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  1. #1
    mtbr member
    Reputation: Rollin'in'Zona's Avatar
    Join Date
    Mar 2004

    Caution;  Merge;  Workers Ahead! Titanium in my Elbow! Great pictures! (long post)

    This happened a few months ago, but other MTBR members have encouraged me to post it up:

    On October 4th I washed out on some loose gravel after landing a small drop – no big deal. The washout occurred on a narrow, sloped ridge, and the fall was very slow speed, cartoonish almost, so I chose to stick my left arm out to keep from rolling off the cliff. Somehow, at the last instant before I hit the ground, my bike caught on something and sort of "sling shot" me into the ground at an accelerated rate - I landed much harder than I expected on my open left palm.

    The sound from my elbow was that of breaking several pencils at once. I looked down and saw the radius and ulna sticking 2 - 3 inches out of the back of my arm (triceps) @ almost 90 degrees to the upper arm! It looked like special effects in a horror movie. At least the bones didn't break through the skin! I instantly put the cup of my elbow pad over the bones and reset it myself on the spot. Again, sounded like snapping pencils (for an instant I thought I was going to vomit). The sun was down, and I thought my elbow was "fixed", so I insisted my friends go on while I sat for a few. They waited a mile down the trail, and when I arrived, pedaling with one hand on the bars, they cheered and figured I was okay - and heeded my suggestion that they hammer out of the woods before complete blackness set in - I'm the uber outdoorsy one, the darkness dosen't bother me. But about 20 minutes into my one-armed solo ride out, as the endorphins began to wear off, I realized something was seriously wrong. Unable to ride at this point, I hiked out many miles with my 40 lb bike in one hand, in the dark, and eventually drove myself home.

    Having worked in ER's, I knew the wait could be hours, and being sweaty, stinky and hungry from a 5 hour ride/hike, I showered, splinted my arm properly, cooked a meal, and then drove to the ER.

    Somewhere in there I remembered a phone call I’d just received the day before - my medical insurance through a past employer had been terminated on the 30th - just 4 days prior - and I had not yet picked up new coverage... F%#K!!!!! The timing was uncanny...

    So the guys in the ER did their thing - x-rays, cast and hydrocodone ($1300)... Yup, the films revealed that there was a good sized bone fragment floating in my forearm. The ER doc initially thought it was a piece of the radial head, but I pointed out that I had full rotational articulation with no associated pain, so it simply could not be the radial head - must be the ulna... all agreed...

    The next day I went to the "sports medicine" orthopedist the ER doc had recommended. He glanced at my x-ray and came up with a dignosis in seconds. He ordered a CT scan, which he never looked at because it wasn't completed till the next day (another $3000 out of my pocket). This guy was the quintessential young uber-arrogant "a$$hole" Dr. – so cocksure he wouldn't listen to the patient (who has a background in the field and knows his body) nor consider the ER report! And he wore this super-cheesy due-rag in the office on top of it all... I showed him that it couldn't be the radial head, as the ER Dr. had agreed, because I had free rotation with zero pain, zero stiffness, no clicking, yet considerable swelling on the ulnar side. But he just wouldn't listen to me, and insisted, based on a ten second glance at the ER x-rays alone, perfoming no actual exam (he spent less than 15 seconds touching me) that he, "as the Doctor in the room", was absolutely certain the bone fragment was a thin but sizeable chunk of the radial head, and that the best, and only thing for me to do was to just go home, use the arm as much as possible, and come back in a month to have the fragment removed. ($300 for less than 5 minutes, and no exam) Well, he IS a doctor after all, and I'm not, so I trusted the guy.

    Actually, I thought, "this is GREAT! This is a MUCH better outcome than I had expected", and much CHEAPER (now that I didn't have medical coverage...) to boot!

    I was about to be paid handsomely to escort three doctors (!) and a lawyer on a week long trip in the Grand Canyon and Utah beginning 2 days from this appointment. "Looks like I'll be able to go, and the money from this trip would cover the medical bills I'd just accrued..." This doctors assesment is what I wanted to hear!

