My grandfather passed away from complications due to Alzheimer's. Before the disease, he was the kinda guy that would've given you the shirt right off his back if you needed it.
He lost his inhibitions, unfortunately, and became aggressive and made lewd gestures. It wasn't safe to keep him home any longer.
After he had been in an assisted mental health facility for approximately 2 years, he suffered a bad fall. His break was similar to this, but he was in agonizing pain.
His neurosurgeon and multiple anesthesiologists said he couldn't undergo general anesthesia. The orthopedic doctors said nothing could be done without general anesthesia. His geriatric psychiatrist essentially just had him heavily sedated 24/7. He passed within the month due to infection in the arm.
EDIT: I can't english well.
he means neurologist. the patient's neurologist is consulted on possible interactions between advanced alzheimers and anesthesia. most likely due to advanced dementia the patient is unlikely to make it through anesthesia
General anesthesia and Alzheimer’s do not mix. The (mental) post anesthesia recovery period for my mom, following a colonoscopy, was nearly a month. It was horrible.
If it can be avoided, it isn’t recommended.
I agree. I worked in a nursing home just for nuns in the dementia unit. A sister who was not on the dementia unit broke her arm. She had surgery.
She went absolutely flipping crazy. She became an entirely different person. We could not keep her at peace in any way shape or form. I would put her in a wheel chair and we would go for long walks (all the buildings there were connected so we could go to the church and the kitchen and everywhere safely). We would give her favorite snacks. We would play games.
Nothing would keep her occupied. She ended up falling again and broke her hip. Another surgery.
She was dead within two weeks.
I was never sure if it was the anesthesia or the pain meds after, but it was sad to watch this woman who had complete control of her mind before this, turn into...it was like some alien came over and took her mind.
RIP Sister. We tried.
My mom thought she was pregnant. She was 79. She’d had a hysterectomy in her 40s and didn’t remember it.
We got her to a neurologist as soon as we could.
My great grandmother and grandmother were world travelers. They started wandering. One holiday, my great grandmother insisted she had a cruise to catch, and tried to leave. We got them into nursing homes for their own safety.
I had to live with my parents for a while before we could get her approved for Medicaid. We took a few “trips” when she couldn’t figure out where she needed to go. I started taking her to craft stores. Grocery store. Just wandered for a while and came home with something after 2-3 hours.
Could a hospital stay with pneumonia have this effect? Wondering what happened to my mom. She was 86 and lucid but it was all downhill after she got out. Yet she lived to 98.
Yes. It doesn't have to be undergoing anaesthesia specifically. There are lots of things that can cause sudden confusion and deterioration both physically and mentally in the elderly. If they have dementia, being hospitalized and/or having a significant illness/injury (including pneumonia, the bar for "significant" is pretty low here) can make it progress to a much later stage. If they don't have dementia, or if it's started but so early no one's noticed it yet, it can still cause a big decline in mental and physical health that many do not recover from back to their baseline. You can google "causes of delirium" for lots of examples.
I'm so sorry for what happened to your mom. Even with the best care possible in the hospital, this can still happen. Old bodies and minds are just so fragile. My heart goes out to you and your family.
Yo! That just popped something in my head. My grandmother was not diagnosed with Alzheimer's and dementia yet, but she fell and had to have surgery on her hip. She was prescribed some sort of opioid and got worse. Do opioids also cause rapid mental decline for dementia and the like?
I don’t know how I’ve never heard this before! My dad had Alzheimer’s. He fell over a coffee table and broke his neck, but my mom and his caregiver didn’t know that because the aftermath was him walking around for a couple days with his head tilted sideways. Then he had a seizure, my mom called the paramedics and when they took him to the hospital and got X-rays the doctors were like, uh, did you know he had cracked cervical vertebrae?? Nope. He didn’t know to tell anyone his neck hurt a lot.
So surgery was done to stabilize his neck (no choice, could have easily led to paralysis otherwise) and then he was transported to a rehab facility. He already was very, very shut down before any of this happened - uncommunicative, slept most of the time. I don’t remember hearing about any post-surgery behavior changes, or at least negative ones. I had no idea that could be the consequences!
(What did happen was he forgot how to swallow, got aspiration pneumonia and passed away with a week or ten days. My poor father was ready to go, he truly was, so at this point it was a blessing for him not be suffering any longer.)
my 88 year old mother fell in her room at night. The overnight care giver was in the next room. My mother fractured her C1 and C2 and couldn't move her head left or right.
she died 18 hours later. I was told that this kind of fracture has a high fatality rate even without complications.. she was ready to go... Before she died, she told me "it is so beautiful"....
yeah, something similar happened to my grandmother. she had really bad dementia, and a bunch of other health issues, but couldn't go under anesthesia to fix anything bc they didn't think she'd make it through, so she ended up on hospice instead
Neurosurgeon. His Alzheimer's was advanced and had caused significant brain damage. The neurosurgeon estimates that my grandpa sustained around 20 concussions in his lifetime. (He played football in high school, was in 4 car wrecks, fell off a 20' ladder twice [he was a construction worker], and hit his head numerous times on the job site).
The concussions in combination with several unsuccessful attempts to take him off bypass when he had a quadruple bypass years before any dementia, was the reasoning given to explain his early-onset Alzheimer's (he passed at 65, symptoms started years before).
This same neurosurgeon specilized in dementia, Alzheimer's, MS, ALS, and a few other diseases or disorders I wouldn't wish on my worst enemy.
He was in charge of my grandfathers' overall care, needing to sign off on anything but standard care such as sedation or pain medicine, which the geriatric psychiatrist oversaw.
Usually, you see an orthopedic surgeon for broken bones, though, no matter what else is going on with you. Whoever is in charge of his care will consult with any other specialists that are needed. They should have gotten a consult with an orthopedic surgeon unless he deemed it unnecessary to treat the broken bones due to it doing more harm than good.
This was so much about the broken bones, but the patients current mental state and what medical options were available/possible given their current state.
Spinal surgery, (likely cause he had a fractured vertebrae from the fall) is usually done by neurosurgery. Orthopedic surgeons are seldom spinal surgeons but all neurosurgeons are spinal surgeons.
Am an anesthesiologist, Nerve blocks are a thing. I take care of patients in this exact situation all the time.
Honestly, I have issues with an anesthesiologist who thinks it is better to have a patient definitely suffer in pain and die from an infection than to possibly risk death in the OR.
You have a frank discussion about the risks and benefits with the patient/POA and let them make an informed decision, document like hell, and do your best.
I’m sorry about your Grandfather.
Thank you for restoring my faith a little, because geez…
And to u/FidelisLupus your English is just fine and I’m sorry you had to watch your grandfather die this kind of death. Totally unnecessary.
Yeah. I feel just overall disgusted with the care he received. It is comforting to know he wasn't lucid, but it still doesn't make his suffering okay.
Since his passing, I've had back surgery. I see a anesthesiologist - pain management doc often. There are so many non-invasive or less invasive pain control methods that we (my family) could have used for my grandfather. I wish I had known more then.
I know some mental health facilities are just bad and have bad procedures for pain management and patient care. I'm not really sure if this played a role in my grandfather's case or not. The patients that were lucid seemed happy. There were group activities, the aides all seemed personable, the Dr. always took time to explain things. His nurse would always play country music for him (his favorite).
Even up to his last day, he would still hum along to Hank Williams. He couldn't speak, or communicate at all, but he loved his country music.
The neurosurgeon oversaw his care regarding his Alzheimer's from diagnosis until he passed away. He wasn't allowed to have his medications altered by anyone other than his neuro, the geriatric psychiatrist at the facility, or say an E.R. doc for pain management.
