Cannulated Screw hip repair

General cycling advice ( NOT technical ! )
goatwarden
Posts: 692
Joined: 20 Nov 2009, 12:03pm
Location: Bristol

Cannulated Screw hip repair

Postby goatwarden » 23 Nov 2010, 5:54pm

On Tuesday last week I was enjoying a ride from Basingstoke to Bristol despite the cold and fog; I do this journey fairly regularly. For the first time ever I made it most of the way through Devises without anyone cutting me up. So I inadvertently celebrated this by bringing the traffic to a halt. A small roundabout was still in shadow and must have been icy on its road markings, despite the day having warmed up considerably at that point and there being plenty of traffic to help melt ice. I was gently going right in a position to block the possibility of anyone passing me when my back wheel slipped out to the left as it was on a big white direction arrow and I landed squarely on my right hip on a manhole cover.

Suddenly the traffic stopped and I was surrounded by people trying to help. My leg felt quite numb and I couldn’t put weight on it, my saviours helped support me and sat me down next to my bike on a chair kindly provided by the landlord of the pub I was outside. I was thinking “This feels quite bad; it will be at least 15 minutes before I get feeling back and ride on.”

Needless to say, I didn’t get back on my bike. I was taken to Swindon Hospital and they established I had Broken my femur at the top; a typical “old lady’s” injury. The next day they repaired it by fitting three cannulated screws. Despite being perfectly healthy from last Thursday, it took a fight to get them to release me (pure bureaucracy – everyone there was wonderful, but the system that is supposed to synchronise them simply doesn’t work, leaving me a very angry prisoner blocking a bed from use by someone who needed it) and I finally got home on Monday evening.

Getting answers concerning rehabilitation, stitch removal, etc. proved impossible but I was just glad to get out of there. My GP hasn’t been much more helpful today, and the labyrinthine method by which the hospital informs them of my state seems unknown to anyone and certainly hadn’t worked yet; I offered to e-mail a copy of my release summary (The document which the hospital should show them, which is lacking any details of method of wound closure or time for removal – so not much help anyway!) to them, but they “can’t accept e-mails, could I fax it t them so they can scan the fax into my record?”

I would be grateful to hear from anyone who has undergone similar injury and repair. I am particularly interested in what exercises were safe during the six week’s non-weight bearing, what happened after that (I have been given no clue beyond “come back in six weeks”) and how soon and easy the path back to cycling was achieved.

Nutsey
Posts: 1270
Joined: 19 Apr 2010, 3:31pm

Re: Cannulated Screw hip repair

Postby Nutsey » 23 Nov 2010, 6:09pm

A broken femur is a serious injury that is VERY costly for the NHS. It is the second most resource-gobbling diagnosis in terms of bed-days, second only to schizophrenia. (IIRC)

Its not any old broken bone. Its the bone that needs to be strong to support a lot of weight (not personal :o ), so listen to your doctors and do what you're told!

Get well soon



(For anyone that cares here is the data - http://www.hesonline.nhs.uk/Ease/servle ... ile_name=d:\efmfiles\1937\Accessing\DataTables\Annual%20inpatient%20release%202010\Diagnosis3_0910.xls&short_name=Diagnosis3_0910.xls&u_id=8914)

cyclingthelakes
Posts: 231
Joined: 13 Aug 2009, 2:34am

Re: Cannulated Screw hip repair

Postby cyclingthelakes » 23 Nov 2010, 6:18pm

Ouch, sorry to hear about your misfortune. I know I've read your postings so for you to tell us this story is a surprise. Sorry I don't have anything to contribute directly, however Phil Liggett sidekick and former racer (Seven-11) Bob Roll broke his femur in a ski accident early this year http://roadid.posterous.com/roll-call-i ... r-bob-roll questions to him but where are the answers?

It's that back wheel you talk about sliding, that's the wheel to watch out when riding on ice, ouch, to be turning that much I can kind of see how that would happen. Ice isn't much good for cornering, that's when it happens, still being November, it seems early for ice to be doing that. Yeh, I've tumbled 2 times like that on roads. Took my bike across a frozen lake and saw it do that but that doesn't count. The bike and body go one way, the back wheel goes the other.

A small roundabout was still in shadow and must have been icy on its road markings, despite the day having warmed up considerably at that point and there being plenty of traffic to help melt ice. I was gently going right in a position to block the possibility of anyone passing me when my back wheel slipped out to the left as it was on a big white direction arrow and I landed squarely on my right hip on a manhole cover.


Isn't the Femur actually the biggest bone (bones?) in the body? I believe that is so.

User avatar
Cunobelin
Posts: 9312
Joined: 6 Feb 2007, 7:22pm

Re: Cannulated Screw hip repair

Postby Cunobelin » 23 Nov 2010, 6:24pm

One of the problems with the operation and this fracture is that there is immobility so the blood flow is less. This combined with the clotting that occurs as part of the healing process and the operation puts you at a high risk of a blood clot n the lung (PE Pulmonary Embolism). It is not uncommon to sit on a patient who is otherwise well as a precaution

reohn2
Posts: 35314
Joined: 26 Jun 2009, 8:21pm

Re: Cannulated Screw hip repair

Postby reohn2 » 23 Nov 2010, 6:30pm

I broke the neck of the femur (and dislocated the hip) when I was fourteen,a cycling accident very similar to yours.The break was pinned (similarly to yours,mine has four in it) and I was layed up for 3months.
The plus is that its lasted 44 years without a problem :) other than restricted articulation which has never troubled me when working or cycling,only in some Yoga postures :| .
I seems like the six weeks mentioned is the healing time as with any broken bone, the screws are probably to hold it all in place whilst the healing takes place,so its important not to weight bear I would have thought.
The Femur (biggest bone in the human body) needs to heal properly as it takes a lot of stress,so get well soon and take you're time about it,at least its winter so you're not missing much,by mid January you'll be as right as rain :)
-----------------------------------------------------------
I cycle therefore I am.

