“Climbing high mountains is full of dangers, but because of ‘boldness and carefulness’, you can always overcome dangers. This is a successful experience; walking on flat ground is stable every day, but you can stumble because of ‘living in peace’. This is a lesson of failure.”
This is a message I posted on WeChat Moments, in order to record my unforgettable and sour hug experience with Mother Earth when I went to the airport after climbing the steep and wild Great Wall in Beijing.
Ground staff accompanied all the way to the boarding gate
Solemnly “handed over” me to the crew
One day in October 2019, I was on a business trip from Beijing to Guangzhou by plane at 8:00 pm, and I fell hard when I was about to leave. Think back to the moment when I was injured: when I was running towards the vehicle in front of me quickly, I tripped over some obstacle under my feet, and my body fell down uncontrollably . A thought popped into my mind instantly: Oops, my arm is broken.
The pain made me lie on the ground for a long time before I stood up. My colleague asked with concern: “It seems that the situation is a bit serious, should I go to the hospital directly?” He said lightly, “Forget it, go directly to the airport as planned, and fly to Guangzhou if there is anything to do.” Because I have an important meeting at 8:30 the next morning, if I go to the hospital at this time, it will definitely delay the flight that night.
When I arrived at the airport, my colleagues helped me check in my luggage, and I went straight to the airport emergency treatment center with my arms in my arms. The doctor looked at the red and swollen arm and said that the possibility of a fracture could not be ruled out. He suggested that I go to the hospital to take an X-ray first , and take the opportunity to risk bleeding. I weighed the condition of my arm that was not particularly painful at that time (or I was numb to the pain after a 2-hour drive), and said that I should go back to Guangzhou first. So I signed the “Responsibility Letter” to bear all the consequences at the request . The doctor did emergency protective treatment for me. China Southern Airlines specially dispatched a ground crew member who took my backpack and accompanied me through all the formalities, sent me to the boarding gate, and solemnly “handed” me over to the crew.
On the plane, I wore a simple nursing belt, tried to avoid touching, and raised my arms as much as possible to reduce congestion and swelling . The plane landed safely, and it was already 12:00 in the middle of the night when I left the airport, and went straight to the emergency department of the hospital.
The airport ground staff who escorted me丨Photo courtesy of the author
“Your condition does not require surgery”
I choose conservative treatment
The results of the filming came out soon: avulsion fracture of the medial epicondyle of the left humerus! I took the film to see the emergency doctor, and he said without a doubt: Come here tomorrow morning to go through the admission procedures and prepare for the operation! I need surgery? is it so serious?
I couldn’t sleep much that night because of the pain. The next morning, despite the increased pain and swelling, I managed to get through the meeting. Thinking about the surgical recommendations of emergency doctors, I would like to listen to the opinions of several experts before choosing conservative treatment or surgery. So, that afternoon, I went to two orthopedic hospitals one after another. The doctors said that surgery is the first choice, so that the recovery will be faster, but it does not rule out that the nerve was injured during the operation, which may affect the function of the little finger in the future; if there is no operation, the arm may be damaged in the future. deformity. One of the doctors left a message: It can be done immediately, or it can be observed for a week before deciding whether to operate.
I didn’t want to have surgery, so I went back to my residence and talked to a friend who was engaged in 3D printing research at night. She said that she was cooperating with a famous director of orthopedics, and she could invite me to the hospital for face-to-face consultation. The next day I took the film to see the director. He analyzed my situation in detail and said that conservative treatment and surgical treatment have their own advantages and disadvantages . According to my condition, surgery is not the type that must be performed. It is up to me to choose. Of course, I chose conservative treatment.
Can’t wait for the doctor to remove the plasterboard
Replace with a new lightweight 3D brace
Choose conservative treatment, which means I need to go through: 6-8 weeks of fracture fixation, and at the same time take some drugs to promote fracture healing.
