Severe, complicated, traumatic bone fracture nearly needing arm amputation
“It was tough. My arm atrophied, but the doctor kept encouraging me to push through.”
Road traffic accidents, while not necessarily the leading cause of fatality, pose a significant risk of severe injuries, organ loss, and even deaths when they occur.
Ryan Joseph Cooke, a 36-year-old Englishman, shares a chapter of his life in which he experienced a complex fracture resulting from a motorbike accident with severe injuries. He underwent several surgeries before eventually recovering, and he was able to return to normal life. His journey is a testament to his resilience and determination. Let us follow his story.
Dozed Off riding a Motorbike, Broken Bones, Nearly costing an arm
“I have lived in Thailand for about 17 years. I spend my spare time learning new languages, hanging out with friends, and traveling. You can say I am an inveterate biker; it is in my blood. I rode to Khao Yai, Prachuap, and several remote places but ended up with an accident in Pattaya.”
“It was around mid-2023. I joined my friends after work and stayed up late before riding my motorbike from Bangkok to Pattaya. After catching just a few hours of shuteye, I attended a meeting and went on a location scouting. In the late afternoon, my friend asked me to join him for another ride. I agreed. After that, I cannot remember anything.”
His friend who witnessed the incident said he saw Ryan suddenly hunch over the motorbike falling asleep before crashing into a barrier. His face and body were bloody. The wounds are significant, especially the ones above the right ribs. A first responder team arrived and rushed him to a hospital. X-rays revealed fractures of his right clavicle and arm in four places. The doctor performed preliminary external arm bone fixation.
“My adoptive parents rushed to the hospital as soon as they heard about the accident. My dad described my condition as severe, with exposed lung and bones. The broken bones were perforated. All my friends were shocked and deeply concerned; some stayed with me day and night and ended up getting sick and needing admission to a hospital. My sixteen dear friends pitched in two million Baht for my medical expenses because they thought I did not have insurance coverage. Luckily, I bought my insurance just four days before the accident.”
Ryan was at the first hospital for several days before moving to MedPark Hospital to be closer to his family. He was under the medical care of a team of specialists led by Dr. Jay - Dr. Pongsakorn Bupparenoo, an orthopedic surgeon specializing in orthopedic trauma.
“At the first hospital, I was supposed to have my arm amputated, but my friend refused to sign the consent form. I am a programmer; my right hand is crucial to me. Honestly, I was downcast at the time. When I arrived at MedPark, Dr. Jay said 'Ryan, it is amazing that you are still alive!' The fractures tore through nerves and tissues but miraculously sparing the blood vessels. If they were severed, the arm amputation would be inevitable. I mused to myself that if I woke up without my arm, I would commit suicide.”
Dr. Pongsakorn Bupparenoo, an orthopedic surgeon specializing in orthopedic trauma
Fighting against physical and mental pains
Injuries from road traffic accidents not only cause physical harm but also mental anguish that could result in severe stress and anxiety. As for Ryan, he faced many heart-rending events and was unable to eat, losing 17 kilograms in three weeks.
“My arm hung limply, rendering me unable to lift or work, ultimately leading to my job dismissal. I had no income, and my savings started to drain dry. I could barely get up to eat. I was depressed and hopeless. Everyone at MedPark, however, took good care of me and encouraged me. Dr. Jay always called and provided advice. He went beyond his call of duty. I became close to the staff in no time. After my discharge, I assured Dr. Jay that I would visit them when I returned. I received a warm welcome here.”
Ryan required six surgeries, including a neurosurgery due to intracerebral hemorrhage. These were trying times demanding willpower, patience, and discipline. Following the surgeries came rehabilitation and physical therapy.
“I can move my fingertips, just barely. But when I attempted to grab something, my hand would curl in and droop. The doctor advised me to persist in daily practice to stimulate my nerves. It was quite challenging for me. My arm atrophied as the muscle mass was thinning, but Dr. Jay reminded me that I needed to overcome this and said he knew I could. He estimated my best recovery would be about 80%, but I was determined to go for 100%.”
Encouragement is critical in helping one navigate through challenging times. His mother crafted a heartwarming video montage that quickly went viral on social media. The touching clip garnered millions of views and over 9,000 messages of heartfelt encouragement, and over 60 friends expressed their desire to visit Ryan at Medpark. The outpouring of support extended to his Facebook posts, which received overwhelming attention and fueled his determination to persevere.