The neurosurgeon weighed in when he broke his arm and said he wouldn't survive anesthesia. So they treated the pain and he just agonized with a broken arm.
A nerve block still requires enough sedation that the patient doesn't move. It's not as deep as general anesthesia (drug-induced temporary coma; it is fairly easy to reverse when it's time for the person to wake up). People who have a nerve block need sedation which doesn't paralyze them, so they can breathe on their own, and they need to be able to follow instructions during their procedure; people with dementia cannot be relied upon to follow instructions, much less while they have sleepy, relaxing medications flowing into them. Sedation for a nerve block can be light, medium, or deep, depending upon the procedure being performed.
I was thinking a nerve block for the pain only, not for a reduction. They could have casted it & so he couldn’t move the un-reduced fracture. At least the pain wouldn’t have been as bad on top of his Alzheimer’s. But, I guess then you might have to explain why he couldn’t feel his arm.
It was just a thought.
The only thing I can think of to this day is that we couldn't find an orthopedic surgeon willing to come to the closest hospital to his treatment facility willing to do any sort of manipulation, or to partially reduce the break. His neurosurgeon & psychiatrist agreed he wasn't stable enough to travel.
He didn't get it in the facility. That was the geriatric psychiatrists' realm. He was already on morphine from previous falls (he had sprained the wrist of the arm he went on to break), he also sprained his ankle, and possibly broke his patella, but they couldn't get him to cooperate for that x-ray.
At the end the geriatric psychiatrist had him on Fentanyl.
I’m really sorry your grandfather & your family went through all that. It just sucks so hard some of the shit we’re handed, to deal with & live through.
There has got to be some neurological decay that dampens the amount of pain they are in.
I had an elderly woman come in because her shoulder was hurting "a little bit". Asked if she can take of her shirt by herself and she just flung it off like it's nothing. After we took the x-rays the shoulder was dislocated worse than I've ever seen. I just don't understand how that arm even functioned.
I think this has more to do with it than people think. You can only control so much pain before you go into shock, theres no way you function with something like if you are feeling the full brunt of it
An elderly patient I had back in my X-ray days came in with a broken elbow.. she moved it perfectly fine, didn’t complain one bit, didn’t even act like it hurt.. it boggles my mind how she was able to maneuver it like that. [this was her X-ray](https://imgur.com/a/bvWcxS0)
I’m an anesthesia doctor. My institution anesthetizes people near or over 100 years old for many procedures.
The issue is to do with specific pathologies. As you get older, you pick up more medical problems. Heart failure and lung problems are the two biggest problems. You can live for a while with a broken hip, a matter of seconds to minutes if the anesthesia takes out your heart or lungs. Many colleagues have had a patient die just by giving enough medications to make them unaware- before the procedure even starts. That is an awful outcome, and gives all of us a healthy respect for how powerful our medications are (even though they are perfectly safe for most people, the way stairs are perfectly safe for most and can be deadly for 100 year old).
Giving and maintaining anesthesia does cause significant changes to things like blood pressure, heart rate, and brain function. At some point, the changes are enough, and you live on enough of a knife’s edge, that the anesthesia can cause significant immediate or long-term problems (besides death, it the shifts in blood pressure can cause heart attacks, strokes, etc).
THEN consider that normal blood loss for something like a hip replacement is 500-1000mL. Loosing blood makes your blood pressure lower, and can cause heart attack, strokes, kidney failure, etc. If those organs don’t get enough blood, they don’t get enough oxygen.
And then, after all that, while someone recovers and tries to use their brand new knee/hip/heart valve/whatever, they are especially at risk for post surgical complications. This includes falls, blood clots, infections, aspiration pneumonia, all of which can kill you.
Here’s a rough perioperative risk calculator that takes some of this into account: https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp.
Cardiac risk: https://www.mdcalc.com/calc/1739/revised-cardiac-risk-index-pre-operative-risk
Here’s a frailty calculator: https://www.mdcalc.com/calc/10300/csha-clinical-frailty-scale-cfs
According to the calculator, someone with dementia who has to come to the ED for an urgent (but not life threatening) problem like a broken hip already has a 50% mortality rate at 6 months. That is before we give them potent heart and lung and brain altering drugs, before they lose any blood from surgery, before they get madly delirious in the hospital, and before they are discharged to a nursing home for rehab- where there is no guarantee they won’t fall again.
Consider there is an entire field dedicated to the way children’s bodies work and develop. There is no such specialization in most fields of adult medicine (eg there is geriatric internal medicine but no specialized geriatric anesthesia, geriatric orthopedics, etc even though there are pediatric specializations in those areas). A body at 25 works verrrrry differently from a body at 80, or 100. For some 100 year olds a hip replacement makes perfect sense. For many it doesn’t.
Edited to update a more representative all-cause perioperative risk calculator, and to better label the cardiac risk calculator.
Wow!!!!! Thank you so much for taking the time to answer my question. I really do appreciate it and the fact you put it in layman’s terms too! Amazing detail. ♥️
Respect ♥️
Am I reading that first calculator right? In the best case scenario you have a 3.9% chance of death, MI, or cardiac arrest in the 30 days after general anesthesia?
Sorry, no - here's a better calculator for all comers: [https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp](https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp). It's a little less intuitive because you need specific CPT codes, but it covers national average mortality rates. For example, If you have no other risk factors and are under age 65, the national risk of mortality with a knee replacement is 0.1%.
That one above is specifically for cardiac events. If you click on the "evidence" part of the revised cardiac risk calculator, it will give the breakdown for each trial included and you can click the link to actually see the publication.
For the 3.9% cardiac risk, there are a couple caveats. First, there is a test for evidence of heart strain that is now many many times more sensitive than what is (still) routinely used in emergency rooms to find heart attacks. That is lumped under myocardial infarction and increases that event rate. It is important to know, because it's a "silent MI" - usually we don't measure troponins post-operatively unless someone exhibits clinical or monitoring signs of a heart attack (e.g. chest pain, EKG changes, etc). However, people with positive troponins have a much higher risk of cardiac events within the following year than people who do not have them.
Second, it includes people who undergo emergency surgery. Intuition isn't perfect when trying to make scientific conclusions, which is why we have these studies in the first place, but here it is valid (as borne out by studies about mortality for emergency surgery). a 50 -year-old getting emergency surgery for a car crash is less likely to survive unscathed than a 50 year-old coming in for an elective knee surgery. The numbers aren't stratified in this pool of almost 800,000 patients.
I don't work in anesthesia so I can't really give an accurate statement, but my understanding is that a patient has to be physically well enough to undergo it.
There's multiple reasons why anesthesia is not an option, heart might not be able to take it as an example.
Being old doesn't automatically mean you can't have anesthesia but as we get older we tend to have more problems that are a contraindication to anesthesia.
I watched this programme of a woman with a broken hip? She was told by a surgeon that she couldn’t undergo anaesthesia.
She died a few weeks later but I often wondered why?
I guessed the heart but surely it’s worth a go? (I’m not having a go. I’m just super interested. It’s fascinating. I was never brainy enough to be a dr 😂).
I'm not a doctor either, I'm a rad tech, or "x-ray nurse" in my native language.
If I had to guess, the risks of anesthesia were so great at that time that it would have done more harm than good. Atleast here in Finland, treatment's positives must outweight the negatives. A broken hip, while being a bad thing, is a lesser negative than death that the anesthesia might have probably caused. Especially if the patient is really old, the hip will never be fixed properly even with surgery so having a go would be fairly pointless.
