Injury Duty - Bruised, Battered And Broken. lyrics

[Injury-Duty Hurt Locker] : There is a thin line between bravery and stupidity, and at UFC #140 Antonio Nogueira proved that telling one from the other can be damn near impossible. After having Frank Mir within his clutches, Nogueira decided to pa** up what was as close to a certain knockout victory as one will ever see, and instead went for a submission. The result, well… a reflective Nogueira had this to say about his decision: “It was stupid. The fight was won, but I made up my mind to go for a submission. Two more shots and I knocked out Mir for sure. But I wanted to finish the fight beautifully. I wanted to finish with a submission. For a long time I had not finished a fight with a submission, so for a moment I wanted to submit him (laughs). But it was stupid, I should have gotten the knock out. The fight was mine and I missed the opportunity. I felt very well. I was fast with good movement and very confident. I tried to submit when I was in a position where he could counter attack and he ended up taking my arm. I made a mistake, it was stupid …" For his efforts, Mir recovered and slapped a kimura (arm lock; see figure 1 on Nogueira's right arm, fracturing (breaking) it at the humerus (the upper arm; see figure 2. Original reports were that no surgery would be needed, and the MMA community breathed a collective sigh or relief. The PrideFC legend and former UFC Heavyweight champ would be back in no time. (click here if you haven't seen the end of the fight yet) …Not so fast. For general purposes, humeral shaft fractures are cla**ified by simply describing the break in terms of location, the forces involved in the injury, pattern of the break itself as well as noting if any vascular (blood supply) or neurologic (nerve) injuries occurred. However, for things like clinical trials and research purposes the AO/ASIF Comprehensive Long Bone Cla**ification System is a more useful for categorization. The three big categories are in this system are 1) Simple Fractures 2) Wedge Fractures and 3) Complex Fractures (see figure 3). Nogueira's fracture was originally reported to be a simple fracture. The treatment for these sorts of low-energy fractures is most often nonoperative, meaning no surgery is needed (high-energy fractures would involve things like car accidents or being hit with a baseball bat). Simple fractures generally heal with a period of immobilization (fixed in one position) with a cast or splint followed by a gradual rehabilitation. From there most times weekly x-rays are taken of the arm to make sure it is still properly aligned (see figure 4). Unfortunately, Nogueira's fracture was worse than first thought. On Dec. 19th, 2011 his surgeon, Dr. Tom R. Hackett, MD (… sounds a little too close to Dr. Hack-It for me. We're kidding, dude is actually one of the best in the biz) reported that the break was later cla**ified as a complex fracture and not a simple fracture, as previously thought. Worse, while being checked out by his doc it was noted that Nogueira had weakness in his right hand and almost no strength at all in his thumb; all signs of radial nerve entrapment(“pinched nerve”) (see figure 5). The radial nerve and its branches are some of the “wires” that cary signals for communication between your arm and your brain. Here's a short list of the movements this radial nerve is responsible for (see figures 6 and 7): Supination of the forearm (the ability to turn your wrist and have the palm of your hand face up or down) Extension of the hand at the wrist (holding your hands up, as if you were signaling to stop traffic) Adduction of the hand Flexion and extension of the thumb Extension of the elbow (flexing your triceps muscle) *Sensation to most of the back of the arm, half of the top of the hand and most of the thumb. With Dr. Hackett's appropriate concern about Nogueira's nerve being entrapped somewhere along the fracture, the protocol to correct this is to grab a scalpel and dive in. Other circumstances where operative treatment (i.e. surgery) is also considered, besides nerve entrapment, include fractures that can not be aligned (lined-up) properly, if there is tissue (e.g. muscle or fat) preventing proper alignment, open fractures (meaning the skin is broken), and vascular (blood supply) injuries. The fancy talk for what is involved in the surgery is internal fixation with compression plating, and what that means is getting down to the area where the broken bone is, lining up the ends of the broken bone (which is needed for the fracture to heal properly), moving all tissues out of the way (muscle, nerves etc.), slapping a plate on that links the fractured pieces together and finally drilling the plate into place. I'm sure Nogueira's doc used more flowery terms than we just did, but you get the point. Once Nogueira agreed to have the operation, his surgeon then had to map out his plan of attack; how did he want to approach the fracture, meaning which “angle” did he want to take? Should he make his incision (cut) on the front of the arm (anteriorly), the outside (laterally), the inside (medially), or the back (posteriorly)? Experience has provided orthopedic surgeons (“bone surgeons”) with a basic rule of thumb: For fractures involving the middle or proximal third the best approach is somewhere between the front and the outside of the arm (the anterolateral approach aka brachialis-splitting approach). Approaching from the back of the arm (the posterior approach aka triceps-splitting or modified posterior approach) is best for fractures that are mid-shaft or extend into the distal third of the humerus (see figure 8). Of course, there are other approaches that work, but again, this system works well for most fractures (see figure 9 for a drawing of the surgical procedure… but if you want to see pics of the real deal click here). From the report posted on the Nogueira's Brothers website, its sounds like it was a textbook surgery: The operation involved an incision behind the arm [the posterior approach]. The [radial] nerve was removed from the location of the fracture and treated. The fracture was fixed with a plate and 16 screws, and now, less than 12 hours post-op, his hand functions are returning and the bone is mending. Here's a sample before and after x-ray following the same procedure Nogueira had… So, it sounds like the surgery went off without a hitch. Not having the operation done could have led to all sorts of badness such as permanent nerve damage, malalignment (the bone healing “crooked”), nonunion (the fracture never healing at all), and elbow stiffness. But, the operation itself comes with its own risks, too. Complications include iatrogenic radial nerve palsy (damage done to the radial nerve by the surgeon during the operation), infection, nonunion, and loss of fixation (the plate coming loose). Surprisingly, despite how nasty the arm looked after Frank Mir was done mangling it, Nogueira's doctor(s) will have him working on range of motion in the shoulder and elbow within the first week, to prevent his joints from stiffening up. He'll have a series of x-rays soon after looking to make sure that the plate is fixed (in place) and stable. If it is, he will be be allowed to start doing very basic movements with his arm, adding new things as tolerated and by 3 months he'll be back to doing his regular day-to-day activities. By 4 months, if all his x-rays are looking good, the plate looks solid and in place, range of motion is good, he's been keeping up with physical therapy and his strength is full- he'll be fully cleared to resume his sport activities. We wouldn't be surprised if he's in full swing in 6 months, tops. And, if he does decide to return to the Octagon, lets see if we can get TapOut to sponsor him. Digging what you've read here? Show some love, follow us on TWITTER @InjuryDuty