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ORIF Broken Femur/ORIF surgery Dec. 20, 2020.

liam2015

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I was walking my dog on a cold, icy night where I couldn't see the black ice In front of someone's house; the sidewalk was on a slight downward slope towards the road and my left leg (TKR leg) slipped violently to the left and I fell onto my right side. I had to phone my sister who lives nearby, because my husband was injured with his knee. Was taken to hospital by ambulance, admitted and the next day had ORIF surgery for a broken femur. Fortunately, the TKR was not damaged although I wonder if some of the areas around it might have been.

I was in the hospital for a week with very little pain and a huge brace on my leg over top of a waterproof dressing. I was given pain meds in the hospital and also a blood thinner med for 25 days. I took regular strength Tylenol a few times when I got home, for discomfort but very rarely did I need it. My first follow up was 4 weeks post surgery and the x-ray looked good (staples removed). The surgeon said that I had to wear the brace for another 4 weeks until next follow up but I could take it off to shower (no weight bearing). Prior to that I had a waterproof bag to put over and a bath transfer bench to shower, with help of hubby. I also started to go to the table for dinner, sitting in the wheelchair with my leg down, which caused some discomfort.

Around a week ago, I started to have more discomfort and pain, mostly in my thigh, also a little just below the knee. I have been taking extra strength Tylenol 4 times a day, but it wears off before the next dose is due. The routine I have is to use the walker to stand up, and then sit in the wheelchair. I wheel myself part way to the bathroom and hubby takes the walker to put inside the bathroom and wheels me the rest of the way as there is a narrow entrance in the hallway. I then use the walker and hop on one foot to the toilet and then to the sink to wash my hands and brush my teeth. Every time I get up now causes me pain, even sitting in the wheelchair I feel pain on the back of my thigh. I also have to wake up my hubby at 3:30 a.m. to take me to bathroom which triggers the pain.

I was given a prescription of hydromorphone (dilaudid) when I was discharged from hospital and didn't open it up until yesterday, to use for breakthrough pain. (I have a hard time with opioids so trying to use them sparingly if possible).

My questions are: (1) what would be a good pain management schedule with the e.s. Tylenol and Hydromorphone so I can get through the night without going over the daily limit of 4000 mg.Tylenol?
(2) Secondly, in the back of mind I wonder if I've damaged something (hopefully not broken anything) due to my straining to turn onto my side In bed at night and the actions of getting up and down. I can't stay on my back all night.
(3) Thirdly, another thing that goes through my mind, is the possibility of a blood clot. My next follow up is on Feb. 19. I'm really hoping to not have to visit the hospital any more than necessary during this pandemic.

Thank you in advance for reading this.
 

Pumpkln

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@liam2015
Welcome back to BoneSmart, sorry you have fractured your femur.
(1) what would be a good pain management schedule with the e.s. Tylenol and Hydromorphone so I can get through the night without going over the daily limit of 4000 mg.Tylenol?
Since the Tylenol is wearing off between doses, you could time the medications so coverage overlaps. You can call your pharmacist and see if they can suggest a schedule for your pain meds.
2) Secondly, in the back of mind I wonder if I've damaged something (hopefully not broken anything) due to my straining to turn onto my side In bed at night and the actions of getting up and down. I can't stay on my back all night.
Most likely you are irritating your soft tissues when you turn causing the pain you are experiencing.
3) Thirdly, another thing that goes through my mind, is the possibility of a blood clot.
Being up and around reduces your risk, Blood clots risk and anticoagulant .

Did you fracture your femur (the long bone) or the neck of your femur?

You'll notice that I have moved your newest post in the other joints forum and started your recovery thread in the knee forum as you have fractured your femur. For several reasons, we prefer that you have your own recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • With your own recovery thread, you will see the posts and advice others have left for you.
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts?Many members bookmark their thread, so they can find it when they log on.
 
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liam2015

liam2015

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Thank you so much for your reply. I realize no one can answer the question about whether I have a blood clot unless I am examined but you're right, I am up and about several times a day, (at least every 4 hours around the clock) so that's a relief that it lowers the risk. I also move my ankle around and wiggle my toes plus hopping on the good leg and pulling myself up to the walker.