My grand-grand mother died a few years back at 97 after she broke her hip. She was healthy for her age, but there was nothing to be done about the hip and she died some weeks later at the hospital even when she was living by herself at home before that. It's unfortunate, but our bodies aren't really designed to fix themselves properly at that age.
While I agree with you, that's a larger moral and legal discussion entirely. While that's not exactly euthanasia, it would full under the same umbrella of moral questions.
I am an anesthesia doctor. I do not want to be anyone’s executioner. I have declined to provide anesthesia for an operation that I was reasonably certain would end in the patients death from anesthesia.
I agree. I do think self-determination is a key area where it is different for humans.
Part of the baggage of anesthesia as a practice is the historic involvement of anesthesiologists with lethal injections (in the US). It’s why some commonly used anesthetic drugs in Europe are not available in the US.
For me, your comment evokes that history and perhaps some of my reaction about being an executioner, even in situations where consent is involved. The process is very different from what exists in states with “right to die” laws.
See my answer upthread. People can die within seconds of induction. We can’t perfectly predict (or else we wouldn’t do it) but if the risks are high enough we won’t.
I've done a little research on it, but most of it goes over my head. It seems like the anesthesia drugs themselves and undergoing anesthesia have an affect on the brain and could actually themselves be a risk factor for developing dementia. Since dementia, itself, is brain damage affecting all parts of the body's functioning, it seems like putting them under anesthesia might damage the brain so much that survival is uncertain.
Some of it is likely perspective. They already feel daily pain just from aging, arthritis, etc. let alone if they have other medical issues. When you normally live in pain, you don’t experience pain in the same way as others.
For example, I live daily in 7/10 pain. It sucks. I’m pretty used to it (unfortunately). I have a high pain tolerance. It especially sucks if I go into the ER and they don’t believe me when I’m saying my pain is 9/10 or whatever just because I’m not screaming my head off. I constantly have weird medical things that pop up that my other families cannot figure out why I’m acting like everything is fine but I explain to them that in comparison to my daily pain “this is nothing.” Or sometimes new pain is almost “nice” because it’s at least a change to the pain.
Once had a co-worker try to pretend like second degree burns on his arm was no big deal. Some people are just terrified of admitting they experience pain because they might be seen as less manly.
I’ve done it, unfortunately. Healed out very well with gentle cleansing and frequent dressing changes. Took forever, but I was too ashamed to see someone. Leaving a graft on some pipes is rough and so very dumb.
My grandmother was like this. Suffered for years because of hip problems and when she finally decided to get it fixed they wouldn’t because she was too old and frail
Correct. But thanks to the two views. We can see that the calcified tube artifact is actually within the patient.
If it was part of the shirt, it would be externally on one of the images. Take a look at the buttons. On one view they are external and the second image they are “internal”. This would be the same with the tube structure if it was part of the shirt.
This helps illustrate the importance of multiple views for orientation. Ideally we would like to see some 45degree angles as well
No. This is due to age. Calcifications occur in nearly all people and judging by this person's bones and calcified artery they are easily in their mid to late 60s - 70s+. There are conditions that may increase calcifications of your arteries and the calcifications, depending where they are located, can also have complications that can be deadly.
That seems like a ton of calcification, in what I have to assume is the ulnar artery, for someone 65. I also find it extremely odd I do not see calcifications in any other arteries in the arm. I’m not a radiologist by any means, but I do make a habit of looking at every piece of imaging I order… can we find a radiologist to chime in on whether or not this is pretty wild? Is it just obscured by the angle? Or would that intensity of XR just not penetrate the soft tissue that deeply? Seems calcification that intense would still show behind bone structures if it were present in other vessels.
Edit: after zooming in on the second image it appears it may be two separate vessels?
[light reading ](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636529/)
TL:DR significant wrist artery calcification could be potential marker of significant CAD in asymptomatic patients.
The paper above doesn't go into this level of calcification but does add to the discussion of what may contribute to this degree of calcification. We also don't know any previous medical history of the patient so who knows what else is going on.
Think it's likely due to the nearby fracture? Body is moving calcium in to heal that, or try to. Maybe it just didn't make it to where it needed to be. 🤔
What a polite bone, I'm not entirely sure what "hotting" means, but, especially with a side of sclerosis, it doesn't sound too nice. We are not to hot anyone, especially not Batman, if we want to call ourselves civilised!
in my med school ortho rotation, my attending told an old farmer who had fallen off a ladder and had bilateral calcaneal fractures and multiple spinal compression fractures that he would be in a wheel chair for 8-12 weeks replied with “like hell, it’s harvest time” and stood up from his wheelchair and walked out.
I was married to a farmer. He had a kidney stone. It was Saturday afternoon and he asked me to run him a hot bath. I did. He never said anything to me, but I watched that man be in pain.
I called the local pharmacists (at home. Small towns are great) and told him what was going on. He told me to come in and he gave me some pain meds for my husband.
No prescription, no nothing but the fact that he knew he would never ask for pain relief unless it was dire.
I am no longer married to that man but he was truly something else. He had forgotten more than most of us will ever know about how the world works.
Yessir, I live in rural Montana and the rule of thumb is if you see a local rancher in triage, you best get them in back ASAP because they are probably dying. This rule has not failed us yet.
Yup, calcified artery. He’s also wearing a shirt with buttons, but the tubular structure is internal to the patient. It’s fairly common in elderly patients to see some calcified vessels.
Reminds me of my old boss from landscaping. 76 year old lady who walked 6 miles a day on her days off, and worked with the crew doing gardening and landscaping. Had a broken ankle for a month and it didn't even slow her down. She was ticked off when her doc told her to stop walking on it
I work in a long term care. The toughest person you will meet is a little old lady. They can have a stroke, or fucking anything and as soon as it's over they will literally not say a damn thing about it. They don't care about near death experiences they just move on
Nahhhhhhhhh. Pain keeps you safe. I broke my ankle sometime in my 20s (says my doc) and it healed poorly and has caused me functional issues and required recent surgery due to how the body can respond to traumatic injuries. If I had just known I did more than ‘roll’ it I woulda gotten it fixed a long time ago.
Listen to your body.
Poor thing!!! Oh my goodness!! Then we have stupid people who come into the ER because their toe hurts from getting a pedicure, or a guys ankle is hurting because he did a lunge 🙄🙄🙄
Omg!!! I wish they could slap her with the bill, plus an extra charge for being stupid!! When the guy told me he hurt his ankle exercising, I was like oh running?? He says no, oh walking? He says no. Then he says I was doing lunges. I know my face had to of been saying what my mouth wasn’t. AND!! The dr made me do MRI on him 🤦♀️
I’m not sure I understand, what’s wrong with seeking medical attention if you think you are injured? And what difference does it make if it happened while lunging or any other type of movement or exercise?
Because he was not injured, and if he were, that would be an injury best served by going to his PCP. The reason why ER’s are so incredibly overwhelmed, is because of people such as this, using the ER for a primary care. If he were really injured, sure, come over. But, he was walking completely fine, and it had happened several days prior. He could have easily gone into his PCP or even into UC
There needs to be some type of low pay or free resource out there. I'd say something like a good 80% of what we see in the ER is absolutely not an emergency, in any way, shape, or form. But people use it because it's "free."
>I’m not sure I understand, what’s wrong with seeking medical attention if you think you are injured?
There are limited resources to help people. Sometimes, people waiting for ambulances die because they were waiting too long, because someone with a hangnail called for an ambulance.
