1995 – Elbow Repair, Surgical Care?

This piece follows on from 1995 – The Major Accident and gives a far more detailed account of the lack of care taken during the surgery to my left elbow. This post covers the following two issues.

  • The surgical removal of dressing caught in healing wounds.
  • The removal of the pins and my reason for requesting the removal.

Recapping the car accident, the 22nd of May 1995 I was involved in a head on collision that resulted in a fracture to my left elbow which required surgery and the pinning of that elbow, amongst other injuries.

1995 - The Major Car Accident - Photo 2 - 3072 x 1448

Scene of car accident, 22nd of May 1995. Photograph purchased from the Adelaide Advertiser 1995.

To start with let me explain the type of cast that was used after the surgery was performed on my arm.

The type of cast I had is called a “Backslab” there is a good diagram HERE, at the website of The Royal Children’s Hospital Melbourne.

Basically the arm is dressed with padding and bandages, then the plaster cast is applied to only the underside / outer of the limb. In my case with the elbow fracture this was with my arm bent, supporting my arm much in the positioning of a sling.

Velcro fasteners were then applied as straps over the open section of the cast to hold the cast firm and to allow the removal of the cast during therapy and exercise sessions.

Bringing it all together was a collar cuff sling to support all the weight required for my arm to heal (which really did not help the neck pain terribly much).

Within days of the surgery I began to feel an extremely sharp painful cutting sensation on the inner side of my arm, just below the elbow.

After a number of days persevering with the pain and telling myself it was just part of the healing process, I could not stand the pain any further and attended the Emergency Department just for peace of mind. It was actually a group of friends who saw my distress while we were together one evening and insisted on taking me to the hospital themselves.

10:49pm on the 31st of May 1995, nine days after the accident, I was logged in at the Emergency Department of the local hospital.

It was a quiet time in the Emergency Department and thankfully I had landed myself a compassionate doctor with a very pleasant bedside manner who gave me all his time, completely unhurried.

As the doctor began to remove the dressing we chatted about the accident, the quiet period in the Emergency Department that evening, and then all of a sudden I shrieked as he attempted to remove the final layer of dressing from my arm.

That dressing was STUCK and it was not going anywhere!

The doctor tried to gently pry the dressing from my arm, it would not move. He tried dampening the dressing to release it and still it would not move.

By this time I was giggling hysterically due to the discomfort I was feeling, not only from the pain associated, but my general emotional discomfort about the pain I was sure I was about to experience the longer this went on.

You see, I am an “Inappropriate Laugher”, an inappropriate crier too for that matter.

Oh, heck! I’m just an emotional kind of Gal really.

I smile, giggle and laugh when I am uncomfortable or trying to hide distress, I smile too much at funerals and laugh too loud in public due to my introverted nature making me uncomfortable in social situations.

By this time the doctor decided it might just be a good idea to apply a topical anaesthetic gel to make the situation a tad more comfortable for me, and himself too I would assume.

As the gel did its thing he began to pry the dressing, ever so gently.

Until he realised the cotton wool type dressing was embedded into a 2 inch gash I had sustained during the accident….. The healing of the wound, knitting my skin together with the fibres of the dressing.

Becoming more nervous, now not only was I giggling and laughing, the chair I was sitting on was quite high and my feet only just touched to floor. As my nervousness increased I started to swing one leg, tapping my foot wildly on the floor while making flippant jokes about the situation as I laughed uncomfortably.

With that the doctor stepped across the room for a moment and returned to my side with a vial, syringe and scalpel in hand….. Then the fun part really began!

I looked away from my arm as he injected the anaesthetic into the area, and even more so as he cut the dressing from my arm slowly and carefully, all the while chatting to distract me. At times voicing his concern that such a lack of care had even occurred in something so simple as dressing a wound.

Once the wound was thoroughly cleaned and all the embedded dressing removed it was then dressed correctly. Thankfully no stitches were required, just a simple dressing, ensuring that a non adherent form of dressing was applied prior to re-bandaging the entire arm.

