A Thick, Ugly Humerus Story

[wesleycomerer]

I broke my arm on October 30th, 2005 while landing after a two-hour ridge soaring flight from the Pulpit. I flared late and attempted to run it out in soft, ruddy ground in the northwest corner of the upper field of the Pulpit’s main LZ, but I lost my footing and fell forward. I think that I put my arms forward in defense and snared my right arm under my base tube. Airborne above a few hundred feet, John Simon, the only witness, saw a “hard whack”. John, Cragin, Carlos, Mark, and Scott tended to me and packed my undamaged Eagle. My parents, who live in Chambersburg, fetched my car, my wing, and me from the parking area and drove me to Chambersburg Hospital. Cragin splinted my arm with my tip battens, so I made quite an entrance walking into the ER with metal rods protruding from me.

My right humerus (shoulder-elbow bone) was in three pieces; the break was near the bone’s midpoint. Two shards of almost equal length—one jointed to the elbow and one to the shoulder—were angled outward. We didn’t need X-rays to know that—both shards were ready to punch through my skin. A third, smaller bone fragment was held in place where it belonged by the muscles to which it was attached. Surgeon Roger Robertson, the duty orthopedist, scheduled surgery for the following day, Halloween ’05. We knew that I traumatized the radial nerve—a vital conduit of signals to-and-from the hand and along the arm—because the limb was numb to surface touches. The ER X-ray-ing was the most painful part of the hospital ordeal, and it was quite painful, because the techs (two attractive women, of course; not Cragin, whose well-executed splinting hurt little) manipulated my arm to place the films.

After surgery I woke in a terrible state and I was irked that Dr. Robertson debriefed me while I was fighting for lucidity. He said that the surgery was successful. He explained that he inserts hardware according to the principle of ‘minimum fixation’ and that he and the other doctors who participated in the surgery discussed the fixation and inserted two screws and not a plate. That was fateful. It has a sensible rationale: Plate insertion requires stripping muscle from bone, and it’s via muscle that bone receives nutrients needed to heal, so if you strip muscle and insert a plate you have a stronger fixation but the bone pieces take longer to fuse. Additionally, plate insertion increases the risk of radial nerve entrapment and impairment. If I could have considered the doctors’ decision, I think I would have figured that Dr. Robertson and his partners knew what they were doing and that because I was unconscious and ignorant and without recourse, anyway, I could only let time tell. But I was cognitively overwhelmed by my attempt to pay attention to the syllables Dr. Robertson was articulating and I didn’t consider the fixation for almost three months—the time that told.

The post-op X-rays looked good: The main bone pieces were aligned. The third, non-fixated piece looked removed to me, but Dr. Robertson assured me that it was in fine position and that it would fuse in place to form a stronger bone than I had before the break. After a week at my parents’ house I came home to Sterling and figured out how to function. I wore a Humerus Fracture Brace—a smart, multi-paneled, hard plastic contraption that cinched tight around the arm with Velcro straps—and I wore a hand splint that prevented the unmanly wrist flopping to which I was helplessly inclined. A sling housed the arm with brace and splint. Dr. Robertson instructed me to not remove the brace but to remove the splint for hand and wrist exercises that were proscribed by a Chambersburg occupational therapist. I borrowed a car with an automatic transmission and manufactured day-to-day procedures.

My work supervisors razzed me personally (“Hand Gliding!?”) but were gracious about my employment; my boss granted me indefinite leave. The first three weeks were uncomfortable but follow-up X-rays looked good—we saw calcium forming at the seams—so Dr. Robertson cleared me to remove the brace to shower; I did so and immediately felt better. For the next two months I enjoyed a Sartre-ian coffee shop lifestyle. (I still don’t understand the many people who asked, “Don’t you get bored?” No, I didn’t. I paid homage to Sartre and his post-prison-camp wartime lifestyle by reading his (translated) Roads to Freedom series amongst many other books, and I finally got my money’s worth out of my Netflix account.) A month after surgery I began biweekly sessions with an occupational therapist, Lan Tran. We worked on radial nerve rehabilitation—hand control and strength exercises—and we stretched the shoulder and elbow, but we didn’t stress the bone.

At the beginning of January—two months after surgery and after one month of therapy—we introduced, on doctor’s orders per more good X-rays, more ambitious motion exercises and lightweight strength routines. By then I used the limb for any activity that did not bear more than a few pounds or require abduction—the motion of the arm away from the vertical place of the body. I typed, used keys, ate and drank, etc. I realized that working through gears 2-4 of my Subaru put no more strain on the bone than many of my exercises, and that I could put the transmission in 1st and reverse with the left hand and neglect 5th, so I happily reassumed my natural human condition and returned the borrowed automatic to my bemused girlfriend.

