Thursday 23 August 2001  

08:00  I was out with Paddy in Jaranda Street, Berowra.  He always likes a good run, but as I am not the fittest, the only way to keep up with him is to ride a scooter.  This morning he spied two dogs about 200m ahead of us and took off.  I still had hold of his lead, so I also took off.  I estimate our speed at around 40 km/h.  Once we caught up to the other dogs Paddy pulled sharply to the right.  What followed was a spectacular demonstration of: 

Newton's First Law of Motion (Law of Inertia): Every body continues in its state of rest or of uniform speed in a straight line unless it is compelled to change that state by forces acting on it.

The above law, combined with gravity, caused me to tumble from the scooter onto my left side.  I instinctively broke my fall with my left hand.  Final score: Road 1, Peter 0.  I became nauseous and had to sit on a rock wall for a few minutes. Paddy and I then walked the remaining 200m back home.  It was difficult to keep him under control, as I only had the use of one hand and needed to carry the scooter as well, and was in considerable pain.

Once home I informed Anja that I wanted to go and get X-rayed because I suspected I'd broken my wrist.  She bundled everyone into the car and took me to see the local doctor in Berowra.

09:30 X-rays pictures taken revealed multiple fractures.  I was immediately referred to the same hand specialist who operated on me last time.

(click to enlarge)

12:50 The staff at the Hornsby Hand Centre all remembered me.  We all had chuckle.  Dr. Ian Edmunds (orthopaedic, hand and elbow surgeon) ordered a CT scan, as it was not possible to determine the extent of the damage from the X-Rays alone.  Anne Wajon (hand physiotherapist) remodelled the splint from last time, and made a new splint for my thumb.

(click to enlarge)

Monday 27 August 2001  15:00

CT scan day. I had never had a CT scan done before so was a little curious.  I'd heard all sorts of descriptions, but decided to reserve judgement. The nice lady had me take off the splint, then lie left side down with the left arm outstretched, grabbing hold of the edge of the 'tray' which was attached to the table (not shown the picture here), so that the wrist was in clear 'view' of the machine.  She strapped me in position.

She left the room and then the table magically levitated and thrust me (with arm still attached) through the hole.  I then had to hold every part of my body still for several minutes while the machine whirred and clicked. (By the way, getting a CT scan hurts about as much as having your photograph taken). I moved my foot once, and she scolded me (nicely!) via an intercom: "I would ask you not to move any part of your body".  After several minutes I was allowed to relax.  (Did that mean I could move again?) The lady appeared again and told me I could get up - phew!

It will take her a few hours to process and report on the images, so when I have them I will update this site again.

The CT scan report for those for whom this makes sense:

CT SCAN RIGHT [sic] WRIST

"Volume acquisition has been obtained and images are displayed in the axial, coronal and sagittal planes. 3D reconstruction has been obtained.

There is a mid carpal fracture with a transverse fracture through the waist of the scaphoid.  This is not significantly displaced.  There is continuation of the transverse fracture line with a comminuted fracture through the base of the capitate at its proximal end.  Alignment is satisfactory.  There is a continuation of the fracture line medially with a comminuted burst fracture of the triquetrum. There is slight separation of the fragments although the position is acceptable.

No other fracture is seen.  There is normal alignment of the radiocarpal and intercarpal joints."

The 3D images are quite good, but I have no reliable way to capture them for the web just yet.  (I'm thinking about it...)

So, what will the doc say tomorrow morning?

Tuesday 28 August 2001 08:30

I visited Dr. Edmunds again this morning.  The following surgery is planned:

1. Closed reduction internal fixation (CRIF) left thumb. Kirschner-wire. Item # 47303
2. Open reduction internal fixation (ORIF) left scaphoid + capitate. Mini-acutrak. Item #'s 47357, 47351 

The triquetrum will (need to) mend by itself.  I will be in hospital from Thursday afternoon till Friday morning.

