The Smashed Elbow

dr putra vatakal, orthopaedic surgeon, kuala lumpur, selangor, elbow fracture

The brown car sped up the road sending clouds of dust waving through the quiet plant nurseries of Sungai Buloh Drive. Up the ramps the wheels turned, then I screeched to a stop in the UiTM Private Specialist Centre car park, flung the door open and jogged down the sunny road, briefcase swinging in my hand… to the Operating Theatre on level 4.

Some 10 days before, in a different series of road related events many miles away, my patient… let’s call him Mr Gan… found himself with his arm squashed between his motorised bicycle and the shiny rear-end of a mini-van.

I saw him several days later, in the orthopaedic clinic in Sungai Buloh , arm slung across his barrel chest, elbow purple and about to burst with swelling.

A quick x-ray, and a CT-scan later found us staring at a computer monitor, spinning on the screen- not unlike a rather deformed ballerina- was a reconstructed model of Mr Gan’s elbow.

Dislocated… shattered…disjointed…I searched for a word to describe the damage to the anxious patient.. In the end we settled for ‘badly broken’.

And that’s how we all ended up, some weeks later, in the operating room, crowded around an unconscious Mr Gan. Mr Nizam the operating room assistant strapped a clean pneumatic tourniquet around Gan’s arm.

OR nurses Nazliyana and Azua cracked open sterile boxes, their frowns deepening as a scruffy masked stranger pushed through the OR doors and set his briefcase on the floor in the corner.


Greetings, introductions and a short time later, I ran my scalpel along the side of Gan’s elbow, slicing through muscle and tissue to expose the shattered bone fragements within.

“Can I have the saw?”

The green snaking tube with the oscillating power saw exchanged hands, and we cut out some damaged bone.

Dr Reza Aridz reached deep into the wound to position the smashed Coronoid- the bony process that keeps the elbow joint stable as it moves – and Dr Wan Kwong Lee fired up the drill, driving a thin wire to hold the fragment in place.

Some time later, ligaments sutured back into place, I nervously held my breath as we ran Gan’s elbow through the full range of movement.

Thank God it was stable again.

Later, in the operating room pantry (masks on, of course), there was laughter and the smell of coffee, and thoughts in my mind of the difference teamwork can make in solving the complex problems of the world.

We all drove home happy that day. Mr Gan is recovering.

Now all that remains is for COVID to disappear, as quickly as it came.

Originally written on 8 February 2021 in UiTM Private Specialist Centre, Selangor

Note: Names and some details have been changed to protect patient privacy.

Photo credits: Jo-Yi Cheong

As our operating rooms in Sungai Buloh Hospital remain closed to all but COVID infected patients, UiTM Specialist Centre has stepped up to offer their surgical services to some of our despairing patients, and equally despairing surgeons. The author would like to thank Dr Reza Aridz, orthopaedic surgeon and UiTM Orthopaedic Surgery lecturer and his colleagues and staff for opening their hearts, and their operating rooms to the patients of Sungai Buloh Hospital.