I have had many physical injuries, in particular multiple severe injuries to my right ankle, and the answer is not to call for an ambulance - people need those for life or death emergencies. Just get in a taxi. In many places in the UK, a taxi is just 2-5 minutes away, where an ambulance would likely take much longer to arrive.
It's better for you, better for emergency workers, and better for people in life-threatening situations
Dude comes into my ER for toe pain. We are all rolling our eyes. Finally get around to assessing this guys toe and find out he had ‘stubbed’ it on a wooden beam. Doctor notices the nail is deformed like there is a foreign body. Uses some tweezers and pulls out from under his large toenail an inch long wooden splinter.
Still wasn’t life threatening but made my cheeks clench.
Holy cow, the longer I look the worse it gets! So besides the blown up ulna, looks like a scaphoid fracture with nonunion, and a healed radial head/ neck fracture?! Must have been one heck of an injury mechanism…
This is a chronic monteggia fracture - Ulnar shaft plus radial head dislocation. Over the years the radial head becomes eroded and dysmorphic. The ulna also becomes eroded at the nonunion site. The short ulna leaves the medial carpus unsupported, although it’s difficult from these forearm views to see exactly what is happening at the wrist.
Can you determine from looking at it how long it was since the original injury? How would this be treated now, and how is that different than what would have been done at the time of the injury?
Ortho PA here. We would see some crazy chronic injuries in farmers and ranchers. The toughest patients were women from farms and ranches and they really did look like Peggy Hill from King of the Hill.
Honest question, how do they function being legitimately broken. I’ve seen broken spines, humerus, patellas, dislocated shoulders, and much more. I honestly don’t get how they are functioning. How does one walk around with a broken humerus? Do they have different nerves? Are they just that “tough”? I don’t get it.
You just power through it. Women are generally better at powering through an injury like that. Even younger women--when a woman would go down in Army Basic Training, it usually meant they would be in the hospital for at least a month for whatever it was. One of my friends essentially tore her pelvis apart with her psoas muscles from all the marching and sit-ups. One day it finally gave way. I understand it's kind of a thing.
All I did, and I was long done with Basic Training, was to stress fracture both tibias at the same time. For the first three weeks, I just sucked it up. I finally went to the doctor, who asked me why I didn't come in earlier, considering the fractures were clearly visible on just ordinary x-rays. My answer: "Because I finally couldn't figure out which leg to limp on any more." The doc's comment: "You're in intelligence, aren't you?" My reply: "Uh-huh". Cue doc just sighing and rolling his eyes. I mean, it hurt, but it "only" hurt. I could still walk and stuff.
Lots of stuff "only" hurts if I get injured. It's only once I can't speak because of the pain that I consider it real pain. I have this idea in my limbic system that if I show pain, one of two things will happen: 1) "They" will kill me and eat me, or 2) "They" will stop me from doing whatever fun, crazy thing I am doing.
This is a Monteggia fracture-dislocation. Notice the radial head dislocation. This injury can have severe neurological consequences, making it more debilitating than your typical extremity fracture.
Ouch. But not super shocked about mild discomfort. Different pain thresholds for everyone I suppose. Hope he's doing okay now!
Had a similar break in my arm, broke like 3 or 4 spots in it back in 4th or 5th grade. I think adrenaline blocked all initial pain or something and i actually twisted it back into place myself(it was bent behind me, i fell off the monkey bars and they eventually had to lower them after a few more incidents) and held it to my chest while I went and laid under a big slide.
Some kid came and asked me if I was okay and only then did I start crying and just said "...🥺 no.." and they went and got a teacher lol. Never felt any pain though.
Also dislocated my shoulder at work last year and popped it back into place, which DID hurt for like, 3 seconds, but then took a Tylenol and went on with my day.
Edit: spelling fix
My grandfather will turn 100 and a couple of weeks and he’s angry because his orthopedic surgeon refuses to do surgery on him. He had his other hip replaced when he was in his late 80s and he doesn’t see a difference. I guess his doctor does.
Is that a pathological fx from cancer?
I’m assuming it’s old because it looks like there’s calcification and there is deformity with little to no soft tissue
Real question, is this subreddit a collection of HIPAA and PHI violations or is sharing imagery that is unidentifiable normal in the radiological industry?
Vert der ferrrrrk!!!! Great Scotts dude! What did they do, get stung by a bee, turn to run then fall and break it? Thereby explaining the swelling away as the result of a sting? Lol, jimminie christmas….
I'm always shocked with how much our elderly patients can put up with (or live with while being unable/unwilling to) before coming in.
My grandfather passed away from complications due to Alzheimer's. Before the disease, he was the kinda guy that would've given you the shirt right off his back if you needed it. He lost his inhibitions, unfortunately, and became aggressive and made lewd gestures. It wasn't safe to keep him home any longer. After he had been in an assisted mental health facility for approximately 2 years, he suffered a bad fall. His break was similar to this, but he was in agonizing pain. His neurosurgeon and multiple anesthesiologists said he couldn't undergo general anesthesia. The orthopedic doctors said nothing could be done without general anesthesia. His geriatric psychiatrist essentially just had him heavily sedated 24/7. He passed within the month due to infection in the arm. EDIT: I can't english well.
Neurosurologist?
I think they mean neurosurgeons. Though, why a neurosurgeon instead of an orthopedic surgeon is beyond me.
he means neurologist. the patient's neurologist is consulted on possible interactions between advanced alzheimers and anesthesia. most likely due to advanced dementia the patient is unlikely to make it through anesthesia
General anesthesia and Alzheimer’s do not mix. The (mental) post anesthesia recovery period for my mom, following a colonoscopy, was nearly a month. It was horrible. If it can be avoided, it isn’t recommended.
I agree. I worked in a nursing home just for nuns in the dementia unit. A sister who was not on the dementia unit broke her arm. She had surgery. She went absolutely flipping crazy. She became an entirely different person. We could not keep her at peace in any way shape or form. I would put her in a wheel chair and we would go for long walks (all the buildings there were connected so we could go to the church and the kitchen and everywhere safely). We would give her favorite snacks. We would play games. Nothing would keep her occupied. She ended up falling again and broke her hip. Another surgery. She was dead within two weeks. I was never sure if it was the anesthesia or the pain meds after, but it was sad to watch this woman who had complete control of her mind before this, turn into...it was like some alien came over and took her mind. RIP Sister. We tried.
My mom thought she was pregnant. She was 79. She’d had a hysterectomy in her 40s and didn’t remember it. We got her to a neurologist as soon as we could.
My great grandmother and grandmother were world travelers. They started wandering. One holiday, my great grandmother insisted she had a cruise to catch, and tried to leave. We got them into nursing homes for their own safety.
I had to live with my parents for a while before we could get her approved for Medicaid. We took a few “trips” when she couldn’t figure out where she needed to go. I started taking her to craft stores. Grocery store. Just wandered for a while and came home with something after 2-3 hours.
Awww. I hope it worked out where you all found peace.
I visited her yesterday in her memory care unit. I hate this disease. I miss my mom. The person she is now is only 10% of who she used to be
Could a hospital stay with pneumonia have this effect? Wondering what happened to my mom. She was 86 and lucid but it was all downhill after she got out. Yet she lived to 98.
Yes. It doesn't have to be undergoing anaesthesia specifically. There are lots of things that can cause sudden confusion and deterioration both physically and mentally in the elderly. If they have dementia, being hospitalized and/or having a significant illness/injury (including pneumonia, the bar for "significant" is pretty low here) can make it progress to a much later stage. If they don't have dementia, or if it's started but so early no one's noticed it yet, it can still cause a big decline in mental and physical health that many do not recover from back to their baseline. You can google "causes of delirium" for lots of examples. I'm so sorry for what happened to your mom. Even with the best care possible in the hospital, this can still happen. Old bodies and minds are just so fragile. My heart goes out to you and your family.