Thursday 30 August

Surgery in Sydney Adventist Hospital, Wahroonga (a.k.a. "The San")

I paid the $200 gap upon admission. The estimate of Accommodation & Theatre Services was as follows: 1 day of accommodation: $543. Surgery $604.  Total $1147, which my health fund would pick up but charge me $200.  [I actually stayed 2 days, and had more surgery performed than estimated, so it'll be interesting to see how this pans out.]

I went under the knife around 16:00, and woke up in Recovery just after 19:00.  Later, back in the ward, I was put on Patient Controlled Analgesia (PCA), which meant I could request that the machine give me 2ml of morphine every time I pressed a button - minimum time interval between doses of 5 minutes.  

The picture (click to enlarge) shows the 6 screws from the previous operation, and the 2 new ones inserted today.

Friday 31 August 2001

By the morning I was unable to even lift my head because of the nausea, so I asked for a different painkiller. I declined Panadol Forte (constipates me leading to severe headache, because of the codeine content) so I was put on Di-Gesic, but that gave me diarrhoea and made me itchy.  I was given a shot of Toradol, which didn't seem to kick in for several hours.  

Dr. Edmunds visited me today and explained the surgery he had performed.  He found more damage than either the X-rays or CT Scan had shown.  The scaphoid fracture was also comminuted, and the other fractures so bad that he needed to perform a bone graft, extending the incision and taking some bone from my radius (big forearm bone).  He inserted two screws (scaphoid and capitate) and a wire, as planned.  The screws will stay in, but the wire in my thumb will be removed (by pliers!) in 3 weeks' time.  He also stated that because of the extensive damage, the risk of eventual avascular necrosis had increased.  I had originally intended to go home today, but because of the pain and the side-effects from the drugs, stayed in.

(click to enlarge)

Saturday 1 September 2001

I was put on Tramal this morning, which seemed to control the pain a little better.  I still suffered from bloating and diarrhoea during the night, but it had settled by mid-morning, when I was discharged.  During the day the pain radiated from hand to shoulder, but was mostly under control.

Sunday 2 September 2001

I had to get up during the night and take tablets because their effect had worn off.  I took me quite a while to get back to sleep.  I suffered spasmodic pain during the day, reasonably controlled by Tramal capsules. The throbbing pain is mainly confined to the wrist, but occasionally radiates about. 

Tuesday 4 September 2001

A Kirschner wire sticks out of my thumb.  This is not in the least bit painful. I am not looking forward to this coming out in a couple of weeks. I am continuing to experience pain in my wrist.  

(click to enlarge)

Friday 7 September 2001

Yesterday the plaster cast was removed and a new black fibreglass put on. The K-wire is still in place.

(click to enlarge)

Thursday 20 September 2001

Dr. Edmunds pulled the K-wire out of my thumb this morning. He warned me beforehand that some patients faint, and would I prefer to lie down.  Sure!  I lay down and he proceeded to gently pull the wire out with pliers.  It hurt, but wasn't too bad (better than the dentist!).  The picture shows the actual wire that was in my thumb for three weeks. The Band-Aid covers the hole made.

Anne made me a new thumb splint (not shown in picture).

There should be no need for any professional attention for the next 4 weeks.

Wednesday 10 October 2001

Here is a summary of costs so far.  There will be more hand therapy. I am still unaware of the hospital charges.  The gap payment was $200.00.

Thursday 18 October 2001

I had the cast sawn off today - finally!   Although I can now scratch my arm whenever I feel like it - hooray - it actually hurts more because the wrist is very sensitive to any movement.  Range of motion is disappointingly limited - this will greatly improve I was assured by both Christine the hand therapist and Dr. Edmunds today.  I need to do exercises every four hours to improve mobility.  There is considerable atrophy, but the scar looks fine.  Dr. Edmunds was pleased with the healing in the wrist so far after examining today's X-rays, but the thumb joint is not as promising.  It has not aligned properly - despite the K-wire, and so it's likely I will experience some arthritis in the next ten years.

Upcoming appointments:

• Thursday November 1, 2001 - 15:40 Hand therapy
• Thursday November 29, 2001 - 10:30 Dr. Edmunds (after getting more X-rays)

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