The doctor who took over the diagnosis and treatment told me that they are conducting clinical trials of 3D printing braces instead of plaster fixation, and if I want to, I can try a new method. He’ll still put me in a cast, though, until the new tools are ready. I’ve always been interested in new technologies, and I readily agreed. So he invited 3D engineers and technicians to perform a 3D scan and reconstruction of my arm with a handheld 3D scanner. After the scan, the technician said they would build a model based on the scan and in a day or two they would make a 3D elbow brace based on the model. After the scan, the doctor put a cast on me and said that the cast will be replaced after the brace is done. I am looking forward to it.
In addition to pain, the life of a patient with a plaster cast has a series of difficulties , such as: washing hair with one hand, showering with one hand, eating with one hand, typing with one hand… At this time, I am fortunate that my left arm was injured. Otherwise, your life will really be unsustainable.
The plastered arm and swollen left hand丨Photo courtesy of the author
A day later, the doctor informed me to go to the hospital at 5:00 pm. I fell in love with the light and beautiful 3D printed brace when I first saw it, especially when I picked it up, it felt very light, which was a world of difference compared to the heavy plaster. I couldn’t wait for the doctor to remove the plasterboard and put on a new 3D brace. After using the new brace, the arm looks very relaxed, and I thought that maybe soon the new technology of 3D printing will let the fracture patients say goodbye to the plasterboard.
the arm is getting swollen
I took a taxi back to the hospital late that night
The doctor was very careful, and he left a phone number asking me to call him as soon as I felt any discomfort after I went back. Two hours after dinner, I felt that the swelling in my arms had increased. I thought it was almost 21:00, so I should observe and observe first. Don’t rush to call the doctor and trouble them.
However, the new brace couldn’t expand and contract with the swelling of the arm, and the pressure became stronger and stronger. At 22:00, I felt that my arm was so swollen that I couldn’t hold on until tomorrow morning to call for help. So I called the doctor to explain the problem. The doctor didn’t say anything: “I’ll go back to the hospital right away. I’ll be there in 20 minutes. Come quickly.”
Special thanks to the doctor who worked so hard to rush back to the hospital from home in the middle of the night. The moment I took a taxi to the hospital, the doctor was already waiting in the ward. He quickly removed the 3D printed brace and replaced it with plasterboard . Seeing that the arm that was imprinted by the brace relaxed, I finally breathed a sigh of relief. I thanked the doctor and apologized to him for visiting the doctor in the middle of the night. He said that it was his responsibility. Called and dealt with promptly.
It seems that the time is not yet ripe for the lightweight and beautiful 3D printed brace to completely replace the plasterboard!
I only used the 3D elbow brace for a few hours丨Photo courtesy of the author
In the next few days, I used a sling to support my injured arm, wore the simplest clothes, and struggled to wash my hair and shower with one hand… I often woke up with pain at night. “There is nothing wrong with it” has become a truth-like existence. I didn’t expect that I could knock myself down with a single somersault.
Major changes gradually subside
I just realized that the arm will never be the same again
As the saying goes, “one hundred days of injury”, the recovery after injury is extremely important. My arm has not been able to return to its original state due to failure to persist in rehabilitation exercises.
Ten days after my injury, I returned to Beijing from Guangzhou. The weather in Beijing was getting colder, and it was inconvenient to wear clothes on my arms with plaster casts, so I removed the sleeves of some clothes and wrapped them in down jackets. Although it affected the image, it did not delay my business trip and work. When it was time to go on stage, I took off the cast and bent my arms.
Thinking that the plaster cast can be completely removed after 40 days, my heart is full of expectations. Unexpectedly, the recovery after the removal of the plaster was the beginning of the “nightmare”.
The circle of friends I posted after I was injured丨Photo courtesy of the author
After the plaster cast was removed, the muscles of the left arm were atrophied, and the two arms were of different thicknesses. What’s more serious, due to the long period of immobility, the left arm was bent so badly that it could not be stretched at all . In order to recover, the doctor said that it is best to use physical therapy every day, and at the same time loosen the sticky tissue with manipulation. So, the last thing I wanted to do was to go to the hospital, and I reluctantly started the difficult road to recovery. Although the therapist was careful, I often cried out in pain whenever my arm was rotated outward.
