ere
are some details and further information on the various types of operations that
I have received since my accident, to try to resolve any ongoing problems. The
operations were undertaken at a number of hospital establishments throughout the
North East of England, including:- Gateshead Queen Elizabeth Hospital, Newcastle
Freeman Hospital, and Sunderland Royal Hospital. I am hoping to add further
information for the operations undertaken on my abdomen and jaw in the near
future.
Broken Ankle - Open Reduction
and Fixation
What is it?
Your ankle is broken. The bones are not in their proper place. If the bones are
left to heal in this position, you may develop arthritis in your ankle. Your
ankle is broken in such a way that you cannot be treated in just a plaster cast.
Fractured means broken. There is no difference in severity between a fractured
bone and a broken bone.
The Operation
You will be given a general anaesthetic so that you will be completely asleep. A
cut on one or both sides of your ankle is made. The pieces of your broken bone
are brought together. Special screws and plates are used to hold the pieces in
place while the bone heals. The skin wound is then closed up with stitches. A
temporary plaster cast is put on your leg. The plaster extends from just below
your knee to your toes.
Any Alternatives
If you leave things as they are, the ankle will be painful and will get
arthritis in a year or more.
Before the operation
You will have come to the hospital as an emergency. You need to let the doctors
and nurses know about your general health, past illnesses, and drug treatment.
Arrangements will be made for you to have the operation done within 24 hours or
so of the injury.
After - In Hospital
The physiotherapist will help you to get out of bed with crutches once the
swelling of the ankle has gone down. The physiotherapist will teach you how to
walk and how to go up and down stairs with crutches. The surgeon who performs
your operation will give you instructions about when you may start to move your
ankle. Some surgeons prefer to get your ankle moving in hospital before putting
your ankle in a plaster cast and sending you home. Other surgeons will not get
your ankle moving before sending you home in a plaster cast. For the first two
weeks after your operation, you should rest with your leg elevated when your are
not walking. This is because your ankle will tend to swell within the plaster
when you are upright. You must not get your plaster cast wet. You will be in
hospital two or three nights after the operation. You will have an x-ray of your
ankle before you go home. You will be given an appointment to come to the
orthopaedic out patient department ten days or so after your operation. Your
stitches will then be removed. You will be given an appointment to visit the
orthopaedic out patient department to have check X-rays. You will be in a
plaster cast for approximately six weeks. The nurses will advise about sick
notes, certificates etc.
After - At Home
When you go home, you will be able to move around the house and manage stairs.
You will not be able to go shopping for the first few weeks after you go home.
Please make arrangements for friends or family to shop for you. Your ankle will
continue to improve for up to twelve months. Looking after a plaster cast. Do
not press on your plaster for 48 hours. Do not let your plaster cast get wet. Do
not cut or bang your plaster. Do not put anything down the inside of your
plaster (e.g. coins). Do not use anything to scratch under your plaster. Come
back to the hospital if: you have pins and needles or numbness in your toes. you
cannot move your toes. your toes go blue. your toes become very swollen. you
have severe pain. Come back to see the plaster technician if: the plaster cracks
the plaster becomes soft the plaster is loose. How soon you can return to work
depends on your job. If you sit whilst at work, you will be able to return to
work two or three weeks after your operation. This also depends on you being
able to get to work. If your job is manual you will be unable to work for at
least three months. You may play light sports twelve weeks after your operation.
You may not play contact sports until you have been told that the break has
soundly healed. When you start playing, you will not be able to play for as long
as normal. Your leg will ache at the end of a game. Your leg will continue to
improve for up to twelve months. The screws and plates do not have to be
removed. If they become uncomfortable, they can be removed eighteen months or
more after your operation. Physiotherapy will be arranged for you.
Possible Complications
Wound infection sometimes happens. You will be given antibiotics to prevent
this. You can develop a blood clot in the veins of your calf. This is called a
Deep Vein Thrombosis (D.V.T.). A combination of medicine and compression
stockings will be used to try to prevent this. Occasionally the fracture does
not heal. If this occurs you will need another operation. If it is impossible to
put the bones together so that the joint surface is smooth, you may develop
arthritis in your ankle.
General Advice
Your may have damaged your ankle quite badly. Even with an operation, it may
never be as good as before the injury. However you should be much better off by
having the operation. We hope these notes will help you through your operation.
They are a general guide. They do not cover everything. Also, all hospitals and
surgeons vary a little. If you have any queries or problems, please ask the
doctors or nurses.
Femoral Shaft Fracture -
Internal Fixation
What is it?
