Surgery Again

May 28, 2006

After a few days of preparation; including 3 hours on the x-ray table and various other types of testings and imaging, I rolled off to the surgery ward. Fortunately, my bestest mom-in-law was able to come up and stay with my husband, and visit with me.

I don't remember the first surgery at all, don't even remember waiting in prep, starting anesthesia; don't remember a thing. This surgery I remember. I was a 'fit in on the schedule', and since it was expected to be a long surgery, it was questionable what time my surgery would be. As such things would be, about the time I rolled into the prep area, my pain medication was wearing off. My biggest worry was getting my pain meds.

Here I lay on my bed, looking up into the faces ringed around me. Thinking to myself, this is the crew who will help me walk again some day. Huge conversation about where to put the surgical IV line. I had a PICC in my left arm, but this one person wanted an additional large bore line to get fluids in me in a hurry. I had already had one blood transfusion, and knew that I would also be getting blood for this surgery. So this discussion didn't bother me, what I found endearing was that the team worried about putting the line in my neck and leaving yet another scar; but there was literally no other place on my body available for the IV line.

About this time, I piped up and said something to the effect "take a look at me, what the heck do I care about whether I have one more scar? What I care about is keeping my leg and walking again; go right ahead and stick the IV in my neck; it will help you take good care of me!"

That's about the last thing I remember before waking up in recovery. When I woke up in recovery, both my husband and my mom-in-law were with me. I wanted to know two things, what time was it (which nurses shift) and what happened in surgery.

In my short time in hospitals, I had learned that the night shift is h*ll on poor pitiful patients who can't do a single thing for themselves; as well as happen to be in severe pain that quickly escalates to the most awful maddening monster as the pain meds wear off. I most adamantly did not want to be left alone with that "evil night shift". Between the concussion mental confusion and the pain meds, at the time I truly considered night shift an evil time.

Dr. Cole and his PA's had warned me and my family several times, that they didn't know how much or what all they would get done on me. They had a limit to time they could keep me under, and I had just too much broken. So, my other recovery question was what did they do? Did they get it all done, or would I be going back to surgery again in a brief time?

The next morning the PA sunders in carrying some papers and asks if I want to see my x-rays! Well of course; leaving the most complicated for last, I see that my left hand has a temporary pin in my hand; my right hand has two temporary pins in my finger, my right collarbone can't be plated. The PA is showing my an 8 x 10 copy of my right leg x-ray, that first glimpse inspired the "bionic leg" euphemism.

Using some medical jargon, my right leg fractures were set by ORIF - Open Reduction Internal Fixation. This means I had surgery, and the "fixing" or holding of the broken bone is by means of something internal, or inside me. External fixation would be a cast, traction, or the Hoffman External Fixator I started with.

Here is a chart illustrating ORIF with an IM - Intramedullary - Nail. I have an IM nail in my femur, from my hip to my knee; with another IM nail in my tibia between my knee and ankle. Both the tibia and fibula are displaced fractures. Also called a tib/fib fracture. The tibia is the load bearing, big bone in the lower leg. As I understand it, the fibula bears little load, and will heal without requiring internal stuff.

Additionally, I have a plate that runs from my knee up the outside of my femur. The plate is screwed in many places. You can see an example plate chart here. The femur was shattered so badly, it needed both the IM nail and the plate.

I'm pleased to see that I don't have an external fixator on my knee, as I had been warned by Dr. Cole that the x-rays of my knee looked pretty bad and he expected that I might end up with one; but I'm wondering of course what's going on with my knee. Looking at the copy of the x-ray, my knee just looks like solid metal. I can see that I have a lot of incisions and staples around a very swollen knee.

About this time, Dr. Cole comes in looking very pleased with himself. Since we were discussing my knee, he enthusiastically starts telling us how happy he was to find more to work with in my knee than he expected. The patella was intact, and he was able to reattach various ligaments, tendons and things to live bone. The knee should eventually gain enough function while allowing the femur to heal; but will be riddled with bad arthritis in a few years requiring a knee replacement.

Dr. Cole goes on to tell me to keep a very close eye on one particular incision site, as they had found infection where one of the external fixator rods went through my leg; and had removed between one to two inches of dead and infected bone. He tells me that luckily the surgeons in Lakeland had put antibiotic beads in my leg, as well as I had been on IV antibiotics before surgery with Dr. Cole.

I don't understand the ramifications of many of the things Dr. Cole told me that first morning after surgery; in fact I had forgotten completely about the internal plate. I'm happy that Dr. Cole seems pleased and happy that I'm alive and likely to be walking again. Dr. Cole tells me I will need more surgery, but should be walking in a year or so. Ward and I are pleased.