“After discharge, I continued physical therapy at home. It hurt a lot, to be honest. I trained by grasping a bottle and trying to lift it every day. Finally, I was able to lift a bottle and drink from it. I did achieve the 100% recovery.”
“I have seen people who cannot use their legs. I understand how it feels, but one should not dwell on the current situation. I have been through tough times and recovered. For people who have lost their limbs, we cannot bring them back. But we must see the new possibilities for ourselves in the future. We can reinvent ourselves at any time. Do not lose hope.”
Complex fractures, traumatic injuries requiring proper treatment
High-energy trauma is common in motorcyclists, particularly the big bike riders speeding over 120 km/hr. In a high-speed accident, the person will tumble off the bike and sustain heavy multidirectional impacts, leading to multiple and complex fractures, potentially damaging blood vessels, nerves, lungs, head, and other internal organs.
The two types of fractures are:
- Compound or open fracture: Deep wounds with exposed broken bones or fractured ends penetrating through the skin are open fractures, which require emergency medical attention. Because there may be damage to the arteries and nerves. The risk of bone infection is high, which could result in ultimate amputation.
- Simple or closed fracture: Fractured bones without open wounds or exposed fractures are not emergencies, but require immediate medical attention. Any movement can cause the sharp end of broken bones to damage surrounding soft tissue, nerves, blood vessels, and muscles.
Dr. Jay, an orthopedic surgeon specializing in orthopedic trauma, discusses his condition upon arrival at MedPark Hospital.
Dr. Pongsakorn Bupparenoo, an orthopedic surgeon specializing in orthopedic trauma
“He had four fractures, one of the right clavicle, treated at the first hospital with open reduction and internal fixation. The other three were on his right arm, treated with an external fixator frame. In addition, he had a palm-length wound over his ribs. He could not flex his right wrist back, probably due to nerve damage in his right arm. Plus, he had intracerebral hemorrhage. The injuries spread throughout his entire body.”
Ryan’s treatment necessitated multidisciplinary collaboration. Dr. Pongsakorn performed fixation surgery for the three broken bones in his arm with Dr. Somsak Charoenchaipiyakul, a neurovascular surgeon, and Dr. Kittiwan Supichyangur, an orthopedic surgeon specializing in hand surgery. For the chest injuries, Dr. Bundit Suntornlekha was the surgeon who tended to the chest wound surgery in the same sitting.
What are the benefits of minimally invasive fixation?
In the past, external fixation was usual because of its convenience and simplicity -- small metal pins are inserted through the skin and drilled into the bone fragments above and below the fracture site. An external frame may hinder sleep and movement of the affected arm. In Ryan's case, the referring hospital performed external fixation as a stop-gap measure; it is not as strong as internal fixation. Another disadvantage is the possibility of nonunion. Because of this, Dr. Pongsakorn decided to reoperate for fracture repair.
“For open fixation with plate and screws, the wound will be 15-20 centimeters long. We planned to place a metal rod into the central medullary cavity of the bone. The rod is called an intramedullary nail. An X-ray imaging with fluoroscopy was required to guide the nail placement. We made a small incision near the end of the bone and drilled into the medullary cavity to insert the nail. The small incision allowed for quick recovery.”
“Then, we checked and repaired the damaged radial nerve. Most likely, the chance of full recovery after repair is minimal, depending on the technique used. We meticulously repair the nerve to the best of our ability. The wound over his rib was quite large and infected, requiring multiple wound cleanings in the operation room, as well as 1-2 weeks of IV antibiotics.”
The outcome was satisfactory to a large extent. Dr. Pongsakorn said most broken bones heal within 2-3 months. And for nerves, it takes about 3-6 months. Some people only recover 30% to 50% of their normal nerve function, while Ryan achieved almost 100% recovery. For his right clavicle, the team of physicians reached a consensus that revision surgery was necessary to bring the fixation plate closer to his clavicle.
“His bones fully mended in two months, and it required approximately three months for his nerves and chest injury to heal before resuming work, just in time to greet his new baby. Ryan deserves recognition for his unwavering resolve. He had foreseen a complete recovery, and I am pleased that he has admirably attained this degree of recovery.”