I don't know where the break was as I haven't seen the x-rays but the nurse in e.r. said it was broken just above the knee. I didn't want to ask the surgeon too many questions on his rounds as he was obviously busy and, well...Covid, even though we all wore masks and the nurses and dr.'s also wore face shields. I had the test when I was admitted and negative, but trying to stay safe and not talking too much. I intend to ask for a copy of the x-rays on Feb. 19 follow-up. The incision goes from my hip down to my knee.

Thanks again for the link about blood clots ~ I will read it and update as soon as I can.
 

Jockette

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Hi, there, long time no see!

I’m so sorry to read about your accident. I am so afraid of falling like this, this winter more than others, but reading your experience reinforces my attempt to be extra careful.

I don’t know much about the recovery from this type of surgery but I hope it will go according to plan for you.

Sending lots of virtual hugs! :console2::console2:
 
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sistersinhim

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I am praying for your complete recovery. This time of year it's so dangerous with all the ice around. Baby that leg of yours and you should be OK.
 

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Hi @liam2015 so sorry to hear about your fall, what a horrible thing to happen. How is the pain now? I’m sure they will be able to put your mind at rest re clots, but sounds as if you’re moving around as much as poss.

My surgery is in 2 days time, and I took a fall yesterday in snow and mud - well actually I was kicked over by one of my ponies whilst trying to free her feet (she had got them stuck in something in her field). I was kicked on the side of my head, so as well as a swollen knee I now have a nice black eye ready for surgery! But could’ve been a lot worse.

Good luck with your follow up appointment
 
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liam2015

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Oh my goodness @Carmencita, I hope you're okay from the pony kick. I have to tell you that my total knee replacement was a complete success, although it took me 7 months before I could rotate the pedals on my bike, which was set up on a trainer. I didn't start physio until week 6 post op because I was so nauseous from the opioids, which I stopped at week 3. eventually I had very little pain and at 7 months and after, had no pain whatsoever and good range of motion. Wishing you all the best in your surgery ~ try not to overdo it after.
I'm still having a lot of pain in my thigh every time I get up to head to the bathroom or bed. I found a soft furry pillow to put on the wheelchair which helps as sitting in the wheelchair hurts my thigh. Once I get back sitting I undo my brace put a cold pack over my thigh which gives almost immediate relief so I can space out the Tylenol.
I'll definitely give an update after next follow up. Take good care. (ice and elevate).
 
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liam2015

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UPDATE ON 2nd FOLLOW-UP:
I saw the surgeon today and he said everything looks good and I can now put some weight on my leg (half of my weight) and I can start physio anytime. I forgot to ask him if I had to continue to wear the brace but since he didn't mention it, I will keep it on until I see him again in 4 weeks.
I did ask him where the break was and he pointed to it, right above the knee replacement. I also got my son to take a photo of the x-rays (so my physio can see) and I will try to post them.

Regarding the pain I was having in my thigh, it subsided after around a week. I stopped eating at the dinner table where my leg was not elevated; I changed my sleeping position as I think the turning over on my side was causing the pain. Now I'm sleeping sitting part way up so I don't have to use my leg to turn over and I lean my head on a big pillow. I've also adjusted the brace more often as it slides down if it isn't snug enough and I don't think it was giving enough support to my thigh.

It was quite an adventure getting to the hospital today. My husband had booked (or thought he had) a wheelchair taxi for 8:20 this morning. When it didn't show up, hubby phoned and they said "did you receive a confirmation email?". Well he didn't so my son took me, the wheelchair and the walker in our station wagon. It's been snowing here for 2 days so we had to be careful on the snow and ice and parked as close to the entrance as possible (which was a bit of a hike) and at a spot where there was no curb. My son took me into the entrance, then parked and met me back inside. It worked out fine but was a bit of a rush to get there on time. I am a little nervous to put weight on my leg, maybe a repeat of TKR with the pain.
89F7B710-5255-45BB-A30E-D487E5F4FE4B.jpg
 
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Pumpkln

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@liam2015
Glad you had a good report from your Doctor, hoping you can get rid of the brace at your next visit.
Sounds like quite an ordeal getting to your appointment.
You will notice I cropped your x ray photo to remove your personal information.
 