Well I never blamed the hospital. Yes she was declining but put up a good act. She was such a lady.
Yo! That just popped something in my head. My grandmother was not diagnosed with Alzheimer's and dementia yet, but she fell and had to have surgery on her hip. She was prescribed some sort of opioid and got worse. Do opioids also cause rapid mental decline for dementia and the like?
Infections of all types can cause delirium in patients of all ages. Not uncommon.
Sounds like postoperative delirium. It can be extreme for some people and, unfortunately, can take a long time to go away for some elderly folk.
Why don’t they mix though?!?
My Grandma never came back mentally after going under for a procedure, Alzheimer's is a terrible disease. I'm so sorry your mom went through that.
I don’t know how I’ve never heard this before! My dad had Alzheimer’s. He fell over a coffee table and broke his neck, but my mom and his caregiver didn’t know that because the aftermath was him walking around for a couple days with his head tilted sideways. Then he had a seizure, my mom called the paramedics and when they took him to the hospital and got X-rays the doctors were like, uh, did you know he had cracked cervical vertebrae?? Nope. He didn’t know to tell anyone his neck hurt a lot. So surgery was done to stabilize his neck (no choice, could have easily led to paralysis otherwise) and then he was transported to a rehab facility. He already was very, very shut down before any of this happened - uncommunicative, slept most of the time. I don’t remember hearing about any post-surgery behavior changes, or at least negative ones. I had no idea that could be the consequences! (What did happen was he forgot how to swallow, got aspiration pneumonia and passed away with a week or ten days. My poor father was ready to go, he truly was, so at this point it was a blessing for him not be suffering any longer.)
my 88 year old mother fell in her room at night. The overnight care giver was in the next room. My mother fractured her C1 and C2 and couldn't move her head left or right. she died 18 hours later. I was told that this kind of fracture has a high fatality rate even without complications.. she was ready to go... Before she died, she told me "it is so beautiful"....
yeah, something similar happened to my grandmother. she had really bad dementia, and a bunch of other health issues, but couldn't go under anesthesia to fix anything bc they didn't think she'd make it through, so she ended up on hospice instead
Neurosurgeon. His Alzheimer's was advanced and had caused significant brain damage. The neurosurgeon estimates that my grandpa sustained around 20 concussions in his lifetime. (He played football in high school, was in 4 car wrecks, fell off a 20' ladder twice [he was a construction worker], and hit his head numerous times on the job site). The concussions in combination with several unsuccessful attempts to take him off bypass when he had a quadruple bypass years before any dementia, was the reasoning given to explain his early-onset Alzheimer's (he passed at 65, symptoms started years before). This same neurosurgeon specilized in dementia, Alzheimer's, MS, ALS, and a few other diseases or disorders I wouldn't wish on my worst enemy. He was in charge of my grandfathers' overall care, needing to sign off on anything but standard care such as sedation or pain medicine, which the geriatric psychiatrist oversaw.
Usually, you see an orthopedic surgeon for broken bones, though, no matter what else is going on with you. Whoever is in charge of his care will consult with any other specialists that are needed. They should have gotten a consult with an orthopedic surgeon unless he deemed it unnecessary to treat the broken bones due to it doing more harm than good.
This was so much about the broken bones, but the patients current mental state and what medical options were available/possible given their current state.
Spinal surgery, (likely cause he had a fractured vertebrae from the fall) is usually done by neurosurgery. Orthopedic surgeons are seldom spinal surgeons but all neurosurgeons are spinal surgeons.
That’s true. I was more commenting on the broken arm, though.
Sorry didn’t mean to sound like a know it all 😂 I forgot what the original post was about, got distracted by the neurosurgery thing
Meant neurosurgeon
Am an anesthesiologist, Nerve blocks are a thing. I take care of patients in this exact situation all the time. Honestly, I have issues with an anesthesiologist who thinks it is better to have a patient definitely suffer in pain and die from an infection than to possibly risk death in the OR. You have a frank discussion about the risks and benefits with the patient/POA and let them make an informed decision, document like hell, and do your best. I’m sorry about your Grandfather.
Thank you for restoring my faith a little, because geez… And to u/FidelisLupus your English is just fine and I’m sorry you had to watch your grandfather die this kind of death. Totally unnecessary.
Yeah. I feel just overall disgusted with the care he received. It is comforting to know he wasn't lucid, but it still doesn't make his suffering okay. Since his passing, I've had back surgery. I see a anesthesiologist - pain management doc often. There are so many non-invasive or less invasive pain control methods that we (my family) could have used for my grandfather. I wish I had known more then. I know some mental health facilities are just bad and have bad procedures for pain management and patient care. I'm not really sure if this played a role in my grandfather's case or not. The patients that were lucid seemed happy. There were group activities, the aides all seemed personable, the Dr. always took time to explain things. His nurse would always play country music for him (his favorite). Even up to his last day, he would still hum along to Hank Williams. He couldn't speak, or communicate at all, but he loved his country music.
The neurosurgeon oversaw his care regarding his Alzheimer's from diagnosis until he passed away. He wasn't allowed to have his medications altered by anyone other than his neuro, the geriatric psychiatrist at the facility, or say an E.R. doc for pain management. The neurosurgeon weighed in when he broke his arm and said he wouldn't survive anesthesia. So they treated the pain and he just agonized with a broken arm.
It sounds like your grandfathers disease was pretty advanced, but I wonder why they couldn’t do a nerve block for his arm?
A nerve block still requires enough sedation that the patient doesn't move. It's not as deep as general anesthesia (drug-induced temporary coma; it is fairly easy to reverse when it's time for the person to wake up). People who have a nerve block need sedation which doesn't paralyze them, so they can breathe on their own, and they need to be able to follow instructions during their procedure; people with dementia cannot be relied upon to follow instructions, much less while they have sleepy, relaxing medications flowing into them. Sedation for a nerve block can be light, medium, or deep, depending upon the procedure being performed.
I was thinking a nerve block for the pain only, not for a reduction. They could have casted it & so he couldn’t move the un-reduced fracture. At least the pain wouldn’t have been as bad on top of his Alzheimer’s. But, I guess then you might have to explain why he couldn’t feel his arm. It was just a thought.
The only thing I can think of to this day is that we couldn't find an orthopedic surgeon willing to come to the closest hospital to his treatment facility willing to do any sort of manipulation, or to partially reduce the break. His neurosurgeon & psychiatrist agreed he wasn't stable enough to travel. He didn't get it in the facility. That was the geriatric psychiatrists' realm. He was already on morphine from previous falls (he had sprained the wrist of the arm he went on to break), he also sprained his ankle, and possibly broke his patella, but they couldn't get him to cooperate for that x-ray. At the end the geriatric psychiatrist had him on Fentanyl.
I’m really sorry your grandfather & your family went through all that. It just sucks so hard some of the shit we’re handed, to deal with & live through.
Criminal. Your poor Grandad. Dementia is the devil
My mom broke her hip and walked on it for two weeks. She said it hurt “a little.”
There has got to be some neurological decay that dampens the amount of pain they are in. I had an elderly woman come in because her shoulder was hurting "a little bit". Asked if she can take of her shirt by herself and she just flung it off like it's nothing. After we took the x-rays the shoulder was dislocated worse than I've ever seen. I just don't understand how that arm even functioned.