I returned to work in January 2006. (I could have returned sooner; I held out as long as I could.) I trekked to Chambersburg at the end of January for what I knew would be my last visit to Dr. Robertson. I didn’t mind returning to him for follow-up while I wasn’t working (The visits allowed me to see my grandmothers, one of who passed away in the Spring, and I got to know the bookstores and coffee shops in Chambersburg.) but I planned to switch to a local doctor when I resumed work. Dr. Robertson and his physician’s assistant, Danielle Mason, entered the room with pale faces, put the X-ray films on the reader, and stared at the films as if the X-rays might look better in the examination room than they did in the hallway. It took me a few seconds to take in the sight and I asked, in stunned seriousness, “Are those my X-rays?” Dr. Robertson said yes and asked me about my arm’s sensations, the conduct of therapy, and my use of the arm. With the radial nerve healing I felt all manner of sensation—pain, tingling, tightness, etc.—but I had no event in the previous month, in therapy or otherwise, that felt unusually unusual. The X-rays revealed an angulation—a misalignment of the two main bone spurs, and a nonunion—a gap. The two screws appeared to barely hold the bone together. Dr. Robertson doubted that the bone was stable; I moved the arm while he cupped his hand around the break point, expecting to feel movement between the fragments. Robertson said that the situation was bad: The surgery of almost three month previous had partially come undone, the bone lineup was probably not stable enough to heal, and I would likely need another surgery.

When my brother-in-law Jim, an anesthesiologist, saw my initial emergency room X-rays, he could only chuckle, “Nice one, Wesley,” but when he looked at these films he grimaced and said, “Eew, that’s ugly.” My sister Andrea, an occupational therapist, looked at the films and said, “That’s an O-T’s worst nightmare.” Dr. Robertson stopped my therapy and severely restricted my arm motion, and he proscribed an electronic bone growth stimulator. He said that a second surgery might damage the radial nerve—that I might end up with a straight bone but a gimpy arm—and that we would wait six weeks to see if the bone might heal in the position that it was in. He was clear that, surgery or not, my optimistic prognosis was history—my humerus would take a long time to heal either way and the final outcome was not certain. Was the bone under-fixated to begin with? All of the subsequent specialists said that it was, but they have it easy like that. Was the therapy overaggressive? Who knows? Lan seemed perfectly competent and prudent as we progressed with motion, but what do I know? Did I overstress the bone? Maybe… I always tried to do something new with it. The only judgment I can make—and I’ve mulled it all over too many times—is that the surgery did not fixate my humerus enough to withstand the forces that were applied to the bone. Of course, It’s my arm; Dr. Robertson and Lan Tran have surely forgotten about me by now.

In late March I went to Janet Baker, a Sterling orthopedist. The appointment was brief. I didn’t meet Dr. Baker; she communicated with me via her physician’s assistant, Dan Duelm, who was sharp. Dr. Baker apparently looked at the new X-rays and identified me as a candidate for a complicated surgery, which she does not perform, in which an orthopedic surgeon works with a neurosurgeon. I left the office in a bad state and made an appointment, per Dr. Baker’s referral, with a specialist at Georgetown named Scott Edwards. I did not like Dr. Edwards (He veritably has ‘Hotshot’ tattooed on his forehead.) but I trusted his professional judgment. Edwards quickly decided that he would not immediately operate. I saw in the X-rays what he saw: The positions did not change since January and fusing bone growth was evident, although the gap looked enormous. He said too many times and in an alarmingly smarmy manner that if I went to enough doctors I would find one who would operate immediately, but he was self-assured in his judgment that although it would take a long time to heal as it was, as long as I continued to fill in the gap I was at greater risk of terminal impairment if we took the bone apart and put it back together with more fixation. In September Edwards conclusively decided that he would not operate. I asked him if my humerus would heal to full strength; he evaded the question.

I no longer had reason to journey to Georgetown for follow-up, so in February (’07) I returned to Dan Duelm (the PA in Janet Baker’s practice) to spend more time watching paint dry. Dan had not seen me in eleven months; he said that he did not remember me until he saw my X-rays. I appreciated his candor despite that it reminded me how screwed I am. These latest X-rays, from fifteen months after the accident and surgery, look as I expected: The inside curve of the bone (it’s not supposed to be curved, you know) is smooth and strong. The unfixated bone piece fused into good position and forms the pivot point of the main pieces. In the gap along the outside curve we see more calcium than we did in September. If it fills in then I’ll have a very strong humerus with an ugly bend at the bone’s super-thick midpoint. Dr. Robertson, Dr. Edwards, and Dan Duelm concurred throughout that if the bone heals in that position then I’ll be fine.

I figure my nerve function at 90%. I’m slightly numb along the top of the hand—it may or may not ever improve—but I’m not functionally impaired. I don’t know how much weight the bone could presently support. I don’t test it, but I put moderate strain on it to inspire the healing. I stopped wearing the brace last Fall; I go through day-to-day and work activities with full range-of-motion and without any apparent injury, but I avoid heavy lifting and weight-bearing abduction. Dr. Edwards talked around prognosis; Dan Duelm is candidly uncertain. I’ll go back to Dan in May and we’ll look at it again. I can fly a hang glider in the air, but I won’t yet try carrying and ground handling, so at least until Summer I’ll only dream of flying. Thanks for your well-wishes; I appreciate them.

[Flying Lobster]

Man, I feel for you buddy! I had a bad crash in 1995 that almost killed me--my right humerous split in half along it's length and then buckled about midway in the thick area--sounds similar to your break.

