Bad Break, Good Outcome: Team Effort Restores Joint Function

“This is me leaving my apartment on my first day in Rome,” says Roberta Kelley, looking through her photo collection. “See how happy I was? And here I am having my first and only cup of espresso.”

Roberta’s dream vacation ended abruptly when after a long day of sightseeing, she stepped off a surprise curb and went down hard. Holding her tour map and phone, Roberta’s elbow took the brunt of the impact, crushing it. She remembers bystanders helping her into a cab and later, falling asleep in her rented apartment.

The next morning Roberta’s shock gave way to the realization her swollen arm was broken. A local hospital took an agonizing X-ray, and Roberta learned she’d need surgery to repair her ruined elbow. She could have the surgery done in Rome, the doctor told her.

“But I said no, I’m flying back to Seattle,” remembers Roberta. “I need to go to Virginia Mason where I get all my care and my doctors know me.” Roberta shares another connection with Virginia Mason, retiring in 2018 as a speech-language pathologist and orofacial myofunctional therapist (treating muscle disorders of the mouth and face).

Fitted with a temporary cast from her shoulder to her wrist, Roberta made the long trip home and then to Virginia Mason’s Emergency Department. She relaxed for the first time in days, with the team making her comfortable and gently guiding her through X-rays. That same morning Roberta met orthopedic surgeon Laura Stoll, MD.

Roberta in chair

Roberta Kelley

“Dr. Stoll showed me the images and explained her plan for surgery,” says Roberta. “She wanted me to know it was a bad break and there were no guarantees about what function I’d get back. I was so worried and nervous, but she said ‘I will take good care of you’ and gave me a hug. That made a world of difference.”

Roberta’s severe elbow fracture and dislocation required a prosthetic replacement of the radial head, the knob-like end of the radius bone that helps form the joint. The radial head sits in a pocket of the ulna bone, allowing the forearm to both flex and rotate. In addition to the prosthetic, Dr. Stoll rebuilt and repositioned Roberta’s elbow with a stabilizing system of plates and screws.

“Because elbows are mechanically complex, they are tricky to repair and surgical outcomes can be unpredictable,” says Dr. Stoll. “Roberta’s dedication to recovery and her positive attitude were so important. Achieving a good outcome really becomes a team effort.”

“Team Roberta” included Dr. Stoll working side-by-side with an occupational therapist in joint visits, going over X-rays and creating a rehabilitation plan. Roberta began a rigorous therapy regimen, which included daily home exercises. Roberta set her smart phone to remind her when to do them. At first she felt discouraged, not able to bend her arm enough to wash her face, put on make-up or even earrings. But her occupational therapist stayed positive and encouraging, even as she challenged Roberta with those very tasks each week to help condition her new elbow.

“My range of motion is excellent now, but it came with a lot of effort and exercise,” says Roberta. “I told Dr. Stoll she did fabulous surgery. She said ‘yes, but you did all the hard work.’”

A version of this story originally appeared in the Virginia Mason 2019 Annual Report.

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