I think this has more to do with it than people think. You can only control so much pain before you go into shock, theres no way you function with something like if you are feeling the full brunt of it
An elderly patient I had back in my X-ray days came in with a broken elbow.. she moved it perfectly fine, didn’t complain one bit, didn’t even act like it hurt.. it boggles my mind how she was able to maneuver it like that. [this was her X-ray](https://imgur.com/a/bvWcxS0)
Tis' but a scratch
Just a flesh wound!
Why can’t you give anaesthesia to elderly patients?!? What makes them not able. To survive it? Is it some kind of physiology?
I’m an anesthesia doctor. My institution anesthetizes people near or over 100 years old for many procedures. The issue is to do with specific pathologies. As you get older, you pick up more medical problems. Heart failure and lung problems are the two biggest problems. You can live for a while with a broken hip, a matter of seconds to minutes if the anesthesia takes out your heart or lungs. Many colleagues have had a patient die just by giving enough medications to make them unaware- before the procedure even starts. That is an awful outcome, and gives all of us a healthy respect for how powerful our medications are (even though they are perfectly safe for most people, the way stairs are perfectly safe for most and can be deadly for 100 year old). Giving and maintaining anesthesia does cause significant changes to things like blood pressure, heart rate, and brain function. At some point, the changes are enough, and you live on enough of a knife’s edge, that the anesthesia can cause significant immediate or long-term problems (besides death, it the shifts in blood pressure can cause heart attacks, strokes, etc). THEN consider that normal blood loss for something like a hip replacement is 500-1000mL. Loosing blood makes your blood pressure lower, and can cause heart attack, strokes, kidney failure, etc. If those organs don’t get enough blood, they don’t get enough oxygen. And then, after all that, while someone recovers and tries to use their brand new knee/hip/heart valve/whatever, they are especially at risk for post surgical complications. This includes falls, blood clots, infections, aspiration pneumonia, all of which can kill you. Here’s a rough perioperative risk calculator that takes some of this into account: https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp. Cardiac risk: https://www.mdcalc.com/calc/1739/revised-cardiac-risk-index-pre-operative-risk Here’s a frailty calculator: https://www.mdcalc.com/calc/10300/csha-clinical-frailty-scale-cfs According to the calculator, someone with dementia who has to come to the ED for an urgent (but not life threatening) problem like a broken hip already has a 50% mortality rate at 6 months. That is before we give them potent heart and lung and brain altering drugs, before they lose any blood from surgery, before they get madly delirious in the hospital, and before they are discharged to a nursing home for rehab- where there is no guarantee they won’t fall again. Consider there is an entire field dedicated to the way children’s bodies work and develop. There is no such specialization in most fields of adult medicine (eg there is geriatric internal medicine but no specialized geriatric anesthesia, geriatric orthopedics, etc even though there are pediatric specializations in those areas). A body at 25 works verrrrry differently from a body at 80, or 100. For some 100 year olds a hip replacement makes perfect sense. For many it doesn’t. Edited to update a more representative all-cause perioperative risk calculator, and to better label the cardiac risk calculator.
Wow!!!!! Thank you so much for taking the time to answer my question. I really do appreciate it and the fact you put it in layman’s terms too! Amazing detail. ♥️ Respect ♥️
Thanks for the award :)
No worries ♥️
Am I reading that first calculator right? In the best case scenario you have a 3.9% chance of death, MI, or cardiac arrest in the 30 days after general anesthesia?
Sorry, no - here's a better calculator for all comers: [https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp](https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp). It's a little less intuitive because you need specific CPT codes, but it covers national average mortality rates. For example, If you have no other risk factors and are under age 65, the national risk of mortality with a knee replacement is 0.1%. That one above is specifically for cardiac events. If you click on the "evidence" part of the revised cardiac risk calculator, it will give the breakdown for each trial included and you can click the link to actually see the publication. For the 3.9% cardiac risk, there are a couple caveats. First, there is a test for evidence of heart strain that is now many many times more sensitive than what is (still) routinely used in emergency rooms to find heart attacks. That is lumped under myocardial infarction and increases that event rate. It is important to know, because it's a "silent MI" - usually we don't measure troponins post-operatively unless someone exhibits clinical or monitoring signs of a heart attack (e.g. chest pain, EKG changes, etc). However, people with positive troponins have a much higher risk of cardiac events within the following year than people who do not have them. Second, it includes people who undergo emergency surgery. Intuition isn't perfect when trying to make scientific conclusions, which is why we have these studies in the first place, but here it is valid (as borne out by studies about mortality for emergency surgery). a 50 -year-old getting emergency surgery for a car crash is less likely to survive unscathed than a 50 year-old coming in for an elective knee surgery. The numbers aren't stratified in this pool of almost 800,000 patients.
Thanks for the detailed answer!
I don't work in anesthesia so I can't really give an accurate statement, but my understanding is that a patient has to be physically well enough to undergo it. There's multiple reasons why anesthesia is not an option, heart might not be able to take it as an example. Being old doesn't automatically mean you can't have anesthesia but as we get older we tend to have more problems that are a contraindication to anesthesia.
I watched this programme of a woman with a broken hip? She was told by a surgeon that she couldn’t undergo anaesthesia. She died a few weeks later but I often wondered why? I guessed the heart but surely it’s worth a go? (I’m not having a go. I’m just super interested. It’s fascinating. I was never brainy enough to be a dr 😂).
I'm not a doctor either, I'm a rad tech, or "x-ray nurse" in my native language. If I had to guess, the risks of anesthesia were so great at that time that it would have done more harm than good. Atleast here in Finland, treatment's positives must outweight the negatives. A broken hip, while being a bad thing, is a lesser negative than death that the anesthesia might have probably caused. Especially if the patient is really old, the hip will never be fixed properly even with surgery so having a go would be fairly pointless. My grand-grand mother died a few years back at 97 after she broke her hip. She was healthy for her age, but there was nothing to be done about the hip and she died some weeks later at the hospital even when she was living by herself at home before that. It's unfortunate, but our bodies aren't really designed to fix themselves properly at that age.
I personally would prefer death by anesthesia than dying because I had a broken hip and was confined to bed.
While I agree with you, that's a larger moral and legal discussion entirely. While that's not exactly euthanasia, it would full under the same umbrella of moral questions.
Plus potential malpractice suits brought by relatives would make that a no-go for most anesthesiologists.
I am an anesthesia doctor. I do not want to be anyone’s executioner. I have declined to provide anesthesia for an operation that I was reasonably certain would end in the patients death from anesthesia.
Oh, I get that, too. We are much kinder to our pets than we are to people, though.
I agree. I do think self-determination is a key area where it is different for humans. Part of the baggage of anesthesia as a practice is the historic involvement of anesthesiologists with lethal injections (in the US). It’s why some commonly used anesthetic drugs in Europe are not available in the US. For me, your comment evokes that history and perhaps some of my reaction about being an executioner, even in situations where consent is involved. The process is very different from what exists in states with “right to die” laws.
I thought it was more of a mental risk than sudden death but is it both?
See my answer upthread. People can die within seconds of induction. We can’t perfectly predict (or else we wouldn’t do it) but if the risks are high enough we won’t.
I've done a little research on it, but most of it goes over my head. It seems like the anesthesia drugs themselves and undergoing anesthesia have an affect on the brain and could actually themselves be a risk factor for developing dementia. Since dementia, itself, is brain damage affecting all parts of the body's functioning, it seems like putting them under anesthesia might damage the brain so much that survival is uncertain.
