Compartment syndrome (Graphic picture warning!)

 At the end of February, I was heading back to Richard's room when two of his doctors stopped me in the hall.  They explained what had happened that day in surgery. They talked briefly about damage done to his hands, but really focused on his arm.  While doing surgery that day they found that the muscle had "started to turn grey," which means it is dying.  They started to remove dead muscle but explained that they would keep doing so every few days until it stopped dying.  They put in antibacterial beads to help avoid infection. They explained that over time, his arm would just be skin and bones.  They also explained that although they were not there when Richard was brought in, they had talked to those who were.  They said that none of them would have given two nickels for his survival even to that point. When they talked to me, they were not sure that he was going to make it.  I have to assume that it is because they didn't think he would make it that they made some of the decisions that they made.

Since then, we have started to understand what would cause such deterioration of muscle. As you can see from the pictures in the first blog post about the accident, Richard was VERY swollen.  When a body swells to the point that they cannot swell anymore, the body cannot deliver blood to the affected parts so the muscle begins to die.  The fact that the crushing trauma to that area was of such a force was also a factor. If the skin is split, compartment syndrome might not occur.  Therefore, if you or your loved one is swollen to the point that the pictures show here, and there is significant injury to an arm or leg especially, talk to the doctor and ask if compartment syndrome is a possibility.  If it is, have the split the skin.  Do this as soon as possible!

This picture was taken during a wound vac change while Richard was at Kindred Hospital.  The white exposed is the bone.  

I like to look at Richard's hand in his picture because it was normal looking here.  It doesn't look like this anymore.

The problems with this arm have gone on longer than any of the other injuries that he has. We have been to Mayo Clinic twice for surgeries on this arm.  He is missing 4.5 inches of ulna and eventually, they connected the ulna to the radius.  I will attach x-rays.
It takes two bones in your arm in order to flip your arm over so he no longer is able to move the arm in that way.  For awhile, his fingers were blue, but after they shortened the arm slightly at Mayo clinic, it seemed to solve that issue.
He has been told by medical professionals to amputate the arm. He refuses to do so. He has some feeling in his hand, and he does use it for some things, although the only movement that it has is produced by muscles in his shoulder and upper arm.
We were unaware that this was even a possibility, and in fact I was told early on that the arm was the least of his worries.  It has not turned out that way.
What have I learned from this experience?  First, doctors don't always know what the worst injury will be long term.  Second, doctors made decisions based on what they think will happen, and in our case, they thought that he would die, so why bother? (Is that blunt enough?)  Third, if compartment syndrome is even a possibility, ask the doctor, nurse, or both about splitting the skin to relieve the pressure.  Doing this could save you many years of surgeries.  I would estimate that Richard has had 20-25 surgeries just on that arm alone.  I have also learned that you have to stand up and advocate for your family member.  They cannot advocate for themselves, and to the doctor, this is just a job.  He or she will not have to live with the decisions that they make every day for the rest of their lives.  You will.  Be firm. Be assertive.  It could make all the difference.  I wish I would have known.

Arm the day of the accident

Arm on 2/9/08

Arm on 2/27/08 You can see the antibacterial beads that they placed in there. 

Arm on 4/3/08

Arm on 4/3/08

After the ulna had been cut out 4.5 inches 1/5/09

Left arm after a medical professional broke it during an exam.  

After the first surgery at Mayo clinic where the ulna was attached to the radius.  This never healed completely and still to this day is a 'non-union."  This is the reason that Richard wears a brace.  It is to protect this arm from further damage.  

His arm today as it usually is, in his protective brace. 

and without the brace.

A better view of his left hand.  This is the position it is always in.  It does not move.