    Fast forward a few days: Even with my arm in a cast, swollen and purple, I was able to hike my marathon-running guests to exhaustion in the Grand Canyon, Bryce and Zion! Yeah, I'm proud of that! The trip went great, my abilities to perform my duties were not compromised to any discernable degree, and thanks to Hydrocodone, I was able to sleep every night... The trip was a blessing for me, actually, because I didn't have time to focus on my situation.

    By the time I returned from the trip, though, it was clear that things in my elbow were very wrong (ironically, 3 of my 4 clients are radiologists, and they themselves questioned Dr. Quack Noodle's methods of assesment and choice of CT scan).

    So I sought out, and eventually found one of "THE" elbow specialists of N. AZ. Upon exam and viewing the films, he instantly saw something very different from Dr. Quak Noodles diagnosis: The primary ligament structure that holds the elbow together, the Ulnar Collateral, which usually tears in this situation, had remained intact (happens in only 1of 840 cases!) and instead actually ripped a chunk of bone (avulsion) off the ulna (coronoid), where the ligament root inserts (apparently I have exceptionally strong ligaments...). This was the bone fragment Dr. Quak Noodle had insisted was a portion of the radial head, though I argued the signs/symptoms contradicted his diagnosis... But it's my fault for trusting him, and honestly, liking his version more than what I saw as the likely truth. (Incidently, on my initial visit to the elbow pro, I recieved over 3 hours of continuous attention from an entire staff of medical pro's, for a fraction of what Dr. Quack Noodle charged for less than 5 minutes and no exam)

    Long story short, a $20,000 cash surgery was required ASAP to reattach the UCL and bone fragment to the ulna with a custom Ti plate and Ti screws! At this point in my life, after loosing my house due to 9/11, contributing to the support of my medical student fiance, and in the "eduactional" (ie. no income) part of a career transition myself, $20K is not something I can just come up with; I was certain beyond doubt that I'd have to sell my bike, and everything else, to pay for the surgey... (I sold my car instead and have thus far kept my bike - word!)

    The Doc told me he didn't want me to sell my bike, and not to worry about that, yet... It was now more than 3 weeks after the accident. I NEEDED to have surgery the DAY AFTER the accident, but as doctor Quack Noodle had failed to do an exam and all that (though I paid him $300 cash for 5 minutes of his time)... . Every day that passed lessend my chances of recovery, so we needed to focus on getting me into the OR.

    Because this unfortunate delay seriously compromised my recovery, my new Dr., the “elbow pro”, was infuriated by the initial misdiagnosis, especially considering it was such an “obvious” injury to anybody who simply took the time to look (3 doctors interviewed me on my experience with Dr. Quack Noodle, presumably seeking disciplinary action? The misdiagnosis was so extreme, the signs and symptims so clear that even the patient himself knew which bone was affected…). My new Dr. went out of his way and made personal sacrifices to insure that I received EXCEPTIONAL medical care from this point forward, and insured that it was done on terms I could afford. SHAMLESS PLUG: Dr. Marc Mellinger @ the SUMMIT CENTER, Flagstaff, AZ, is a top notch physician, excellent surgeon, and an outstanding human being! The facility is fantastic, and every employee I met there loved thier job and workplace! Go there!

    Surgery was on Nov. 7th. I consumed excellent nutrients and pushed myself, I mean really pushed myself with physical therapy religiously (a bit of sports medicine study in college, and a lifetime of working out), to the tune of several hours a day, every day, for months.

    The result - I was mountain biking again on January 31st! 7 weeks after surgery and months before anyone expected, and at that, it was expected I'd be on a road bike initially for at least the first several months! I'm 39 years old.