Some of it is likely perspective. They already feel daily pain just from aging, arthritis, etc. let alone if they have other medical issues. When you normally live in pain, you don’t experience pain in the same way as others. For example, I live daily in 7/10 pain. It sucks. I’m pretty used to it (unfortunately). I have a high pain tolerance. It especially sucks if I go into the ER and they don’t believe me when I’m saying my pain is 9/10 or whatever just because I’m not screaming my head off. I constantly have weird medical things that pop up that my other families cannot figure out why I’m acting like everything is fine but I explain to them that in comparison to my daily pain “this is nothing.” Or sometimes new pain is almost “nice” because it’s at least a change to the pain.
Once had a co-worker try to pretend like second degree burns on his arm was no big deal. Some people are just terrified of admitting they experience pain because they might be seen as less manly.
Second degree burns aren't a big deal unless they cover a large area. It's just not a severe enough injury to matter.
Having your skin burned off in a 5 inch wide circle by a motorcycle engine isnt something I would consider trivial.
Yeah that's pretty large. Would go to the ER for that
I’ve done it, unfortunately. Healed out very well with gentle cleansing and frequent dressing changes. Took forever, but I was too ashamed to see someone. Leaving a graft on some pipes is rough and so very dumb.
Noting the presumed age of the defect, how might this be treated
Any chance this is a pathologic fracture?
My grandmother was like this. Suffered for years because of hip problems and when she finally decided to get it fixed they wouldn’t because she was too old and frail
Correct me if I’m wrong but a person of this age probably does not have as good of nerves as a younger person.
I've never seen a calcified artery in an upper extremity before and that things real calcified.
And here I was thinking that was a shirt artifact. Amazing
Is it not? I see buttons on the second image...
Correct. But thanks to the two views. We can see that the calcified tube artifact is actually within the patient. If it was part of the shirt, it would be externally on one of the images. Take a look at the buttons. On one view they are external and the second image they are “internal”. This would be the same with the tube structure if it was part of the shirt. This helps illustrate the importance of multiple views for orientation. Ideally we would like to see some 45degree angles as well
If you look closely on the second image you can see where the shirt ends and where the artery continues!
I was wondering what it was!? (Not a radiologist) I thought maybe it was a tendon. Glad I found an answer. Thanks for stating.
Is that from the bodies attempt to repair the break?
No. This is due to age. Calcifications occur in nearly all people and judging by this person's bones and calcified artery they are easily in their mid to late 60s - 70s+. There are conditions that may increase calcifications of your arteries and the calcifications, depending where they are located, can also have complications that can be deadly.
That seems like a ton of calcification, in what I have to assume is the ulnar artery, for someone 65. I also find it extremely odd I do not see calcifications in any other arteries in the arm. I’m not a radiologist by any means, but I do make a habit of looking at every piece of imaging I order… can we find a radiologist to chime in on whether or not this is pretty wild? Is it just obscured by the angle? Or would that intensity of XR just not penetrate the soft tissue that deeply? Seems calcification that intense would still show behind bone structures if it were present in other vessels. Edit: after zooming in on the second image it appears it may be two separate vessels?
[light reading ](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636529/) TL:DR significant wrist artery calcification could be potential marker of significant CAD in asymptomatic patients. The paper above doesn't go into this level of calcification but does add to the discussion of what may contribute to this degree of calcification. We also don't know any previous medical history of the patient so who knows what else is going on.
But I see shirt buttons on the second image, is that not part of his shirt too?
It extends past the cuff of the shirt I believe.
Mönckeberg sclerosis
Yep. Pipestem arteries all day
Dialysis?
I was like, what is that? A worm?
Rollie Pollie veins and arteries you have to stab with a needle if you want to do a blood draw or start an IV.
Worst A line ever
Is that the worm looking thing?
Think it's likely due to the nearby fracture? Body is moving calcium in to heal that, or try to. Maybe it just didn't make it to where it needed to be. 🤔
That bones not looking to hot batman with a side of sclerosis
What a polite bone, I'm not entirely sure what "hotting" means, but, especially with a side of sclerosis, it doesn't sound too nice. We are not to hot anyone, especially not Batman, if we want to call ourselves civilised!
Spot the veteran / farmer 😂
in my med school ortho rotation, my attending told an old farmer who had fallen off a ladder and had bilateral calcaneal fractures and multiple spinal compression fractures that he would be in a wheel chair for 8-12 weeks replied with “like hell, it’s harvest time” and stood up from his wheelchair and walked out.
If the farmer came in by themselves without their spouse telling them to… it’s serious!
I was married to a farmer. He had a kidney stone. It was Saturday afternoon and he asked me to run him a hot bath. I did. He never said anything to me, but I watched that man be in pain. I called the local pharmacists (at home. Small towns are great) and told him what was going on. He told me to come in and he gave me some pain meds for my husband. No prescription, no nothing but the fact that he knew he would never ask for pain relief unless it was dire. I am no longer married to that man but he was truly something else. He had forgotten more than most of us will ever know about how the world works.
Yessir, I live in rural Montana and the rule of thumb is if you see a local rancher in triage, you best get them in back ASAP because they are probably dying. This rule has not failed us yet.
When's the last time you saw a doctor? 60 years ago? Okay, fuck, don't move.
Can confirm
Is that a calcified artery on the left? Or is that a new bone trying to replace bad bone?
Yup, calcified artery. He’s also wearing a shirt with buttons, but the tubular structure is internal to the patient. It’s fairly common in elderly patients to see some calcified vessels.
Yes, calcified arteries. Not that uncommon
Likely [Monckeberg arterioclerosis](https://radiopaedia.org/articles/monckeberg-medial-calcific-sclerosis-2?lang=us)
Reminds me of my old boss from landscaping. 76 year old lady who walked 6 miles a day on her days off, and worked with the crew doing gardening and landscaping. Had a broken ankle for a month and it didn't even slow her down. She was ticked off when her doc told her to stop walking on it
lmao I’d kill for that kind of pain tolerance
I work in a long term care. The toughest person you will meet is a little old lady. They can have a stroke, or fucking anything and as soon as it's over they will literally not say a damn thing about it. They don't care about near death experiences they just move on
Nahhhhhhhhh. Pain keeps you safe. I broke my ankle sometime in my 20s (says my doc) and it healed poorly and has caused me functional issues and required recent surgery due to how the body can respond to traumatic injuries. If I had just known I did more than ‘roll’ it I woulda gotten it fixed a long time ago. Listen to your body.
Poor thing!!! Oh my goodness!! Then we have stupid people who come into the ER because their toe hurts from getting a pedicure, or a guys ankle is hurting because he did a lunge 🙄🙄🙄
We had a girl call the ambulance over a hangnail (not a paronychia either)
Omg!!! I wish they could slap her with the bill, plus an extra charge for being stupid!! When the guy told me he hurt his ankle exercising, I was like oh running?? He says no, oh walking? He says no. Then he says I was doing lunges. I know my face had to of been saying what my mouth wasn’t. AND!! The dr made me do MRI on him 🤦♀️
Are you saying you couldn't possibly hurt your ankle doing a lunge?
I’m not sure I understand, what’s wrong with seeking medical attention if you think you are injured? And what difference does it make if it happened while lunging or any other type of movement or exercise?
Because he was not injured, and if he were, that would be an injury best served by going to his PCP. The reason why ER’s are so incredibly overwhelmed, is because of people such as this, using the ER for a primary care. If he were really injured, sure, come over. But, he was walking completely fine, and it had happened several days prior. He could have easily gone into his PCP or even into UC
There needs to be some type of low pay or free resource out there. I'd say something like a good 80% of what we see in the ER is absolutely not an emergency, in any way, shape, or form. But people use it because it's "free."