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liam2015

liam2015

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UPDATE ON FIRST PHYSIO APPT.: (Broken Femur)
Myself and my husband are going to physio at the same time and the therapist will go back and forth for both of us in separate rooms. He had a recurrence back in December from an old high school knee injury. Despite that he has been taking care of me, the house, meals, the dog and we now have a dog walker, my 18 y.o. niece, which has been a great relief.
Since the surgeon told me that I could put some weight on my leg (50%), I've been using both legs, along with the walker to walk around the house. We didn't even use the wheelchair to get into the p.t. clinic.

The therapy was very similar to what I had after TKR (same leg) ~ massage, TENS and she put a warm pack on top (as opposed to cold pack after TKR) while I lay on the bed for around 20 minutes. After filling out a lengthy questionnaire and answering questions, the p.t. checked out my walking with the walker, my balance and strength from lifting my leg up and said I was doing really well.
She gave me 2 exercises to do at home: heel slides and leg lifts plus alternating heat and cold. I won't be doing the number of sets and times she recommended, simply because I know from past experience to not overdo it. (I'm not good with causing pain to myself).

It has been so liberating to walk around the house with the walker and not wait for my husband to wheel me to the bathroom. I'd have to wait for him to come upstairs from his downstairs office (working from home due to pandemic) to wheel me to the bathroom. Now I don't have to wake him up at 3 a.m. to get me to bathroom.

I'm finding that standing in one place, ie. brushing my teeth, washing my hands and today washing my facemasks by hand, causes my lower back to feel weak. I guess it's all the sitting around I've been doing and uncomfortable in bed at night, having to turn onto my left side, with this huge brace.

QUESTION: Can anyone recommend a more comfortable way to lay on the therapy bed while having the TENS and heating pad on my leg? I was so uncomfortable flat on my back. I was given an extra pillow for under my head but didn't help. My lower back was so uncomfortable. I needed help sitting up again, which I normally don't need assistance. I wish I could sit up rather than flat on my back. I'm not sure if the bed can be put in an upright position ~ it is automatic for adjusting the height.
 
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Jockette

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The PT table I was on, when they did the ice and tens unit (at the beginning of every session) was able to sit up, so ask about that. I, too, can’t lay flat on my back, it makes my lower back feel like it is arching upwards.

The other thing I do, if I can’t sit up, is to bend the knee that is not being iced, and that takes a lot of pressure off my back.

Don’t just tolerate laying there in an uncomfortable position, you don’t want to create another issue.
 
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liam2015

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Thank you @Jockette. I do tend to tolerate being uncomfortable and I will take your advice and let the p.t. know. I did try to bend the good leg for some relief but it kept slipping.
 

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@liam2015 Ask PT for a pillow under your back and for pillow under your knees before they start the TENS and other therapy. That may help you feel more comfortable.
 
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liam2015

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Thank you @djklaugh ~ I had one under my knees and my head but maybe I'll ask for under or behind my back as well. I'm hoping that I can sit up for the TENS/coldpack/hot pack 20 or 25 minutes alone in the room.
 

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I just read your thread and, oh my gosh! What terrible bad luck to encounter black ice on your walk. I too walk my dog and always fear treading on ice.

What you‘re going through sounds both very different and kind of familiar. Using a walker. Not being able to turn over in bed because doing so upsets the leg. I couldn’t use my leg (either one) for turning over for months. At least, not comfortably or paying for it the next day. So I spent three months sleeping on my back. We do what we must to get that precious sleep. It sounds like you’re learning all the ways to work with your healing body.

I hope the PT tells you that you can sit up for the TENS/etc. packs. The treatment is even more effective if you’re comfortable.
 
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liam2015

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Thank you @SusieShoes ~ I can't imagine how you and others had both knees replaced at once ~ you are made of strong stuff! 3 months sleeping on your back ~ yikes and you recovered so well, an inspiration to all of us. yes we do learn to make adjustments. physio again tomorrow so I will ask the p.t. to adjust the bed so I can sit up.
 
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liam2015

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UPDATE ON 3RD SURGEON FOLLOW-UP:
Surgeon said the x-rays look good; that I can take the brace off in bed or sitting watching t.v. and that I can try walking without the walker if I feel comfortable.

The appointment was on Friday, March 19 and as of today, I haven't worn the brace for 2 days; mainly because I don't want to bother hubby to help me with it as he has his own knee issues and working full time (at home during pandemic), doing the laundry, cooking, serving me, etc. I haven't tried walking without the walker yet.