Your thigh bone (femur....fee-mer) is broken. Fractured means broken. There is
no difference in severity between a fractured bone and a broken bone.
The Operation
You will have a general anaesthetic, and will be asleep for the whole operation.
A cut is made in your buttock over the top end of the thigh bone. A steel rod
(often called a nail) is then passed down the inside of your thigh bone. It goes
across the break and holds your bone in the correct position. The surgeon may
pass some screws across the rod for added stability. The wound is then closed
with stitches or clips. There will probably be a fine plastic drainage tube
leading from the wound. You will be in hospital four or five nights after the
operation.
Any Alternatives
If you leave things as they are with your leg in a traction splint, the thigh
bone would eventually heal. It might take three months of rest in bed to do so.
There may be shortening of the bone and the pieces may heal out of line. A plate
of metal on the outside of the bone is not strong enough. Some fractures, such
as those at the lower end of the thigh bone, are not suitable for nailing.
Before the operation
You will have come to the hospital as an emergency. You need to let the doctors
and nurses know about your general health, past illnesses, and drug treatment.
Arrangements will be made for you to have the operation done within 24 hours or
so of the injury.
After - In Hospital
Your leg will no longer be in a traction splint. The wound may be painful. You
will be given injections and later tablets to control this. Ask for more if the
pain is unpleasant. A general anaesthetic will make you slow, clumsy and
forgetful for about 24 hours. Do not make important decisions during that time.
The discomfort of the operation can make it difficult to pass urine and empty
the bladder. It is important that your bladder does not seize up completely. If
you cannot get the urine flowing properly after 6 hours, contact the nurses or
your doctor. The wound will have a simple adhesive dressing on it. The nurses
will remove the wound drain after 24 hours or so. Your stitches or clips will be
taken out when you come to the out-patient clinic 10 days or so after the
operation. You will be asked to start getting out of bed the day after the
operation. As long as the fracture is firmly held by the nail, you should be
able to walk, you will need crutches for 6 weeks or so. You will be shown how to
keep your ankle, knee and hip joints mobile. Wash around the dressing for the
first ten days. You can wash the wound area as soon as the dressing has been
removed. Soap and warm tap water are entirely adequate. Salted water is not
necessary. You can shower or take a bath as often as you like. You will be given
an appointment to visit the orthopaedic out patient department to have check
X-rays. The nurses will advise about sick notes, certificates etc.
After - At Home
You must not drive for six weeks after you leave hospital. You will not be able
to perform an emergency stop as quickly as normal before then. How soon you can
return to work depends on your job. If you sit whilst at work, you will be able
to return to work two or three weeks after your operation. This also depends on
you being able to get to work. If your job is manual you will be unable to work
for at least three months. You may swim gently as soon as we have taken out your
stitches. You may play light sports twelve weeks after your operation. You may
not play contact sports until you have been told that the break has soundly
healed. When you start playing, you will not be able to play for as long as
normal. Your leg will ache at the end of a game. Your leg will continue to
improve for up to twelve months. The cross screws may need to be removed after a
few weeks. This is a minor procedure. This is done as a day-case. If you are
less than forty years old, it is recommended that the metal rod is removed. This
will be at least eighteen months following its insertion.
Possible Complications
Wound infection sometimes happens. You will be given antibiotics to prevent
this. There is always a risk of delayed healing or even non-healing. The X-rays
will show these up and you will have further treatment to get proper healing.
General Advice
The operation is a medium sized one. You should end up much better off than if
you did not have an operation. We hope these notes will help you through your
operation. They are a general guide. They do not cover everything. Also, all
hospitals and surgeons vary a little. If you have any queries or problems,
please ask the doctors or nurses.
Hip Fracture - Femoral Neck
Fracture
What is a Hip Fracture ?
The hip joint connects the thigh bone (femur) with the pelvis. Despite the name
hip fracture , the break is actually below the hip joint, at one of two places
at the upper end of the thigh bone. Following a fall, severe pain occurs in the
region of the hip, groin and thigh. Mostly it will be impossible to get up or
walk. Very occasionally when the bone is cracked rather than completely broken,
walking is possible although painful.
How does a Hip Fracture occur ?
Fracture occurs following a simple fall onto the hip, usually without any other
injury. More rarely it can occur as a result of a road traffic accident, or with
other major injuries. About one in eight women and one in twenty men will have
such a fracture in their lifetime.
Why does a Hip Fracture occur ?
