He then fetched some papers and asked me to sign at the bottom. Terrible triad injuries account for approximately 30% of all elbow dislocations. He ran back to his car and got me some water. I was exhausted. 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 tilted my neck and saw the doctor, a nurse, and some guy behind them who seemed to be with the medical staff. I’m going to shift some appointments and operate on you within a few days, as it’s rather urgent. ‘You’re right, I’ll book a holiday. So on the first day of my holiday, I set off for Biodola Beach, which was around 4 miles from where I was. This guy was pacing up and down worriedly, his hands on his head as he looked at me in a panic. Prolonged immobilization in plaster for longer than 4 weeks is detrimental [ 18 ]. My stitches were opening up. varus, posteromedial, and postero-lateral rotatory forces.14,15 Larger coronoid fractures have a progres-sively greater influence on elbow sta-bility. Surgery is the treatment of choice as closed reduction is usually insufficient, as seen in this case. After this, my arm was put in another solid cast, which would be taken off in 2 weeks. As I was walking on the side of the road, something happened that changed everything. Drink it. He nodded. It was like my bones had inflated and were going to tear through my skin at any second. 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. I’m going to be doing my physio again and pushing hard to get more motion back while my arm heals again! ‘I promise, thank you doc. 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 mechanism of injury included fall from height in 9 patients and … 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. 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. 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 took a deep breath and thanked God that I was still alive. Three weeks ago, I sustained terrible triad elbow while studying abroad. 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. ‘Um, why is that guy so worried? EVERY single post on the terrible triad injury was focused on medical professionals and was essentially all doom and gloom. And, annoyingly, my trainers may have been a little knackered. However, whenever I want to use a weight machine at the gym, even guys 3 times my size just glance at my scars and nervously shuffle away, which is lovely. He’d called me in for a quick word, and he looked concerned. 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. 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 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. The MRI hadn’t picked up the ligament damage, and what he had found had been quite a mess. It was like there was a weird rubbery thing just attached to my shoulder. Once the swelling decreases, the next goal is to help the patient straighten their knee completely and begin exercising with a physical therapist. 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. 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. 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. This leads to new injuries. The medial collateral ligament (MCL), anterior cruciate ligament (ACL), posterior cruciate (PCL), and medial and/or lateral meniscus (cartilage) all … I grabbed an ice pack and sat in the living room, and watched a few episodes of a show called ‘Limitless’ on Netflix (wholly recommend it). I let out a loud scream in this weird low rumbling tone I’d never heard before, and looked down. The next day I explored the island, checked out the touristy side and walked through Napoleon’s summer house, which was fascinating. I popped into the walk-in centre and they put a patch on it, and I went about my normal day. They have put me in a custom full arm brace with a hinge to help me recover range of motion. 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. It’s not magic, it’s just science. 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. 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. I’ve realised the biggest blessings in the universe are faith and patience. I asked him if the damage was permanent, and he nodded. ‘You broke your ELBOW, in ELBA!!! I realised blood was pouring from my mouth, and there were shiny shards all around me. But then he told me something that made me nauseous. 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. ‘OUCH!’. You can’t fly for a few days because you’ve had general anaesthetic. As I stumbled into my flat, I realised I was suffering from shock. I nodded and waited a few minutes as we drove back to the main port. ‘Yes, it was successful, you’re okay.’. A junior doctor came over after the x-ray and said it looked ‘pretty brutal’ and that I’d snapped my ulnar in half (that long bone leading up to your elbow), as well as destroying my radial head too, which is the socket type bit that lets you rotate your wrist. Active pronation and supination movements were allowed with the elbow placed in 90° of flexion. I nodded and thanked him for his time, slightly nervous at how serious he had deemed my injury. Please consult with your orthopedic surgeon before you begin to lift anything. Even as I approached it on the ferry it looked beautiful, the waves shimmering in the moonlight. 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. Don’t feel sorry for yourself, get off your ass and stay active. I was wheeled into a room and spent the next few hours drifting in and out of consciousness. Just as the words left my mouth, I felt myself go dizzy and I fell asleep. After a while I went home, getting a pizza on the way back as I wandered through the streets of Elba at dusk. The paramedics thanked Angelo, who disappeared before I got a chance to say goodbye. Terrible triad injuries account for approximately 30% of all elbow dislocations. The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. There are very few articles about terrible triad recovery for the elbow. If you’re going out, wear your sling to make it evident to others you’ve hurt yourself, and if it’s cold wear one of those sport bands, as it traps the heat. I was asked lots of questions. When I got back home, we went to the hospital to get an X-ray. 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. 