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Olecranon Fracture Posts

Metal work removal from elbow – the operation

Well the day has finally arrived. I’m losing my metal work!
Which in many ways makes me think that I need to rename the site to something other than TitaniumGeek, and I won’t have an arm full of the shiny stuff any more.

Metal work removal from elbow – my second operation

Exactly 6 months to that day from fracturing my elbow, its time to get the metal work out, due to causing so irritation to the skin, and beginning to get in the way of my movement. But even before we can get to the slicing and dicing part – I’ve got to get through the night before the theatre.

I WASNT frightened about going into the theatre, in fact from an intellectual stand point I was actually looking forward to it! Most of the time in medicine, you give drugs e.g. antibiotics, but never see a reaction, the patient either gets better, or doesnt, in which case you try a different antibiotic. With an anaesthetic the doctor sees the results in under 30 seconds, but as the patient on the table, you can feel the anaesthetic in your arm, and going up into your head. Its definitely one of the oddest experiences I’ve ever had. You are trying to count to 10, then suddenly you are coming round a hour or so later after someone has essentially switched you off

For my own pride as much as anything else, I want to reiterate that I wasn’t even particularly anxious going into the pre-op evening, but the concept of being switched off did keep on bouncing around my head, I think restless is probably a better description of me that evening.

I managed to distract myself relatively effectively with Zwift, writing and stuff until about 1am (the last point I was allowed to eat), but then time began to drag for want of a better word. I might have actually fallen asleep between 2-4am, but without a doubt it was not the best nights sleep I’ve ever had – the Withings Aura recorded a very unrestful night with less than 2.5hrs total sleep, waking at 5:30am for my last drink – all part of preparing for an operation

To the Day Surgery Unit

Metal work removal from elbow

Day Surgery

Prior to the day of surgery I’d received a letter asking me to arrive for 7:30am sharp, which I assumed would mean surgery to start about 8:15am, recovery for 9:30am at the latest and home before lunch. I’ve only ever dealt with emergencies and ward based operations, when the planning procedures are different, so this didnt seem a unreasonable series of assumptions.

What I didn’t realise was that ALL the patients are requested to arrive at 7:30am in one go, and from there we are invited to sit in little private holding cells cubicles, whilst you wait to go through all the paperwork with the surgeons

Metal work removal from elbow

Paperwork!

Wrong side of the fence.

As you are sitting waiting, you are exposed to all of the sounds of the adjacent ward. Every time the cardiac arrest bell goes off – which is a very frequent occurrence, I still feel that unpleasant squeeze of my adrenals kicking out adrenalin – you never really over come that reaction. That’s not to say there are lots of cardiac arrests, its merely that the bells, triggers and switches are very sensitive, so its easy to call for help, as a result 1-2 sec false alarms are VERY common, to the degree you learn to filter them, whilst in the back of your head listening to making sure its not a sustained alarms – those are the ones you worry about!
There are many things I miss about hospital medicine, but I’m very happy to be shot of the cardiac arrest bells and belt mounted personal bleeps!
Speaking of switching back into the hospital mode – the surgeon on his registrar came round, and I went through all of the consent forms for my operation. I’ve filled in MANY of these forms with patients over the years, so its a little bit surreal to be on the other side of the discussion. Nodding and smiling, agreeing that you take the risk of essentially loosing the function of your arm as potential complication. (Its a theoretical risk for this surgery. I’ve never even heard of it happening in the real world, let alone seen it, but you still have to sign the form). You are then MARKED, to ensure they dont cut off the wrong arm!
Metal work removal from elbow

Marked man!

I did encounter a  problem however. As I say, I’ve gone through the pre-op forms MANY times WITH patients as the consenting physician. So out of habit, I signed the doctors section without looking, not the patient section – thankfully I knew the surgeon, so he merely came to point and laugh! Whilst telling me I was due under the knife in about 45 mins (No pressure)

and more waiting…

By having every patient in the pre-op ward together, allows all of the patients to have the obs checked and pre-pared before the op. But it does mean quite a wait if you are at the end of the list. Waiting is part of life, but unfortunately, when your last drink was at 5:30am, and the clock is ticking round to 11:30am, that waiting gets a little uncomfortable.

A trick my grandpa, who served in Africa, taught me was that if you are thirsty, and don’t have much water, swill less than a tea spoon of water around your mouth, it moves the saliva and improves the feeling without using any water of note – or in my case swallowing any!! There is a balance to be made about being completely nil by mouth pre-op, its all about making sure your stomach is empty to prevent an aspiration of stomach contents into the lungs during the operation. Even chewing gum within 2 hours pre surgery is no no-no, as this too will activate your gastric juices, but a VERY small, VERY FAST swill and spit, you can just about get away with, but there is still a risk to potentially activate the gastric juices.

