torn. There are very few articles about terrible triad recovery for the elbow. 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. 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. EmailLinkEmbedCopy and paste this HTML code into your webpage to embed. !’ I asked. I tried to move but he warned me against it. 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.. 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. I did find this process useful, as every week I got a little more movement back, but there was also pain. 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. I was surprised. The Elbow Terrible Triad - Surgical Treatment 06:33. My doctor’s name was Dr. Paul Robinson, who was a specialist in upper limb trauma. The exercises and activities will help the knee to grow stronger and also help build the support muscles around the knee. Decision Making Algorithm for Terrible Triad Injuries (Complex Instability) Feat. He said he was ‘pretty sure’ my elbow would go passed 90 degrees, but the recovery would be a slow, very painful and arduous process. ‘Hamzah, you might not know it now, but you could have fractured your neck or back. My nose felt weird, and I could smell this strange scent every time I breathed, it was crisp and coppery, like my head was suddenly bursting with blood and oxygen. 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). A special thank you to: And lastly, I’d like to, from the bottom of my heart, thank The NHS for being so amazingly supportive, professional and compassionate during every step of my injury. 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…). It’s called thesaltymanelba on Instagram). EVERY single post on the terrible triad injury was focused on medical professionals and was essentially all doom and gloom. 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. I nodded and waited a few minutes as we drove back to the main port. 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.’. Pass guidewires . 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). I tilted my neck and saw the doctor, a nurse, and some guy behind them who seemed to be with the medical staff. ‘OUCH!’. An anaesthetist came over and said he’d be administering general anaesthetic and that I wouldn’t feel a thing. 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. I used this hot pack, and warmed it up every night to keep the blood circulating through my arm, as the nights were really cold. The journey back wasn’t as difficult as I had imagined. Angelo, the taxi driver, promptly called the ambulance, and I heard it wailing in the distance a few moments later. I feel insanely blessed that this was my outcome, because I can imagine scenarios where I landed on my neck, broke my back, shattered my hip or even worse. I then walked a few miles along a dusty road, and was near the beach at around 2PM. 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. Joaquin Sanchez-Sotelo. I was worried though, as I seemed to be losing motion in my fingers as I travelled. 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. They have put me in a custom full arm brace with a hinge to help me recover range of motion. There’s zero pain now, and the only minor issue I have is that after an intense gym session, the next day my elbow is a little stiff, with random pangs of pain up and down it. I had been working 18-hour days all year, and in the long languid summer days of July, I’d felt myself slow down. I could feel the liquid paracetamol they’d given me wearing off, and a dull, engulfing pain was spreading like wildfire down my arm. ‘Listen, just downplay the whole thing please, it’s not that serious’ I lied to my manager, Lance. Was I just tired or were the lights spinning a bit above me? There’s just a little bit of resistance, which is kind of fun. Please consult with your orthopedic surgeon before you begin to lift anything. After a few minutes, I got pissed at the pain in my arm and just walked onto the plane, leaving them heatedly debating behind me. 20:08. 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. 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. Operative treatment is often complex and should follow a thorough preoperative clinical and … 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. I ended up getting 90% of my movement back in my arm. It was really pricey, but I was fine paying it considering what had happened yesterday. It looked like something out of a cartoon, like I had 2 elbows or something. 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. Now at first all of the above seemed totally pointless. You can’t fly for a few days because you’ve had general anaesthetic. I’ve been baffled and quietly surprised at both the stupidity and courage people have shown this year. 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. Again, his words rang true. 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. 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. My arm looked swollen and misshapen, and I couldn’t move 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. So 1 week later I went back to the hospital, where they did another X-ray. You moving could cause injury that could paralyse you permanently.’. 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. The hospital kindly called me a taxi and I walked to the exit, realising it was the first time I was walking since the accident. Here’s a link above to the squishy ball I used, that really helped me improve my grip. Just as the words left my mouth, I felt myself go dizzy and I fell asleep. I was instructed to come back in 1 week for a final X-ray, as my body needed time to recover from the operation. I was given some pretty strong painkillers, which helped quite a lot with the general day-to-day pain. My whole elbow was in a massive white cast, and the doctor was standing over me. Angelo, for running over when I had just fallen splat on the road. He owned a shop called ‘saltymanelba’ because he loved fishing, and he was a really cool guy to chat with. 