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. They called the hospital and got a stretcher out, putting a neck brace on me and loading me onto it carefully. Your elbow was pretty badly broken, it took 3 of us!’. My physiotherapist was called Pat, and she was absolutely amazing. ‘Doc, could you pop my elbow back in, and I’ll be on my way,’ I said, thinking I’d just dislocated my elbow. 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. Terrible Triad Injury of the Elbow: Current Concepts 138 Journal of the American Academy of Orthopaedic Surgeons. Was I just tired or were the lights spinning a bit above me? 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. So I met Dr. Robinson, who came into the room looking very concerned. I stayed pretty still after that. I clutched my travel bag, which had my passport in it, and closed my eyes once in the ambulance. Then there is severe, which without treatment, a piece of meniscus may come loose and drift into the joint space. I haven’t had one in a long time.’. There was blood all over the concrete floor, and I could hear a car coming, too. I was taken into this well-lit theatre and lied down on a bed. Angelo, the taxi driver, promptly called the ambulance, and I heard it wailing in the distance a few moments later. 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. Dr. Ebraheim’s educational animated video describes fracture dislocation of the elbow also know as the "terrible triad". 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 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. - Critical time period for recovery of range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients. 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. My legs were perfectly fine- not even a scraped knee! The Elbow Joint is the most complex joint in the body. 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. It’s called Arias Archer & the Shadow Cloak, and it’s a dark fantasy about a brother and sister who find themselves stranded in a fantasy world called Falasia. I don’t notice my elbow during the day or night, and my preferred arm has now returned to being my left again. I got a text from my colleagues early that morning and told them the operation was done. 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’. 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. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. One guy looked about my age, and he asked if I spoke any Italian. He’d also removed some shards floating about inside my arm. For the first time I got a bit upset, as the doctor didn’t know what a gym fanatic I was, and how much I loved boxing and running. It was busy when we went, but the staff were friendly and supportive. 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. Angelo, for running over when I had just fallen splat on the road. 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. He had opened my elbow up, and thankfully reconstructed the radial head with a few pins, so it would heal properly. I remember snippets from the operation itself. Epidemiology. After a while, I left the flat and found a pharmacy using google maps, where I got some cream for my lip. Now I know everyone complains about the NHS, but I personally think they’re amazing. OBJECTIVE: The aim of this study was to evaluate the effect of surgical repair of the medial collateral ligament and ulnar nerve release in cases of terrible triad injuries of the elbow. I woke up again and Dr. Robinson was there with a concerned look on his face. 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. 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 asked. I have travel insurance, but how much does this cost?’, ‘Don’t worry about it, we’ll get it sorted with the insurance company. 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 study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. No chance. After a while I grabbed something to eat, trying prematurely to lift my arm to the counter, which proved impossible. Related Posts Unhappy triad is a knee injury that results from a chain of separate injuries in the knee joint. So now although I’m generally a bit quieter, I know the people I would give the time of day to. It was around 10PM when I finally settled down in my flat, which was near Portoferraio, the commercial coast of the island. Instead of taking a car, I thought I’d walk it, as it was super sunny. That week was really tough…you don’t want to move your arm too much, but at the same time you want to test it every day to see if there’s been any recovery. Dr. Kate Thompson for changing my wound dressing every week and cleaning it for me. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. However the patient must stay away from contact sports or activities where any twisting of the knee may occur. I was sweating- it was hotter than I thought it would be. That’s what took so long…it was the state of the ligaments. 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. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be extrap… Damn. It looked like something out of a cartoon, like I had 2 elbows or something. 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.. Twitter I had a few painful physio sessions with her, and my elbow is all the better for it. These results worked really well for me and I want to share them, but everyone’s case is unique. This was by far one of the most important aspects in my recovery. You might laugh and think ‘how could you slip down the side of a road? 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. It was on fire, and even an ice-pack didn’t help. Sixteen studies, involving 312 patients, were included in the systematic review. Today it was push-ups, pull-ups and deadlifts in the gym, and I honestly felt stronger and faster than ever. Trust you to nearly die on holiday, honestly!’ She said, shaking her head in disbelief. I stepped into the water tentatively and let it ebb and flow up to my ankles. Background- This study is to report our experience in the management of terrible triad injury of the elbow and to validate the therapeutic choices of our treatment. 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