As is Murphy’s Law, just after I’d swilled my parched mouth, I was told to get changed, as I would be going to theatre shortly. So on with the hospital gown, a little more waiting and it was round to the anaesthetic room.

Metal work removal from elbow

Does my bum look big in this?

Good Night!

I wasn’t half as nervous this time going into the anaesthetic room. Had a nice chat to the anaesthetist to confirm that I hadn’t developed any new medical problems or allergies in the last 15minutes. A bit of a tick box exercise, but it’s also a degree of distraction whilst the get the cannulae and medications prepared. Normally you could hit my veins from across the room with a dart, as they are quite prominent, however with the slight dehydration, they needed a little more looking for – by the anaesthetist still hit home first time when she went in with the needle – very impressed!

The surgeon pops in again, to check any last questions – I’d forgotten previously to ask if I’d need another cast post op – as that would stop me moving completely again until it came off. No I was reassured. A relatively small cut and just heavy bandages – that was a big relief! And NO I wasn’t allowed to keep the metal rods 😞. Oddly not due to some health and safety thing in terms of infections etc, but that they could be used as weapons to stab someone… didnt think of that! Oh well!

Finally the medications went in. Slightly was less fun this time. I dont know what the first medication was, I think it might have been an anti-sickness drug, as I felt really rather dizzy within a moment or two – my eyes were bouncing left and right, quite vividly to me anyway. About 30 secs more conversation and the anaesthetic went in. Up the arm, slight feeling of cold, before feeling my eyes go heavy and roll back. On the original anaesthetic, feeling the chemicals going round my brain was a really experience, didnt have that this time!

Post-op – The Recovery suit

Coming round really does feel every so slightly like waking up from actual sleep. You are a little groggy, as you come round, but you are somehow aware that you don’t have any control over that ability to come round. Normally when you wake up, you can snap to if needed, somehow you KNOW this isn’t possible. Thankfully  everything return to normal after about 5-10 mins. I say everything – hand eye co-ordination remained  shot, well more so than usual, for a few more minutes – typing notes was a real issue initially!

Metal work removal from elbow

What are they? – Oh yes I remember FEET!

I saw the surgeon again – who explained everything went well! The wound would be reviewed in two weeks. Heavy bandage to remain in place for 72hrs, and then get moving the arm to help get that final few degrees of movement back hopefully. He stressed I was completely and utterly banded from cycling outside for a further 4 weeks, and should ideally avoid running. Mainly because if I trip and fall, my elbow currently has holes in it, just like Swiss cheese.

Similarly no heavy lifting, or going to the gym for at least 4 weeks, 8 would be better still. Thankfully I’m allowed to go on the turbo trainer and Zwift!

Compared to immediately before the operation, even through the thick bandages, it feels as though I can straighten the arm better than before! There is no pain, or strange “stop” as the metal hits the muscle and bone now.

Metal work removal from elbow

Elbow extension – the morning pre-operation

Metal work removal from elbow

Immediately post op – local anaesthetic helping to get it rather straight 😊

So an hour later, post op meds in the bag, and its home for 2 weeks of rest and good food to speed the bone filling in!

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Comments

  1. Hi James,

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  5. Hi,

    I really hope someone will be able to share their experience/offer some advice.

    I have had the metal work in since January but an x-ray last week showed that it is backing out of my elbow so surgery is needed. It seems I will have to wait 5 weeks to have this done even though the consultant said it was ‘urgent’. It seems though that my whole arm aches, my fingers are stiff first thing in the morning until I start moving them and of course, the elbow is a bit sore and the movement is severely restricted. Is this normal and how long did you have to wait? I am worried that it will keep backing out of my arm and cause a lot of damage and pain by waiting so long. Is there anything I can do whilst I wait that might help such as using the powerball etc? Should I try for an operation sooner?

    Thank you.

    Nat

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    • Hi Natasha, sorry for the delay in getting back to you. Five weeks shouldn’t be too bad. Your body will certainly keep pushing the metalwork out, but it won’t cause any damage. Remember, that the fracture is being supported by the metalwork. A lot of surgeons for the approach of the longer it stays in the better, as it reduces the chance of any further damage to the new bone

      What painkillers are you taking?

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      • Hi James,

        No worries and thank you for getting back to me; I appreciate it.