    I've been riding 3-4 days a week for 6 weeks now, and hiting drops to 4 feet (I wear an articulating brace when I ride [$2200, came w/ operation]). Flexability and articulation of the joint is almost 100%. I’m riding better now than I ever have… In fact, I’d be racing DH in Bootleg Canyon this weekend if I hadn't started my new career this week...

    Happy ending

    Thank you Dr. Mellinger @ the SUMMIT CENTER, Flagstaff, AZ.
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    Last edited by Rollin'in'Zona; 02-14-2007 at 11:49 PM.

  2. #2
    mtbr member
    Join Date
    Dec 2005
    That was a great post, thank-you for sharing it.

    Sensational outcome

  3. #3
    mtbr member
    Join Date
    Dec 2006
    I believe you could negotiate with the hospital and initial quack who misdiagnosed to have them cover part of your medical costs. Honest mistakes happen, but this mistake seems to have been caused by willful negligence. That phrase will get the hospital admins cracking.

  4. #4
    Teh Original Dirt Muffin
    Join Date
    Jul 2005
    you should bargain your prices with the hospital like borat. "How much you charge per night?, 127$, we'll call it 85$ ptooey" Nice titanium=) Get better soon!!!!!!!!!!!!!!!!!

  5. #5
    Nightriding rules SuperModerator
    Reputation: crisillo's Avatar
    Join Date
    Jul 2004
    Awesome post!

    I am very glad it worked out fine in the end... I hope there is some sort of disciplinary action posible for that A$$ of a doctor that saw you first...

  6. #6
    KSC is offline
    mtbr member
    Join Date
    Jan 2004
    Quite a story. It's a good lesson and I hope others are listening. I had a similar experience, except not with an orthopedist. My original result from the radiologist in the ER was radial head fracture. I called my primary care doctor to get a rec for an orthopedist and he wanted to look at it. I go in and he does a phone call to the orthopedist office and describes the xray and tells me the displacement of the fracture was not great enough for surgery, so I should let it sit for a week and then start doing some physical therapy on it. I was getting shooting pains when I'd hit a small bump riding in the car and wasn't evening thinking about moving it, so I was suspicious.

    I went to the orthopedist he talked with and after looking at it for about 30 seconds he told me I had a broken fragment at the coronoid process in addition to the fracture. He also ordered a CT scan. Don't know if you if got to see yours, but those things are amazing. Even an idiot like myself could clearly see what was going on. Anyway, it revealed shattered bone at radial head and dislocation in addition to the other stuff. With all that damage I was laying down scar tissue like a mad man and had all kinds of loose bone. Had I taken the initial advice and sat on it for another week I think it would have been really bad news.

    I was told this was quite a rare break - he says it's usually isolated to ulnar or radius and I think as you noted the breakage at the coronoid is not too common.

    Just hope others learn something from these experiences. Probably 99% of the cases that come through these guys' office are very similar and they handle it just fine, but with something like this that doesn't happen very often, I think misdiagnoses happens more often than we'd like to believe and the consequences are potentially disastrous.

    Anyway, that's all of my moralizing for now.

    Do you have the pre-op xrays? Just curious because I noticed they fixated your bone fragment a bit different from mine. I had no plate. They ran a screw all the way from the outside of the forearm below the elbow into the coronoid process. So in your top photo, my screw is rotated about 90 degrees clockwise w/ no plate. Looks like your setup may be advantageous. I recently had the screw removed because any pressure on my forearm caused quite a bit of discomfort as the screw head protruded slightly from the bone forming a small bump outside the bone. Can you feel that hardware? Did he tell you anything about how they chose to fixate it?

    Anyway, major bummer about the no insurance. Even with insurance I paid quite a bit out of pocket for the procedure and tons of PT. I was thinking how screwed you would be without it. But, sounds like it recovered well and that's way more important than $.

  7. #7
    Still learning
    Join Date
    Dec 2006
    Should the moral of this story be "always have private health insurance"?

    Hearing this bothers me the way my knee is at the moment.

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