The Notes in my file … ? Why no Telfa applied.

Arrangements were made for a follow up Emergency Department appointment the very next day, all appeared to be in good order and 23 years later barely a scar can be seen.

I have included this little event to simply demonstrate the lack of care that was given at the time of the operation.

1995 - The Pins Cutting Through - Photo 1 - 3072 x 2048

X-rays taken during November 1995 to prepare for removal of the pins.

As the weeks passed by from this point physiotherapy began, daily exercises to regain movement became a regular routine in my life and eventually the use of the backslab was no longer required.

The lack of independence I had during this time became a constant irritation and I was determined to regain the use of my arm in an effort to begin driving once again.

I began to use my left arm for everything I possibly could to increase the range of movement.

However, the greater the range of movement I acquired the more painful the elbow became. The increased range of movement I had hoped to regain had become impeded by a pain that was so sickening I simply could not push myself past it to make the gains I desperately desired.

The pain I felt, it was not a muscular pain, it did not feel as if it was the type of pain from the stiffening of a joint.

No, the pain….. Was like something in my elbow was tearing or cutting away at my skin from the inside, under my skin….. Cutting its way out!

After several appointments with doctors and eventually the surgeon who did the repair to my elbow in May, x-rays were taken and the option to have the pins removed was offered.

During November of 1995 I was admitted to hospital once again and the pins were finally removed.

No real discussion was entered into with the surgeon who performed both the repair and the removal of the pins, other than the standard post op check up.

It was not until I received my “souvenir” of the pins and the x-rays from the second surgery that I realised exactly why I felt like something was trying to cut its way out of my body.

That is because….. Something WAS Cutting Its Way Out of My Body!

1995 - The Pins Cutting Through - Photo 2 - 2048 x 3072

X-ray of pins November 1995. The red arrow showing the jagged wire that was cutting through the tip of my elbow.

1995 - The Pins Cutting Through - Photo 3 - 3072 x 2048

The pins once removed.

1995 - The Pins Cutting Through - Photo 4 - 3072 x 2048

Close up! … It doesn’t take a genius to understand the painful irritation associated with this piece of wire, slowly cutting away at my flesh from the inside.

Far from what I had imagined to be in my arm, “The Pins” in my arm were actually nothing more than pieces of wire twisted together to hold the bones in place as they healed (as shown in the two x-ray images above).

The piece of wire that was cutting its way out of my body, simply two pieces of wire that were twisted together and then snapped off on the end, leaving a sharp jagged edge at the tip of my elbow, as indicated by the red arrow.

This is what was cutting through my flesh from the inside out.

In all honesty, I very firmly believe that if I had not elected to have the surgery to have these pins removed, at some point I would have been back on an operating table having them removed after they had made their way out of my flesh, having done who knows how much damage.

Over time I did regain almost full movement of my arm, which allowed me to regain my independence completely.

Several years after the accident I persevered through pain to enjoy a short lived period of my life as a weight training gym junkie, fighting hard against the pain in my arm to push hard and beat my personal best every training session with my personal trainer.

However, the elbow has been very painful over the years, the scar extremely sensitive to touch, the winter months producing sickeningly deep aching pain and the elbow has even produced occasional issues such as Ulna Nerve Dysfunction.

Added to the later is a locking of the elbow that began within the first few years subsequent to the removal of the pins. A locking of the elbow that has increased over the years and a locking that can only be resolved by a painful forcing of the elbow to crack or pop in an effort to release the joint and restore movement once again.

While I am truly thankful to have had the medical staff with their expertise available to operate on my arm as it was, I can’t help but ask if this repair to my arm was standard practice?

And, if it is standard practice. I then have to ask, “Would any surgeon, or any other medical professional be content living with pins in their arm that are literally cutting their way through the flesh from the inside out?”

Categories:Medical

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