I was extremely lucky in that I was near Charlottesville and was taken to U VA at Charlottesville hospital--one of the best in country. I was pretty toasted on morphine much of the time--but I distinctly recall that the docs had teams that carefully weighed the options and did a great job of presenting the pros and cons of every operation to me. They wanted to operate on my spleen, which was hemoraging and losing blood, and they mentioned pinning my arm up for a faster recovery and greater probability of range of motion.

I ended up declining the operations in both cases, as the bleeding finally slowed down and I was willing to take a slow recovery with possible restricted arm movement.

I've broken lots of bones, but the recovery of this took longer and was more painful than any other. A combination of impatience and a desire to regain range of motion made it easy to push things too hard. Always be suspicious of a doc that promises a short period of recovery, like a promised glider delivery time it will end up taking two or more times longer.

9 months later I was cleared by my PT to resume flying--and I tried PG at a training hill and found I couldn't even steer the glider and ended up flying into the bushes--good thing I didn't try HG or I might have crashed again and really screwed things up.

Don't underestimate the effect of diet and homeopathics on the bone mending process. It took years, and I now have a big lump in the middle of my arm, but I eventually regained full use of my arm and I'm told the bone is even stronger now than it was before the accident.

Good luck,
marc

[huddlec]

My sister was in an auto accident while driving from CA to VA (moving a household). She was in the hospital for several days and spent months on a leg bending machine to make sure her knee stayed workable. After several months of that, she went for some x-rays to see how it was coming along, and was told it was doing fine and was approved for walking on the leg that had suffered the break. She went back for another x-ray a couple of months later and this time they did a different angle and caught something they didn't the previous time - that the bone wasn't healed nearly as well as they thought. She was put back on the machine, really bummed. But it finally healed and now she's able to hike on rough terrain at a decent clip. While stuck on the machine, she got in a bunch of reading, and watching tv shows in French (to improve her French), and really learned patience, which she already had a lot of, having had a home day care business for 20 years.

Take care,
Christy

[Matthew]

Holy CRAP!!! That really sucks. I'm glad you are finally on the mend. Karen has a slight bend, kink, in her arm from when she broke her humerus. They told her that over time (like 20 years) the bulge in the bone at the break would smooth out. She also had to use the electic bone stimulator. And X-rays a year later still showed the gap. I had to fight with the X-ray technicians and doctors a lot becaues of the poor quality of the X-rays. Often they were overexposed and didn't show any regrowth. It was only when they tuned down the power, after my complaints, that the X-rays showed bone growth in the gap.

Doctors. Hrrrmmmmphhh!

Anyway. on the bright side maybe you're one arm might be a little longer than the other as with Karen. It's an advantage in rock climbing. When we are climbing together and Karen has trouble reaching a handhold, I yell--

"Use the monkey arm. Use the monkey arm!"

Get well.

Matthew

[deveil]

at my request, my physical therapist prepared and then spent a whole session going over the catscan xrays of my five lower vertebrae and pelvis with me. i was impressed by all one could see and how it related to what i was experiencing. this is by way of asking whether catscans are done of injuries such as wesleys and if so, using his experience as a cautionary tale, whether it would be helpful to tuck that in a corner of ones mind.

[Paul Tjaden]

Guess I'll chime in with my broken humerus story. I recieved a spiral fracture of my left humerus about three years back during a botched attempt to land while a thermal was kicking off. It seems I was lucky in that the injury healed fairly quickly and is only moderately bent now. I had complete loss of feeling and use of my arm, hand, etc. for several minutes after the accident but it all returned quickly. Scared the hell out of me for a while though.

Sorry you are having such a hard time with yours but it sounds as if you are finally on the right path. When you feel that you are ready to try flying again I highly recommend that you get your butt to a flight park and do a tandem with a qualified instructor. There is no better way to find out if all the right muscles are working and it will help knock off some of the rust. I also spent a bit of time landing on wheels before going back to foot landings.

Good luck,

Paul

[Joe Schad]

Wesley,

Keep working at the recovery. You will know when it is time to do more. Each day that you are alive is the best part however, even if you are not flying.

Joe

[brianvh]

Wow, sorry to hear about that Wesley...but remember, all the time you don't spend flying you can spend learning things you'd never take the time to do otherwise. While stuck at home with my back I learned some nifty programming techniques that made such a change in my life that I've ended up giving seminars at places like NASA. No kidding.

Once it heals all the things you normally love to do with a fully functional arm will still be there. Enjoy exploring other aspects of your life for now, but remember that we miss you!

[hepcat1989]

I am just now reading this Wesley.Wow, man. Heal yourself. Don't neglect your supplements as far as some whey protein powders and some calcium supplements.Talk to your doctor , they may speed you along.It's tough to get all the protein down your neck when you're trying to heal up.
Hope to see you soon Wesley.....
Peace, Shawn.

[mcelrah]

Hey Wesley,
I'm offering trike rides if you need an airtime fix. Sallie wants me to post that her wrist, broken a year ago in a bicycle accident, is still bothering her. Bicycling?! A grown woman! She should be seated on the couch eating Fritos like a mature adult!
- Hugh