        I was actually doing really well with physio etc so all of this has been a big setback. I haven’t needed pain killers as the pain is more of a dull ache and bearable but the hand cramps in the morning is a worry as is the arm ache. Some of it may be tension as I am worried about catching the elbow; the screws are very prominent. I am sure it wouldn’t take much to pierce through the skin. My range of movement isn’t great so I have started back with the powerball but one just doesn’t know if more damage is being done. So difficult to know what to do for the best.

        All I know is the pentathlon training will have to take a back seat for a while. I am pretty sure it is going to take a full 12 months to get back to normal!

        Natasha

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    • I wouldn’t worry about the screws coming through. That isn’t likely to happen, you skin is stretchier and tougher than we normally appreciate.

      HOWEVER caredulnyou don’t bang them, I struck mine on a window about 2 weeks before they were due to be removed, it feel like someone had put an red hot poker in my arm. Truley horrible!!

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    • Hi James, the metal work is now out! I have been sent home with no guidance though so hope you can help!

      Bandages taken off after 48 hours and large plaster in situ. I have no idea if I should elevate or exercise it gently! I don’t see the surgeon for 4 weeks so have no idea about the stitches or if I need to have it checked beforehand? All a bit odd really but I was too out of it to ask! Nat

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  6. I am three days post op from my metal work removal on my elbow and like you I already feel better! Thanks for sharing all of your experiences and information, I didn’t see the surgeon after my surgery so it was great to read about the reason why I have been told to keep it bandaged for two weeks (I was impatiently thinking I could just take them off and get on with it!)

    I also had a long starvation before my surgery and the headache was immense…I was actually desperate to be knocked out by the anaesthetist!

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  7. Hi James
    Ive been following your story of your Olecranon fracture as I to have one (fellow over in Oct)
    Your blog has kept me going and been wealth of knowledge better then the internet..
    I too have just had my metal work removed 14.4.16 and feels so much better without it..

    My question is when did you return to work and drive as no one seems to know a defiant answer..

    Take care

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    • Hi Lisa

      No one can tell you when it’s OK to drive. It’s down to your elbow.

      I was able to drive about 6-8 weeks after initial fracture. It’s about being able to turn the wheel with strength and without pain.

      I had my car parked on a side road, and didn’t go back to driving until I could do a three point turn in the side road without discomfort.

      The car is also a good place for a bit of rehab. Straightening you arms and pushing against the wheel.

      I found if I pushed hard, it was sore, and then improved over a week, I think that was actually mobilisation of scar tissue.

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  8. Hi James,
    Glad to hear the op went well, since fracturing my olecranon (in an almost identical manner to your accident) about a month ago I’ve been reading your blog to see what I can expect.
    I went in to hospital today to have my bandages removed – my elbow wasn’t in a cast so I’ve had limited movement since my operation two weeks ago – and now can look forward to some physio (and back on the turbo properly!)
    Andrew

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    • There is a school of thought that says to mobile straight away. Now I’ve had an excellent result so far – arm doesn’t perfectly straighten, but then physio did wonder looking at some of the features of my RIGHT arm if it ever did, and I’d compensated since childhood – I need to dig through photos to see.

      Point is, I think that being able to have that small degree of mobilisation in the first two weeks may give even better results.

      From a literature point of view there is not much to answer one way or the other.

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    • Meant to say good luck with the physio.
      Hope you’ve got some rubber ducks as I spent HOURS in hot baths doing physio on my own, but it certainly paid off

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      • Yvonne Moore - July 21, 2015 at 5:01 pm - Reply

        Ha ha!!
        Spent many a long hour in hydro in the past!!

        I see the surgeon on 4 August so will find out his plans

        I am fearful of his prediction of RA flare in the elbow – about the only place I hove not had joint damage
        4 weeks post op and very hot is not encouraging!!

        Will keep you posted

        Make sure you behave!!

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      • That’s good to hear, I’ve been trying to do some gentle stretching over the last few days based on what I’ve read online, and have been using a powerball after it seemed to work well for you.
        Good to know about physio in the bath!
        Also meant to say that I had a long wait without food/drink when I was originally scheduled in for my op. Similar to your removal, all the patients came in at 7:30, but there were a lot of high priority cases that came in through A+E on my day. I was told I could have a cup of water at about midday, and was then waiting until 6:30pm when they eventually said they wouldn’t have time for me! It was over 12 hours with just a cup of water and almost 24 without food…. (and I didn’t even have the operaton)

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  9. Yvonne Moore - July 21, 2015 at 11:58 am - Reply

    Hi James
    Glad that is over for you and that you have a full recovery now

    I saw my physio yesterday and am starting rom – not easy with pre existing RA damage

    Have a really hot joint so hope its not RA flaring

    I have to say I have found your blog 100% more informative than my own surgeon so many thanks for that

    Take care and behave

    Yx

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