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Medical Journals Olecranon Fracture Posts

Fracture cast removed – after olecranon injury

SUCCESS! THE OLECRANON FRACTURE CAST IS REMOVED. I’m free to begin rehabilitation and physiotherapy!

However looking at how my arm moves, or doesn’t, now the fracture cast is off, the road to rehabiliation might be much harder than I thought!

Day 0 removal of the fracture cast – 2 weeks post op

For the last 2-3 days I’d been feeling tightness along my triceps, at the back of my arm. This was especially noticeable if I had not completed my physiotherapy exercises before lunch.

It seem daft, having not done the exercises you know will help you. Although occasionally you don’t want to wrestle with the pain, and doing to tricep stretch over my head, is really rather uncomfortable.

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Walking to fracture clinic

Fracture cast removal

I was a little anxious walking into the fracture clinic. Specifically what the X-ray would show, and what that would enable me to do? From the point of view of getting mobility back, I wanted out of the fracture cast ASAP, but I also appreciate that being without a fracture cast in the third week post op means taking extra care as the new bone is still soft. Yes the wires will stop the fracture from moving to any significant degree, but I might still be slightly susceptible to shear stresses across the fracture should I fall, or the the elbow a really hard jolt. Not that I was worried

Initially the fracture cast was removed, so the consultant could inspect the arm, and assess the movement. Thankfully he appeared happy with the small amount of movement possible – I was shocked, it felt like my arm was wrapped in thick plastic and wouldn’t move!

Radiology

To confirm what needed to happen with the fracture cast and establish the progress of the fracture healing an X-ray was required. Allowing the consultant to see what the fracture lines looked like. Thankfully, unlike my first series of X-rays, these were much less painful. Although rather stiff!

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The radiology plate used to look at the progress of my olecranon fracture

Even though I’ve already been examined by the consultant, who had reassured that moving the arm was safe. The the wires would hold the fracture and the cast was only for protection. I’d only been out of plaster 5 minutes, and I’d become VERY accustomed to the fracture cast. Thus whilst I sat having my X-rays taken, I remained VERY protective of the elbow. This might explain why I’m still holding it in the same position as when in the fracture cast!

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Fracture callus

Xray Results

Looking at the X-ray, above the consultant was happy with the progress, the think dark grey band, shown clearly in the image below is the actual callus. The new, soft bone that has filled in the fracture site. Which will hopefully remodel over the next few months from cartilaginous callus, to strong bony callus, before finally being remodelling completely back into bone.

Bone is an amazing tissue in this sense. Assuming correct position and no complications, bone is the only tissue in the body that can heal without scarring.

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Fracture forces stress point

On both X-rays, there are two pieces of equipment: K-Wires, the bits of string-like metal, and two long straight pins. The k-wires work as a tension-band system. When the arm is extended/straightened, the triceps pulls on the tip of the olecranon (The nub, where the fracture is). However this force is instead transmitted through the K-wires, to pull on the bone after the K-wires, which is circled in orange

Looking at the X-rays, the fracture is healing well! Best of all, the consultant says the fracture cast is to stay off.

Something else that has shown up on the X-rays is the possibility of a microfracture where the K-wires went in. Also in the orange circle. This may have been the reason I was experiencing a lot of pain in the centre of the arm, away from the fracture site.

The upshot of these little fractures is that I will now have to be extra careful when doing physiotherapy stretches

Range of movement

With the consultant happy about the fracture, the movement was assessed again.

As I’d been using a PowerBall over the last weeks my wrist had been well maintained. Unfortunately the same couldn’t be said for the elbow. Even after the reassurance that I would not be able to damage anything, it wouldn’t move much. My elbow had been held at approximately 90 degress for the last week, I couldn’t really bend it more than 100 degrees. As for extension, I wasn’t able to get past 30 degrees.

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Range of normal elbow movement

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Best extension possible

Just so we are clear, not being able to move the arm is one of the oddest sensations I’ve ever had. You try and flex your arm, it starts off moving, and then just stops. It’s like something has jammed in the mechanism and is preventing it closing any further. A similar effect was seen trying to straighten the arm. As though an invisible force just says “no; that’s far enough”

The consultant advised me to try and “let the arm hang, to let gravity start to straighten it whilst walking”. A good plan by all accounts. But what wasn’t explained was that at this stage was that your arm is going to “set” in any position after a short period of time.

A little like sitting with your legs crossed under you on the couch for 30mins. A you come to move, the legs are a little stiff and slow. The same thing would happen with my arm, but in 10minutes, with 10 times the stiffness. Not that this really mattered considerably as I wasn’t exactly wanting to start jumping around.

That was a little concerning, but I was advised the Physio would get that sorted and the arm moving over the next few weeks

Stitch removal

The final stop before leaving fracture clinic was to have the stitches removed. Removed – well pulled out is a better description!

Thankfully, the skin across the operation wound is completely numb. This was particularly useful, as the stitches didn’t want to come away, so I just explained to the nurse she could be a little more forceful – AS LONG AS THE ARM DOESNT MOVE. That certainly sped things used for both of us, but I wonder how long that’s going to be numb for. It’s an area of at least 5-10cm square. Just feels like dead, numb flesh. A little disconcerting, but it will take careful cleaning of the arm a little easier.

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Stitches removed

Although I was advised not to get it wet until tomorrow. Again the worries about infection, this time going down the tracts where the stitches were removed.

With the stitches removed, I was off home, to carry on eating; and to return to following day at 8am for the first physiotherapy session!

 At home update

Upon coming home I was astonished to see what my arm looked like, it didn’t look, and certainly didn’t move, like my arm. The really worrying part, in spite of having eaten like a horse over the past two weeks, was I’d dropped from 74kg in weight to 70.kg!

To be clear, I’m not for a second suggesting a new “Fracture weightloss diet”. Particularly so as my fat mass has remained constant, suggesting the weight loss has been from muscle as much as fat.

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James Gill

Author of TitaniumGeek, which started after smashing off my RIGHT elbow. Feel free to drop me a line about sports tech, medicine, or frankly anything that you want to chat about!!