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 … 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. I haven’t had one in a long time.’. It’s not magic, it’s just science. I couldn’t string a sentence together so I just smiled to show I was okay, which probably looked really weird. Concurrent ipsilateral injuries to the wrist, interosseous membrane of the forearm, and shoulder have been described. I shook his hand and asked what the x-rays had shown. As I was wheeled through the hospital, I realised that if I had fallen slightly differently, I’d have cracked my head open, or snapped my neck. I wanted a blue cast, but they had to put this ugly beige skin on it to stop it from moving around too much. The guy came running back with water and said ‘your teeth, your teeth are everywhere!’, but I told him it was just my phone screen shards. Eleven patients were available for followup of at least 12 months after the injury (mean, 36 months; range, 12-90 months). I’m going to be doing my physio again and pushing hard to get more motion back while my arm heals again! But my extending, pulling back, rotating and overall strength is 100% back. I remember feeling lighter than I’d ever felt, with every tilt of my head sending me into a whole new colourful world of weird light and music. My upper arm, however, was really badly bruised, with various shades of green and purple blotched everywhere. It was busy when we went, but the staff were friendly and supportive. 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. Suddenly, the taxi driver burst out laughing. My medical experience starts and ends with a game of ‘Operation’ I lost about 15 years ago. 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.. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. My elbow? 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,’. 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). The pain wasn’t actually too bad. Facebook And listen Hamzah,’ he said, looking me directly in the eyes, ‘you were incredibly lucky, you need to know that. All patients were followed up regularly for 6 to 24 months. 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. 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. I went flying off the edge of the ledge at high speed and as I was falling, I remember trying to calculate whether I could land without crushing my head or breaking my leg. I got into the taxi and told him where my flat was. When I got back home, we went to the hospital to get an X-ray. ‘Don’t worry, these guys are the best’ I said with a big smile, trying to steady my breathing. It was like there was a weird rubbery thing just attached to my shoulder. 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. The doctor shook his head. 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. ‘Oh…well if I have a metal one, what’s the disadvantages?’ I asked, sighing that it just seemed to be disaster after disaster. She had a very gentle approach, but she was so strong when she was moving my arm, and every time I went to her, I learned I wasn’t pushing quite hard enough with my physio at home. It was beautiful, and I found a sunny spot and lay there for hours, my cast drawing lots of weird stares. 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. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. 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. My stitches were opening up. 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. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. Terrible Triad Elbow Recovery [Physio Template Included]. Twitter 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. 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. ‘You broke your ELBOW, in ELBA!!! When they took off the cast, I saw my scars for the first time, and the nurse had to remove some of the little sutures with some tweezers. Drink it. ‘Yeah, I’ll never forget this one!’ I said, kind of glad as we turned into the street where my flat was. So on the 23rd September 2017, I set off for Elba. Even as I approached it on the ferry it looked beautiful, the waves shimmering in the moonlight. Within a week, I had a bit more rotation back in my arm! Instead, I played lots of PS4, which I usually never got time to do, but in this case ended up helping me move my fingers, which was great. Turmeric milk is amazing if you’re having an operation. ‘Operation has proven to be fully successful, and patient should make a good recovery within 12-18 months.’. The process also involves frequent follow ups and physical therapy. I nodded and in a few minutes, was being x-rayed. I clutched my travel bag, which had my passport in it, and closed my eyes once in the ambulance. On the 5th day after having my cast removed, I felt like my arm was being pressed by an invisible hot poker. Surprisingly, people had left their doors open, and there were children playing in the streets. After a while I went home, getting a pizza on the way back as I wandered through the streets of Elba at dusk. I woke up again and Dr. Robinson was there with a concerned look on his face. Here’s a video showing current movement- it’s back to normal, with an ever so slightly tinge of resistance when I flip my hand over. That’s what took so long…it was the state of the ligaments. Tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex. I went into hospital on 31st January, and was out by the end of the day. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. 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. He checked me over once more and said I could go home for some rest, and I thanked him for operating on me. ‘You’re right, I’ll book a holiday. Mean follow up after surgery was typically 25 to 30 months. The doctor put a big ‘X’ on the arm that was going to be operated on. These results worked really well for me and I want to share them, but everyone’s case is unique. 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