teribble triad elbow

[mikeseid121]

Hi Dr T In 2008 I fell off of a roof and sustained a terrible triad injury to my elbow. my elbow was reconstructed within a week of the accident with an artificial radial head I then developed herterotopic ossification and lost almost all of my range of motion. I also had ulnar impaction from the accident and could no longer take the pain I had the wrist shortening or lopresti surgery? done 6 months after the accident and then had surgery for the HO a year after the accident. I developed an infection from the HO surgery and was hospitalized for 2 months they finally had to remove the artific radial head because of the infection. for 2 years I suffered constant pain grating clicking locking my range of motion is unbeleivably good but the pain is truly very diffacult to live with my mental state is very poor over this. I was finally able to get medical coverage after 2 years of disability from medicare and went to the rothman institute and had elbow experts evaluate my elbow they said at 52 they would absolutly no way do a replacement, and they said because of my history of infection the procedure of lining the joint with a cadaver tendon couldnt be done. and even though my elbow is loaded with bone spurs and loose foreign bodies they said debridement would not help the only thing that would help me was fusion which I am against The Dr appologized and said there was nothing they could do for me and refered me to a pain clinic. I feel that they were afraid to treat me because of my risk of infection I am very depressed now. I refuse to become dependent on pain medication Im hoping you may have an idea by looking at my xrays

[mtomaino]

Michael

I am sorry you are having so much pain---and agree that at 52 the risk of early failure of a total replacement warrants moving ahead with that option with considerable caution.

Regarding your "risk of infection", in general---if you were treated with debridement, radial head removal and antibiotics, an aspiration and culture might be a safe 1st step to ensure that another operation would not be contraindicated by persistent infection. That having been said, there is always the risk of recurrent infection.

My sense, from looking at your x-rays , is that an interposition arthroplasty is not going to reliably provide pain relief.

I am wondering whether you have instability/laxity, whether your ulnar nerve function is okay, whether your pain is at the extremes of motion or throughout the arc, and how much you can flex and extend?

Your x-rays show that some joint space is present, so I am wondering whether a contracture or bone spurs may be causing the majority of your pain, in which case a joint debridement and capsular release might potentially be helpful.

[mikeseid121]

Thanks for replying Dr. Im ok with holding off on the replacement and Im ok understanding that an interposition arthroplasty probably wouldnt help. as far as infection my Dr ordered blood work last week and i am infection free as far as instability/laxity he didnt do the test that you show on the video for my elbow but he did do it on my wrist and forearm and they proved to be very unstable so I asked him if he replaced the radial head that was removed 2 years ago because of the infection and he said it wouldnt do anything to help. Again im in a tough spot they already took bone from my ulner wrist it so making it shorter is not an option but there is nothing to keep my ulna bone from continuing to migrate down and impacting my wrist. In your opinion putting a new radial head a rediculous idea? As i said earlier in spite of the condition of my elbow i do have very good range motion since the HO surgery its just that it is painful. My ulnar nerve function seems to be good with very slight numbness in my hand and ring and pinky finger. As far as a contracture nothing was mentioned in refrence to that in 4 visits to the Dr maybe because my motion is good? But when they did the CT scan he pointed out many bone spurs and loose foreign bodies that could be removed, but I do whole heartly believe that they were afraid to treat me mainly because of my history of infection and the risk of future infection
I guess from a business standpoint it is a good decsion to pass on me my question to you Dr tomaino is would I be wasting my time pursuing help and relief or should I just accept it the way it is and move on?

[mtomaino]

Mike
In order to "close the loop" on this, another opinion/perspective might be worthwhile, if for no other reason than to reassure you that you might best live with things---or alternatively, that you may want to pursue something additional that might help. I am happy to see you if you like.
Best to you!