These fractures occur mainly in older people and particularly in women who have
thinning of the bones. This thinning (or weakening) of bones is a natural part
of ageing, but is worse in some people, especially women who have had their
menopause earlier than usual. Osteoporosis and osteomalacia are two conditions
which make the bone lose its strength, and make the femoral neck region more
likely to fracture when a person falls. In younger patients with normal bones,
much greater force is needed to cause such a fracture. Occasionally the thigh
bone fractures because of the presence of a cyst or growth, which weakens the
bone.
Treatment Involved for a Hip Fracture
Treatment is almost always by operation. This will allow you to get up and move
about with minimum delay. Surgery is performed as soon as possible after
admission to hospital, although other medical problems such as anaemia or heart
trouble frequently need treatment before surgery is undertaken. Often a
weight-and-pulley system is set up and attached to the leg with tapes. This
process (traction) helps to reduce pain before the operation. A general
anaesthetic is usual. A spinal anaesthetic is also commonly used which involves
an injection into the lower part of the spine, deadening the nerves. Fractures
near to the top of the thigh bone are generally treated by replacing the top
completely by a metal fitting. However, in younger patients, this fracture type
is treated by getting the bone ends together and fixing them with a number of
screws. Occasionally these fractures may be managed by total hip replacement.
With fractures lower in the thigh bone, the ends are manipulated into position
and then fixed together using a metal plate and screws.
During Treatment for a Hip Fracture
After awakening from the anaesthetic, you will have found a drip tube for giving
fluid and blood in one of your arm veins. Plastic drainage tubes are left in the
wound at the end of surgery and are brought out through the skin, so that blood
and other fluids can drain away harmlessly. After surgery the affected leg rests
in a foam gutter, or over a pillow. Tablets or injections are readily available
to deal with any pain. An x-ray is taken to check the position of the bones,
screws and metal fittings. A physiotherapist will help and guide you once you
get out of bed. Walking is usually begun with the aid of a walking frame.
Depending on the type of fracture, the doctors will allow a greater or lesser
amount of the weight to be carried by the affected leg. If no walking aid was
used previously, you should be able to manage the stairs two weeks after
surgery. You will be discharged home once you are able to manage to look after
yourself, although more prolonged rehabilitation is sometimes necessary. Some
people require sheltered or warden-controlled housing, particularly if mobility
was previously poor, or if there are other medical problems. Complications occur
in a number of patients. A catheter tube may need to be inserted into the
bladder if difficulty passing urine occurs after surgery. This is removed once
you are walking. Pneumonia or heart problems may develop and affect recovery.
Blood clots in the veins of the legs are common, causing swelling. Sometimes,
these clots travel to the lung, causing chest pain and coughing up of blood.
These conditions may need treatment with blood-thinning injections or tablets (anticoagulants).
Quite often, preventive anticoagulant treatment will be started as soon as the
patient with a hip fracture is admitted to hospital to reduce the risk of clot.
Infection of the wound is rare. Antibiotics are often given to reduce this risk,
particularly if the top of the bone is replaced or a hip replacement is
performed. A dislocation of the hip may develop. This is more likely to occur if
you sit on a very low chair or bend your hip up too far. It may also happen
after a fall. The risk of dislocation is greatly reduced after the first 6 to 12
weeks. Another possible problem is that the fractured bones can move out of
position again. This causes pain and shortening of the leg and may require
re-operation. Sometimes the top of the thigh bone loses its blood supply after
the operation, and therefore die (vascular necrosis). This complication may need
to be treated by a total hip replacement.
After Treatment for a Hip Fracture
Pain should gradually decrease after surgery, and the ability to walk improves.
The doctor should be contacted if there is redness or discharge from the wound,
worsening leg swelling, shortening of the leg, or chest pain with shortness of
breath. In the long term, the development of pain in the operated hip may call
for a total hip replacement. Some doctors will advocate checking bone density to
see whether bone weakness contributed to the fracture. If so, long term drug
treatment can lessen the severity of this problem, and has been shown to reduce
the risk of a second fracture. In addition, it has been shown that certain forms
of exercise training can reduce the risk of falling and thereby the likelihood
of further fracture may fall by up to 30%.
If a Hip Fracture is Left Untreated
Non-operative treatment means that you would need to be in bed on traction for
at least 6 weeks. Such treatment frequently results in a short leg which is
turned out, and some fractures may not heal. Many medical problems such as blood
clots, pneumonia and pressure sores occur in elderly patients who are confined
to bed for this length of time.
Effects on Family of a Hip Fracture
Considerable support from family and friends, including help with shopping and
housework, is necessary following discharge from hospital.
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