However, what is unexpected is that I have only done a few recovery sessions, and I was “stranded” due to the sudden outbreak in Wuhan. Immediately after the Spring Festival holiday, I returned to my hometown and began to live in isolation. During this period, I guarded my father who was seriously ill and had no time to take care of his recovery. My efforts failed to keep the old man’s life, and my father passed away on January 29, 2020. The parting between life and death at this time seemed particularly sad, and I could only use my own unique way: I knelt down 91 times with my legs supported by one hand to bid farewell to my 91-year-old father.
Before I could recover from my grief , a series of unforeseen changes occurred in my family. In the face of life and death, the injured arm was nothing to worry about, and recovery was long forgotten by me.
It wasn’t until a year after the injury, when the major changes gradually subsided, that I realized clearly that my arm seemed to never return to the way it was before.
nearly 60 years old
I need to pay more attention to my health in the future
Having traveled to several continents, I have always had an unfulfilled wish: to travel to Antarctica. However, after this injury, especially because of my poor recovery state, my body and mind made that dream far away. 3 years later, I still can’t fully straighten my arm , and it still hurts when the weather changes drastically. Fortunately, it was my left hand that was injured, and I don’t feel that it has significantly affected my daily life and work.
I was hospitalized the other day with a sprained lower back. After the doctor’s examination, he said that I was nearly 60 years old and had severe osteoporosis , and I must be careful not to fall in the future, as it is easy to fracture. And I just accidentally fell my tailbone not long ago . Maybe it’s because my body inevitably degenerates as I grow older; maybe it’s because I haven’t exercised enough in the past few years, so that my muscles are reduced and weak; maybe it’s because I haven’t been exposed to the sun less , coupled with the lack of timely supplementation at an age that is prone to calcium deficiency, the body is seriously deficient in calcium; maybe I did not realize that I have reached the age that should take care of myself, and I can no longer ignore my health like I did when I was young … In short, I feel The age of easy wrestling has come.
The fracture experience made me understand: impermanence is the normal state of life. Conservation or surgery, whichever you choose has its own advantages and disadvantages. The only thing you can do is to face the pain of life. Make scientific analysis, make decisions without regret, and bravely bear the results of your choices. Of course , if conditions permit, everyone must cooperate with doctors for rehabilitation exercises.
Recently, I saw a report that 3D brace technology can replace plaster fixation. It is hoped that it has become a result that can be used safely and reliably in clinical practice.
doctor review
Zhang Shurong | Attending Physician, Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University
The “medial epicondyle avulsion fracture” suffered by the author is also called “baseball elbow” . As the name suggests, it’s actually more commonly seen in teenage baseball players. Due to the timing of the formation of the ossification center of the humeral head, the bones here are more fragile in adolescents aged 14 to 16. This sports injury is caused by excessive stress on the medial condyle of the elbow joint when the upper body is raised and the elbow is swung at an accelerated pace.
Of course, patients don’t get sick according to the textbook. The author of this article apparently suffered an avulsion fracture due to the violence of the downward pull and rotation of the elbow joint during the fall.
Every patient’s illness process is a unique story. Therefore, each treatment plan includes the doctor’s individualized analysis of the patient, there is no best, only the most suitable . Let’s follow the author’s diagnosis and treatment experience to see how to deal with each stage:
How to deal with the acute phase?
Within 24 hours after the fall, the author achieved “I wore a simple nursing belt, tried to avoid touching, and raised my arms as much as possible to reduce congestion and swelling.” In fact, this is the “R” and “E” in the acute injury RICE principle, namely rest (Rest) and elevation of the affected limb (Elevation) . If you can ask for some ice packs (Ice) at the airport or insist on ice packs at home, you can better control the swelling and bleeding of local tissues, and at the same time slow down the pain nerve conduction, which can relieve pain effect.
