Earlier this year, one of my favorite musicians declared “It is not clear that I will ever play guitar again.”  It was Bono, the lead vocalist of the band U2.  He had been in a bicycle accident in November and sustained a variety of injuries, including a fracture of his left eye socket, left shoulder blade, left elbow, and left hand.  As an orthopaedic surgeon who specializes in upper extremity surgery, many people have asked me whether I think Bono will indeed ever play the guitar again.  Part of my willingness to discuss Bono’s unfortunate accident is that I love U2 and have listened to their music ever since I first purchased legitimate stereo speakers in 1985 (they were KEF model C-55’s).  I have all of U2’s albums and I am fascinated by the band’s continued excellence and relevance, not only in the musical world, but also on several social and philanthropic fronts.  Contrary to a few  complainers, I was delighted when U2’s latest album, “Songs of Innocence,” automatically showed up on my iThings, free of charge.

So let’s get to Bono’s injuries and his guitar-playing future.  The first and most correct answer is:  I don’t know.  There is a lesson here about medical stories reported in the media.  First of all, the only people who are legally in charge of Bono’s medical information is, of course, Bono.  So unless he is explaining his situation to someone directly, the information is probably not particularly accurate or complete.  Even more importantly, it’s really not legal for anyone other than Bono to discuss it.  Furthermore, the only people truly qualified to make comments about Bono’s injuries (and related possible outcomes) would be the doctors that are actually treating his various injuries.  So the careful, legally thoughtful answer on the subject of Bono’s recovery has three parts:  1) I don’t have any facts and can’t guess; 2) it’s really none of my business; and 3) ask the specialists who fixed his fractures.

But can’t I speculate just a bit?  Bono did publish a picture of his elbow, shown as an X-ray image with metal implants in place.   And I do specialize in upper extremity orthopaedic surgery and have performed this type of fracture surgery on a regular basis over the past several decades.  So without discussing any information that Bono didn’t himself release to the public, here goes.

Based upon the elbow X-ray Bono posted on-line and some limited information that has been released to the media, I would agree that Bono sustained a very severe elbow injury in which at least one of the bones around the elbow (probably the humerus) was protruding out of the skin (called an “open” fracture).  As if that’s not bad enough, the fracture type was an intercondylar distal humerus fracture, which means that the end of the humerus near the elbow joint split into several pieces.  These are very challenging fractures to treat.  Given Bono’s relatively young age (note that he and I are the same age, 54, so by my definition, he is very young), and his high level of functioning (lead singer and guitarist in the greatest rock band ever), the orthopaedic treatment plan would be to attempt to connect all the broken pieces back together with plates and screws.  In combination with the need to clean the open fracture, move a major nerve out of the way temporarily, expose the entire elbow joint, and put the broken pieces together, the whole surgery usually takes many hours to accomplish.

So what about the recovery from all this?  Remember that Bono also had an orbital fracture and also a “left pinky” injury.  It’s not clear from the media reports what the “pinky” injury really involved, although ironically, the injury to the little finger (the “pinky”) can be the most difficult to rehabilitate.  Fully flexing the little finger is important for a lot of important things, like gripping anything at all (or strumming guitar strings or holding a guitar pick).

My speculation, in spite of everything, is that Bono will indeed play the guitar again and in fact return to his awesome musical self.  Even though his elbow may never regain totally normal motion, the human body has been blessed with a little “extra” motion – often a little more than we really need to do most things.   If Bono gets two-thirds of his elbow motion back, I suspect his function for most things, including guitar jams, will be fine.  Although his type of elbow injury was very severe, most patients treated with contemporary orthopaedic care will recover enough motion and strength to do almost everything they want.  We are fortunate that orthopaedic technology and medical knowledge have advanced to a point where such severe injuries are treatable and functional recovery is possible.   I am not surprised that Bono stated he is uncertain about whether he will play the guitar again. The initial recovery after this type of elbow surgery is painful, and the elbow (and indeed entire extremity) is initially very  swollen and bruised.  It is common that patients are often shocked to see how beat-up their arm looks in the early recovery period.  Take that in combination with the fact that there were multiple other fractures (eye, shoulder, hand), it can easily seem as though nothing will ever be normal again.

But time and physical therapy can accomplish amazing things, especially when teamed up with dedicated orthopaedic surgeons.  I remain very optimistic about Bono.  Intangible factors also play a significant role in patient outcomes and I have every confidence that not only will Bono receive continued excellent care, but also that his own determination and view of the world will help him return to playing the guitar.  Anyone who has contributed so much to others through both creativity and philanthropy, in my opinion, will be able to get through the orthopaedic challenges from this accident.  Here’s my crazy (unofficial) prediction: Bono will be able to return to his previous greatness over this calendar year.  That’s based upon my confidence in orthopaedic technology, his doctors, his motivation, and his personal strength.  The support of his family and his fans are also intangible factors that will help Bono get better.  He has received great care and he’s The Man.  And I’m not just saying that because I’m hoping for another free downloaded album.

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