Humerus Fracture Operation - Getting My Plate

There are two main forms of reconstructive surgery for a broken humerus that I had explained to me, a humerus rod and a humerus plate. The general gist of each operation goes as follows:

Humeral Rod

This procedure involves drilling through the upper arm and clavical to open up a gap so the rod can be slid down the inside of the humerus. Holes are then drilled through the humerus so screws can be affixed to the rod, securing the break

There is a great photo of the resulting effect on this press release, however, this involves further trauma in order to open up the bone to insert the device.

Humeral Plate

A humeral plate is simply inserted into the arm having made an incision between the bicep and tricep, avoiding the radial nerve and screwed in place to stabilise the break... as model by yours truly below:

Needless to say, the incision to insert a humeral  plate is pretty funky:

As the pictures show, my surgeon decided that not submitting my arm to the further trauma of a humeral rod was for the best and instead opted for a humeral plate. The resulting surgery took in the region of 2 hours and was considerably uncomfortable at first... no surprise there. The most uncomfortable sensation however, was nothing to do with my arm, but hip. You see, they decided that a bone graft was required to stimulate recover within the gap between the bones, and took a piece of bone from my hip, known as an iliac crest harvest. The resulting scar (don't click if you're squeamish) and the sore leg that came with it, were pretty horrific.

Plenty of morphine, tramadol, diclofenac, paracetamol and 3 nights in a private room (beats sharing with "the poor old dear who had obviously left her marbles somewhere back in 1973 who refuses to sleep" again!) and I was released with an appointment to see yet another professional who we will dub: Little Miss Physiotherapy.

Broken Humerus - Time For Surgery

It's hard to believe, approaching the day of my operation, that it has already been over two months since I initially broke my arm with little to no signs of real healing or union as the doctors like to call it. It's Sunday evening, I've been called in to St Bernard's Hospital (yes, the view is actually that nice, from some rooms!) a day early, as the Dudley Toomey Ward already has a bed for me (in a private room no less) and they don't want to lose it (to someone who requires overnight treatment comes in through A&E for example).

I'm issued with theatre stockings (help stop deep vain thrombosis (DVT) setting in) and a gown, offered a bite to eat and reminded that as of midnight there is to be no consumption of solids, and no fluid as of 7am... the fasting starts, the time for surgery is upon me!

7 weeks in a humerus fracture brace - Surgery time!

A couple of nights after the brace was put on and the nice night's sleep with Mr Surgeon Man's prescription for diazepam I was out of hospital, and the next 7 weeks basically followed a pretty structured pattern:

1. Go see Little Miss Radiology or one of her associates on a Wednesday
2. Go see Mr Surgeon Man at the fracture clinic to analyse Little Miss Radiology's pictures
3. Renew my co-codamol and tramadol prescriptions
4. Carry on my day and return the following Wednesday

However, by week 7, with no signs of unison were visible in the fracture area, I guess fixing a broken humerus is harder than originally anticipated... surgery is scheduled for June 6th (a full 9 and a half weeks after the initial break) to insert a titanium plate into my arm. The parts are ordered, I have some pre-surgery tests for infections, that sort of thing and sent on my way, to return first thing on the Monday morning to finally get this sorted!

Hurrah!

Post-script edit:
My broken humerus was sure causing some funky bruising in my lower arm during those 6 weeks:

Broken Humerus - First Day In Hospital

The problem with breaking your humerus, isn't so much the break, it's how to fix it (this is going to become a running theme!) quickly and effectively... how to reduce the pain and discomfort, stabilise the break so it can heal and return the patient to as close to 100% mobility, functionality and range as possible.

A visit from the consultant orthopedic surgeon was the first order of the day. Mr Surgeon Man (no permission to name him has been obtained so I won't break privacy laws) is a renowned surgeon in his field and after reviewing my xrays decided that a humerus fracture brace would be sufficient to restrict the fracture and hold it in place so it could begin to unite. In his words, I had a "clean, mid-shaft fracture of the humerus" which was a "perfect candidate" for the use of a brace and therefore avoid surgical intervention.

Brilliant, get me fitted and get me out of here away from "the poor old dear who had obviously left her marbles somewhere back in 1973 who refuses to sleep".

Not bloody likely.

You must take note that at this point my arm from about 2 inches below the shoulder, is hanging by muscles and tendons, being supported by a backslab cast and some bandages, and that's about it. Any movement of the arm is going to cause raw ends of broken bone to rub against each other, and that's a one way ticket to PainVille right there.

Enter: Mr Occupational Therapy Man who has come to fit me with a brace. Two pieces of moulded plastic which compress everything in your arm, thus holding the bone straight to encourage union, as modelled below:

Those who are interested, there's a blurry picture of my own modelling of said brace here.

The process went something a little like this:

1. Remove backslab cast
2. Support arm from elbow to minimise disruption of the humerus
3. Try not to passout from pain
4. Request to sit down as pain is too great and starting to get that dizzy, room spinning feeling again
5. Wait a while
6. Go for it, slide both slabs of plastic around the arm
7. Tighten
8. Try, again, to not pass out from pain
9. Success

Time for a mix of Diclofenac, Tramadol and Paracetamol IV and back to sleep I go... what with the sleepless night, rest was well received.

I'm woken later that afternoon by Mr Surgeon Man who informs me that another night stay is probably for the best... I inform him that a change of room or a prescription for sleeping medication is probably for the best given the other inhabitant of the ward. He agrees, at least sleep will come easier tonight...

Broke My Humerus

Day One

With 10 minutes left to go of a game of rugby versus HMS Monmouth, a tackle which was clean in every way possible resulted in a mid-shaft fracture of my left humerus. If the prop who smashed me ever reads this, I hold no grudges, and actually kept my shirt which they had to cut me out of, in case the ship stops back in Gibraltar after your six month tour of the Gulf... Would be a great souvenir for the ship's club house (galley) and definitely beats one of those silly ties we usually give out!

I knew something was up from the second I found myself laying on the floor. The pain hadn't kicked in yet, but as far as I could tell my elbow and shoulder were relatively straight... so why was my hand under the small of my back? Had I dislocated my shoulder? My elbow? I tried to move my arm and realised it was excruciatingly painful so actually used my right hand to pull my left arm out from underneath me - and that's when the shaking started.

The pain was like nothing I have ever experienced and the resulting surgery comes a modest second in comparison. It wasn't sharp, or dull... it was hot. I remember repeating to the nurse or doctor from Gibraltar's PRMC (fortunately located right beside the rugby pitch) who had kindly sourced some entonox that it felt like my arm was on fire. The slightest movement stoked said fire even more.

A slow ambulance ride to Gibraltar's St Bernard's Hospital (not wanting to move me about to much) after the mission to get me from the ground onto a trolley and into the bus with only some more "gas & air" to alleviate the pain (the ambulance crews out here are not allowed to administer anything stronger) gets me to A&E to be assessed. More pain as some idiot pushes on my mangled, broken, floppy arm to help move me from the ambulance trolley onto the bed in A&E and my body finally gives in and goes into shock.

Blood pressure plummets to 72/50, the room is spinning, I start to feel sick and ask, nae plead, for some pain relief. "Not until your BP is up a bit". The bed is tilted with my feet raised to try and help bring it back up to "not quite blacking out" and finally we get some analgesia, couple with a backslab cast and a bed in the ward for the night opposite some poor old dear who had obviously left her marbles somewhere back in 1973 who refused to sleep.

Didn't even get a post match pint.