So at 05:30am, 1.5hrs in to the first session, the thing you hope to never happen, happened. Mark had an accident. He hit a pot hole which stopped the bike in it's tracks whilst he continued forwards over the handle bars. The impact of landing was taken heavily on his left hand and face, which resulted in splintering his left canine tooth, shearing off the enamel and exposing the dentine and residual enamel underneath.
Understandably he came in to the RV a bit shaken, he was spitting blood and shards of enamel out of his mouth.
As routine, vitals were checked and all within normal range. Ongoing monitoring was maintained through the following 45mins to watch for shock. This was hugely helped by TempusPro automatically monitoring his blood pressure every 3 minutes, his oxygen saturation, heart rate and respiratory rate, whilst recording it all in the background, allowing me to get on with managing Mark.
Assessing the damage it was apparent of the state of his tooth and cut lip, but when you hit the ground at force, you have to consider the path of energy distribution. Thankfully no signs of neck injury were apparent on initial assessment, however I have no doubt that there will be evidence of a whiplash affect and therefore micro-trauma to the neck muscles which will present tomorrow.
When Mark fell he also automatically tried to brake his fall with his left hand. Although there was direct contact with the ground through the hand, the force was distributed up the arm and he felt discomfort in his elbow. Imagine the braking force coming up from the ground through the forearm and his 90 kg’s dropping down, these two forces converge at the elbow causing compression at the joint. This is a typical mechanism of injury for a radial head fracture in the forearm, so it is on the top of the list for a possible diagnosis. Thankfully though his range is fairly reasonable, he has no pain on palpation and although uncomfortable, he is able to weight bear through the arm.
So main management:
Being linked with World Extreme Medicine, I contacted Mark Hannaford to ask for a dentist expert and he kindly put me in touch with Burjor Langdana who is the ex Antarctic Survey Dentist. After sending some photos I took and an email to Burjor, within the hour he sent me an amazingly informative and thorough email detailing the steps to take to manage Mark’s tooth. Following his sound advice will involve filing down the tooth to smooth it and then applying a resin – all in a normal days work for a Physio by trade! One of Mark’s close friends spotted the incident on social media and lives in Moscow so is trying to source some resin to send to me.
Doctor Andrew Murray is a Sports Medicine doctor who is kindly at the end of the phone for me if I have any medical queries to discuss when Mark’s performance is involved. Andrew and I have spoken today at length about the worst case scenario of Mark’s elbow having an underlying hairline fracture. In any normal situation you would get imaging/ further investigations to confirm a diagnosis, however we are not in the position to spend a few hours looking for and then sitting in a Russian A&E department. In this situation you have to weigh up the worst case scenario, if it was diagnosed as an intra-articular joint fracture or a radial head fracture, what would our management be? Would our management change if we had the imagery? Could it be an injury that would have long term negative affects if it’s not treated correctly now? Etc etc.
Without imagery, we can say that Mark is able to tolerate weight bearing through the arm and can grip the brakes/ gears, so is therefore safe on the bike to continue to ride. Mark is happy to continue riding and doesn’t feel it’s bad enough to stop (that in itself is a strong indication of severity not withstanding his mental strength). For now we ice it regularly, apply compression to be worn when riding, address any secondary stiffness above and below the joint and fundamentally monitor it over the next 48hours. These next 2 days will give us a greater idea to it’s severity and presentation.
Meanwhile, apart from a couple of hours dip after injury, Mark as always has stayed in great spirits and powered along. We are now 2 hours away from close of play today and even with this accident, the machine is still on target for a high mileage day.