This week, Victory’s expert osteopath Jonathan Grice tells us what happened when he broke a bone in his arm – and then developed an infection…
What I learned from smashing my arm up and then getting a bone infection
In 2016 I was descending a mountain in broken, rocky terrain, slipped and took a tumble. I landed on my left forearm, and granite is (unsurprisingly) very hard. Harder indeed than bone.
There are two bones in the forearm. One hinges on the humerus (the upper arm and the “funny bone”) and is called the ulna. The other rolls over the ulna, allowing you to rotate your wrist, and is called the radius. I broke the ulna in 8 places and broke the elbow end of the radius in 6 places. I could give you lots of gory details, and probably will eventually, but in this blog I’ll give you just one detail: I knew I had broken it because on impact I could hear it break and it sounded like a boot stomping on cornflakes but heard underwater.
I’m going to give a few insights into the process of recovery from significant orthopaedic trauma.
When you’re badly injured and the outcome is uncertain, you are a cork upon the ocean.
When you think about injury and its treatment, it is easy when in the middle of it, to believe that the next therapy or surgery will be the end of it. It almost never is. Recovery from surgery is bad enough without having to deal with the frustration and disappointment of your unmet unrealistic expectations. Bone takes time to heal.
The process follows this pathway: First, you will develop a haematoma, which is basically a ball of clotted blood. Anywhere between a few days to two weeks, that haematoma will form collagen fibre links to produce a soft callous. And as time goes on, the soft callous organises itself from a ball of connective tissue to a lump of mostly parallel collagen fibres along the axis of the bone it has formed on, binding the break together.
Once the soft callous has formed, it calcifies and the bone cells (osteoblasts) start organising the calcified bits into the architecture of bone. This is the hard callous. The hard callous is a lump of boney tissue. Other bone cells (osteoclasts) go into this big callous and morph it into bone with internal structure and blood vessels and intrinsic nerves. This happens from 6 weeks to months later depending on the size of the job. The reason you wear a cast or have an internal or external fixation is to stop forces from bending the fracture join which would then harden into bone.
Already you may observe, the pace of healing is pre-digital. There’s no speeding it up. The only thing you can do is drop your expectations. If you are secure in the knowledge that it will work out, that pain goes away, that you will adapt to any changes in function, and in the meantime you get on with your life, everything becomes more tolerable and less stressful. Indeed, if you are calmer and more confident, then your healing is likely to quicken.
Pain is another matter however. Pain wears away at your ability to cope. Pain affects your mood, changes your behaviour, lessens the body’s ability to self-correct. This leads to the next moral:
There is no reward in heaven for suffering pain.
That is to say, there is no pay off in terms of healing to eschewing pain killers, but also, in rehabilitation that great lie “No pain, no gain” is utterly false.
My second surgery on my arm was to remove the external fixation (the mechano of braces and steel dowels that held the fractured bones in place), install a plate to fix the ulna pieces to, and add a prosthetic end to the radius. It was going to be a long operation (4 hours) but turned into a nine-hour epic. I was wheeled back into the ward at a quarter to one in the morning.
I don’t do well on opioids. I tend to need a lot to achieve pain relief, so I get quite high before I stop feeling the pain intensely. I don’t like being high- I can’t go with the flow and struggle against it to maintain lucidity, which makes me upset. Other members of my family have similar experiences including my mother and sister, so I guess it’s just one of those inherited traits.
Because the post-operative recovery ward was closed by the time my surgery finished, I woke up in the operating theatre with one of the theatre clinicians keeping an eye on me. I vaguely remember a conversation about how they were struggling to get my pain under control and that I had had a lot of morphine already. If you have been unlucky enough to need morphine in a hospital before, you’ll know that you get a button which you can push when you need another dose. On returning to the ward, the ward night nurse warned me when giving me the button that they were worried about respiration suppression if I took any more. I tossed the button out of the bed and braced for a long night. I made a mental note that when my partner returned in the morning in about 8 hours time, she could give me the button and I could have a bit of respite.
Describing pain is a little bit like wine writing: notes of cedar and cut grass, underlying crushing cramping cold-burning electric shocks. The only thing I learned that night was that suffering physical pain is indistinguishable from emotional anguish. I am a big believer in meditation and pride myself on being one of the worst meditators around. In the thick of it, I did notice that the pain itself wasn’t the bad part, it was my emotional reaction to it. And the clock watching.
Don’t do as I did. Don’t tough it out. If you have pain, take pain relief. It might not be perfect, but it’s better than not taking it. All pain killers have side effects, but you can deal with them. There is no point in the pain and there is no benefit in terms of speed of recovery in not taking steps to lessen pain.
If you’ve had an injury and need our help, you can book an appointment with Jonathan by calling us on 0207 175 0150, or clicking the button below.