I'm doing more chores around the house, using the walker for support: cooking dinners, feeding the dog, emptying the dishwasher, cleaning part of the bathroom. I really need to get back into walking on my own as hubby is going for an MRI on his knee May 3, probably due to meniscus issue, and most likely will have surgery, so I will be the caregiver. Our dog walker, my niece, will be getting a summer job soon and off to University in person in September, so I want to get back to that as soon as I'm able.
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UPDATE ON PHYSIO:
I've cut back on the exercises, specifically the heel slides where you go as far as discomfort, then a little further. I was finding that I was having more pain after doing those, and I know from TKR that the flexion will come in its own time plus I dislike pain. The leg lifts are easy for me. My R.O.M. in flexion is somewhere between 90 and 95 degrees.

The issue I had with having to lay flat on my back (with a pillow under my head and under my knees) has been resolved. I told the p.t. that it was uncomfortable, so now she has me sitting up for the massage and bending of my knee and also sitting up for the TENS, laser and warm pack on my knee. I'm only going once a week now.

I still get a weak/sore back from standing too long or a lot of walking around the house. I'm hoping that will resolve once I'm walking without the walker and not having to sit so much of the day. In some ways, this is a longer recovery than the TKR but minimal pain. The difference is that I was encouraged to put full weight on my leg after TKR, but for ORIF surgery femur fracture was non-weight bearing for several weeks, then 50% weight bearing. I remember driving with hubby 2-1/2 hours to our friends in Peterborough to stay overnight and go to the "outdoor theatre" in Millbrook when I was 12 weeks post op TKR. I'm no where near ready to do anything like that at 3 months post op femur break.
 
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liam2015

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I've been moving around a lot more in the last couple weeks, with the walker and doing some chores around the house to help out, where I'm standing around 10 or 15 minutes, then sit down for awhile, and up again and continue. The surgeon said I could take the brace off part time and in bed but to continue to wear for walking, which I assume for walking outside or going somewhere outside of the house.

I'm having more pain now, particularly in my lower back, thigh and also my shin and calf. I had physio on Tuesday of this week and the p.t. had me walking while placing my hands lightly on her hands and I took a few hesitant steps. I don't feel quite ready yet. I've cut down on the physio exercises, partly because I am walking around more and also because the heel slides, when I go just a little further outside of discomfort, I get pain. I also get very, very stiff after sitting for too long, even though I try to get up and walk around regularly.

I have no idea if this is normal or not. This is not the knee replacement ~ it's a broken femur, the break just above the knee replacement. I had surgery Dec. 20. Do you think this is due to being more mobile? I do use cold packs and sometimes hot packs as recommended by p.t. I'm not worried about my R.O.M.; I can tell it's improving as I can now put my socks and shoes on by myself and also the brace where formerly I could not reach the bottom, near my heel, to secure it.

Hope everyone is doing okay and having a good weekend. (p.s. I'm booked for my first Covid vaccine on April 1 at a mass vaccination centre, 2nd dose July 22.)
 

Jockette

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Do you think maybe the increased pain is due to the weight and bulk of the brace, and being more mobile with it on?

2 years ago I was wearing a brace at night for plantar fasciitis, and would walk a short distance with it, and it was heavy and bulky, but most likely smaller than what you have, but I knew it would really bother my back if I had to really walk around with it, especially since it made one leg longer than the other due to the thickness of the sole.
 

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@liam2015 Wow, I just read your post. So sorry to hear of your fractured femur. I know first hand just how painful your situation is as I have fractured both of my femurs, one at 10 yrs of age and the other 7 yrs ago when I hit a tree at high speeds while skiing. I did a pretty good job as the femur was broken in 4 places. The surgeon was able to do internal fixation (IM nail) and realign everything but I was on crutches for almost 4 months afterwards. Sounds like you are well on your way in your recovery. I can honestly say today my femur gives me no problems. I went back skiing at 9 months post-op with no issues. I did have 2 of the four fixation screws removed as they were causing significant discomfort but after that surgery I can honestly say I do not realize the rod is even there.
I see that you reside in Toronto. I am awaiting bilateral TKR surgery in London @ the LHSC sometime this summer or fall as long as electives do not get delayed any further. They have had a tough time with Covid outbreaks on all floors.

Take care and best of luck in your recovery.
 

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