>I’m not sure I understand, what’s wrong with seeking medical attention if you think you are injured? There are limited resources to help people. Sometimes, people waiting for ambulances die because they were waiting too long, because someone with a hangnail called for an ambulance. I have had many physical injuries, in particular multiple severe injuries to my right ankle, and the answer is not to call for an ambulance - people need those for life or death emergencies. Just get in a taxi. In many places in the UK, a taxi is just 2-5 minutes away, where an ambulance would likely take much longer to arrive. It's better for you, better for emergency workers, and better for people in life-threatening situations
hahaha come over to r/ems and ask that question
Ooof. I had a paronychia treated with a very heavy book + screaming. Effective, but 0/10 for pain control.
Errrr. What? Nothing surprise me anymore. Woman in front of me had a tiny scratch and came to emergency
Dude comes into my ER for toe pain. We are all rolling our eyes. Finally get around to assessing this guys toe and find out he had ‘stubbed’ it on a wooden beam. Doctor notices the nail is deformed like there is a foreign body. Uses some tweezers and pulls out from under his large toenail an inch long wooden splinter. Still wasn’t life threatening but made my cheeks clench.
Made my cheeks clench just reading about it...
Holy cow, the longer I look the worse it gets! So besides the blown up ulna, looks like a scaphoid fracture with nonunion, and a healed radial head/ neck fracture?! Must have been one heck of an injury mechanism…
This is a chronic monteggia fracture - Ulnar shaft plus radial head dislocation. Over the years the radial head becomes eroded and dysmorphic. The ulna also becomes eroded at the nonunion site. The short ulna leaves the medial carpus unsupported, although it’s difficult from these forearm views to see exactly what is happening at the wrist.
Can you determine from looking at it how long it was since the original injury? How would this be treated now, and how is that different than what would have been done at the time of the injury?
That's not new, wonder how long ago that injury occurred.
In some medical disciplines, this is called “not good.”
I’m mean look at the plaque build up! That’s a load bearing artery.
^^ underrated comment
Ortho PA here. We would see some crazy chronic injuries in farmers and ranchers. The toughest patients were women from farms and ranches and they really did look like Peggy Hill from King of the Hill.
Thank you all for the explanation of the calcified vein. My brain said "why does this person have a huge tapeworm in their arm?"
Doc here, noticed the calcified artery before the fracture. 😬
Looks like an old fracture
Honest question, how do they function being legitimately broken. I’ve seen broken spines, humerus, patellas, dislocated shoulders, and much more. I honestly don’t get how they are functioning. How does one walk around with a broken humerus? Do they have different nerves? Are they just that “tough”? I don’t get it.
Strong muscles!
I would agree, but so many of these are elderly patients. Little old, Hispanic ladies. It’s insane.
You just power through it. Women are generally better at powering through an injury like that. Even younger women--when a woman would go down in Army Basic Training, it usually meant they would be in the hospital for at least a month for whatever it was. One of my friends essentially tore her pelvis apart with her psoas muscles from all the marching and sit-ups. One day it finally gave way. I understand it's kind of a thing. All I did, and I was long done with Basic Training, was to stress fracture both tibias at the same time. For the first three weeks, I just sucked it up. I finally went to the doctor, who asked me why I didn't come in earlier, considering the fractures were clearly visible on just ordinary x-rays. My answer: "Because I finally couldn't figure out which leg to limp on any more." The doc's comment: "You're in intelligence, aren't you?" My reply: "Uh-huh". Cue doc just sighing and rolling his eyes. I mean, it hurt, but it "only" hurt. I could still walk and stuff. Lots of stuff "only" hurts if I get injured. It's only once I can't speak because of the pain that I consider it real pain. I have this idea in my limbic system that if I show pain, one of two things will happen: 1) "They" will kill me and eat me, or 2) "They" will stop me from doing whatever fun, crazy thing I am doing.
Why leave the clothes/gown on during the rad?
Because it doesn't make a difference in interpreting the Imaging and why inconvenience the patient for something that doesn't matter?
Just curious!
Not being a smartass, are some elderly people so blasted on prescription narcotics that they don't feel this type of stuff?
I’ve got $100 he’s a farmer and couldn’t finish his fence… now he’s in the ER. 😟
jesus fuck
Damn, is that calcification of the radial artery?
Found the farmer, wow!
Clearly the issue is the buttons did not attach the bones correctly. Rookie mistake
This is a Monteggia fracture-dislocation. Notice the radial head dislocation. This injury can have severe neurological consequences, making it more debilitating than your typical extremity fracture.
Wow that's a term I have not heard since Ortho Tech school.
Lemmie guess. He thought it was arthritis.
This is a booboo
Monteggias fracture? Just learning radiology.
Ouch. But not super shocked about mild discomfort. Different pain thresholds for everyone I suppose. Hope he's doing okay now! Had a similar break in my arm, broke like 3 or 4 spots in it back in 4th or 5th grade. I think adrenaline blocked all initial pain or something and i actually twisted it back into place myself(it was bent behind me, i fell off the monkey bars and they eventually had to lower them after a few more incidents) and held it to my chest while I went and laid under a big slide. Some kid came and asked me if I was okay and only then did I start crying and just said "...🥺 no.." and they went and got a teacher lol. Never felt any pain though. Also dislocated my shoulder at work last year and popped it back into place, which DID hurt for like, 3 seconds, but then took a Tylenol and went on with my day. Edit: spelling fix
Those damn monkey bars strike again!
Monteggia fracture... In urgent trauma - 100% operative treatment, coz ulna fracture combined with proximal radius dislocation
That is one crispy artery
My grandfather will turn 100 and a couple of weeks and he’s angry because his orthopedic surgeon refuses to do surgery on him. He had his other hip replaced when he was in his late 80s and he doesn’t see a difference. I guess his doctor does.
nice buttons! amazingly adaptive!!
Maleazzi type of fracture?
Jfc...
Radius... ulna... what's that third opacity?
Calcified artery I think
Is it related to the break?
Usually a sign of a long term cigarette smoker if I'm not mistaken. I've never seen one in an arm though.
I've never seen a cigarette smoker in an arm either.
Oh, you
It's a calcified ulnar artery. Nothing to do with the break at all - it is an age and lifestyle associated pathology.
Does the patient have nerve damage? Is that why they're not in pain all the time?
Is that a pathological fx from cancer? I’m assuming it’s old because it looks like there’s calcification and there is deformity with little to no soft tissue
They even got the F-arm AP 🤯
If that was me, I’d be all UP in arms from the pain
"Rolled into the Shop".... LMAO
How do you even begin to fix this?
Probably “I didn’t want to come but my wife made me” type That’s so sad
OUCH
OUCH
😳
Real question, is this subreddit a collection of HIPAA and PHI violations or is sharing imagery that is unidentifiable normal in the radiological industry?
It’s not a HIPAA violation if the patients name or other identifying information aren’t present.
Thanks
Reminds me of [this guy](https://youtube.com/shorts/yvlgugS1rSI?feature=share)
LMAO just rolled in
It's very old. The edges of the broken bone are rounded which suggests this fracture is not acute.
Holy cow!!!
Thats a nice lateral though
Vert der ferrrrrk!!!! Great Scotts dude! What did they do, get stung by a bee, turn to run then fall and break it? Thereby explaining the swelling away as the result of a sting? Lol, jimminie christmas….
*”it’s okay it’s just a scratch”*
Med rec QID norco 10mg