The correct method of ice compress is: put a certain amount of crushed ice into a watertight plastic bag or other bag to make an ice pack, and apply it to the affected area (if you are afraid of frostbite, you can put a wet towel or bandage) on the affected area for about 20 minutes. Stop when numbness is felt. Then rest for 2 hours and apply ice again. Generally speaking, within 48 hours after the injury, apply ice for 20 minutes at intervals of 2 hours. Do not apply heat during this period, so as not to aggravate inflammation or swelling.
The “C” in the RICE principle refers to compression , which is also to reduce swelling and bleeding. Under the guidance of a doctor, elastic bandages can be used to gradually wrap the limbs from the distal end to the proximal end, or pressure gloves or compression stockings can be used to apply appropriate pressure to the local tissues and reduce the aggravation of swelling.
Surgery or conservative treatment, how should I decide?
Not all avulsion fractures of the medial epicondyle require surgery. However, for injuries that require surgery, if only conservative treatment is used, it may cause irreparable consequences, such as difficulty in flexing and extending the elbow joint. Therefore, the doctor will stage and type the injury, and comprehensively consider the patient’s own situation, and finally give appropriate advice.
Avulsion fractures of the medial epicondyle of the humerus are divided into four types according to the Watson-Jones classification:
Type I: Only fracture or epiphyseal separation with little displacement.
Type II: The bone fragment is displaced downward and rotated forward, reaching the level of the joint.
Type III: The fracture fragment is embedded in the joint, and there is subluxation of the elbow joint.
Type IV: Posterior or posterolateral dislocation of the elbow, with bone fragments trapped in the joint.
Watson-Jones classification丨Vrettos BC, Hoffman EB. Condylar fractures in children: fractures of the medial epicondyle. In: Stanley D, Trail IA, editors. Operative elbow surgery, 1st ed. Edinburgh, UK: Elsevier Health Sciences UK; 2012 pp. 65–6
If the fracture displacement is not obvious, then conservative treatment is a more appropriate option for some patients with low exercise requirements. For patients with type III or type IV, the risk of joint lock and neurovascular injury is likely to occur. Therefore, active surgical treatment can better improve the long-term function of the patient. For patients with type II injuries, if they have a large amount of activity, high exercise demands, and hope to resume sports quickly, surgical treatment combined with active postoperative rehabilitation is a more appropriate solution.
Conservative treatment is not easy, we must pay attention to all aspects of the body
In fact, I didn’t realize until the end of the article that the author was nearly 60 years old and was later diagnosed with osteoporosis. No wonder falling would cause fractures. For such patients, comprehensive treatment in the course of conservative treatment is more important.
First of all, during the braking process, in order to reduce muscle atrophy, muscle strength training should be added : such as finger exercises, forearm and upper arm muscle electrical stimulation training. After removing the plaster fixation, the patient needs to accept the release of the joint range of motion to restore the functions such as flexion and extension of the elbow joint.
The use of 3D printed braces mentioned by the author is still very “fashionable” at present. Traditional plaster is bulky and stiff, but 3D printed braces have the advantages of good fit and lightness, and are increasingly being used clinically. But no matter what kind of brace, it is necessary to avoid the disadvantages of excessive fit that causes compression on the tissue . If there is increased limb swelling and darkening of the skin color as described by the author, it is necessary to immediately release the immobilization and replace the brace.
In addition, considering the age factor of the author, it is also necessary to pay attention to nutrition , such as supplementing nutrients such as vitamins and minerals when necessary. In terms of life, it is recommended that the author get more exposure to the sun, and pay attention to eating enough protein-rich foods such as meat, eggs, and milk.
The sharing of personal experience does not constitute a diagnosis and treatment recommendation, and cannot replace the doctor’s individualized judgment on a specific patient. If you need to see a doctor, please go to a regular hospital.
Author: Tranquility
Editors: Shen Xuan, Dai Tianyi
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