User avatar
531colin
Posts: 12448
Joined: 4 Dec 2009, 6:56pm
Location: North Yorkshire

Re: Cannulated Screw hip repair

Postby 531colin » 23 Nov 2010, 7:10pm

Sorry to hear of your troubles.

2 marvellous books which may help you, both by a physio. called Vivian Grisogono.
1) Knee health (Gaz & 4millsix have both borrowed my copy of this)
2)Sports injuries, a self-help guide (bigger, but post-able)

She says that the Vastus Medialis loses tone etc. alarmingly quickly when its not being used. This is an important muscle for cyclists, if its not up to scratch the knee-cap doesn't track straight. (I think thats what 4millsix is re-habilitating now)

I'm just a biologist, and long out of practice at that, but I don't see why you shouldn't do exercises that dont hurt, as long as you go very gently at first, and dont put weight on it. For example, you can work the Vastus medialis by simply contracting your quadriceps to pull the knee cap up when the leg is straight, for example on your back in bed, or with the foot on a chair(etc) when you are sat down. Just so that the knee locks out fully straight, and hold it for a bit.

I find that medical types are usually delighted when I take an intelligent interest in what happens to me. It would be worth trying to speak to a physio. at your local hospital, they will be treating you eventually, and anything you can do now to make their job easier is "money in the bank". Failing that, I would be paying for a physio. session or two now, to speed recovery when you reach that stage. Obviously, you need to find somebody in private practice with experience of post-op. neck of femur (?) fracture patients.

I would also be trying to twitch my calf muscles, and doing ankle circling (eg in the straight leg situations above) just to keep the circulation going - I know somebody who had a deep vein thrombosis.

PM me your address if you want to borrow the books.

snibgo
Posts: 4604
Joined: 29 Jun 2010, 4:45am

Re: Cannulated Screw hip repair

Postby snibgo » 23 Nov 2010, 7:21pm

You have my sympathy.

This is what happened to me. It is NOT advice to you. I am not a medic. Patients, injuries and treatments will vary.

I broke the neck of my right femur on August 3rd this year. I was then 52 years old, a bloke. Addenbrooke's put in 3 cannulated screws that night. Although the bone had broken, the ends hadn't moved apart so my surgery was quite simple. Next morning, a physio therapist taught me exercises, and to walk and go up and down stairs with two crutches. I spent 48 hours in hospital. An occupational therapist visited my bed to discuss whether I needed help for general living. I was told to return for a fracture clinic in 6 weeks, and to see my local GP in a few days for the dressing to be changed. In the meantime, I was to put no weight on that leg.

At the GP's, the wound turned out to be 50mm (2 inches long), with soluble stitches so no need to remove them. There was no sign of infection. I was told that if it turned red, I was to return immediately as infection would be Bad News.

The hospital had arranged for a physical therapist to visit me at home for more exercises, which she did.

At six weeks, I returned to hospital. An x-ray showed the bone and screws were fine. I was told I could then start using just one crutch, and put weight on that leg, leading up to 50% weight-bearing six weeks later (ie 12 weeks after the fracture). "50% weight-bearing" means I could then stand still on both legs, but should only put half my weight on that leg while walking, with the rest of my weight on the crutch (on the opposite side of my body). I was to return for fracture clinic after another 12 weeks (ie 18 weeks after the fracture).

As the fall was fairly trivial, they booked me for a DEXA hip and spine scan. This showed the other hip was osteopenic but the spine was osteoporotic.

In a few weeks, I return to Addenbrooke's to determine treatment for osteoporosis, and for the 18-week fracture clinic. My current problems are mostly because loads of muscles have taken a long holiday and are reluctant to return to work.


The exercises:
- Some movements while lying down, really aimed at people who can't stand.

- While lying down, arch upwards so body weight is supported by heels and shoulders. This strengthens front-pelvis muscles.

- While standing on good leg:
- - Move bad foot out about 300mm (12 inches). Hold for 10 seconds.
- - Move bad foot to front. Hold ditto.
- - Raise bad knee, allowing foot to hang from knee. Hold ditto.
- - Move bad foot back, while keeping upright posture (ie not leaning forwards)about 300mm (12 inches). Hold ditto.

I stress that these exercises were given to me by physiotherapists who had taken my history and examined me. They may be totally wrong for you.

If you haven't seen a physiotherapist, I suggest you shout loudly, probably at your GP. All my care was courtesy of the NHS.

More chatty information at:
http://cycleseven.org/jealous-bicycle What do you do with a jealous bicycle?
http://cycleseven.org/chopping-and-folding Chopping and folding
http://cycleseven.org/a-change-of-plan A change of plan
http://cycleseven.org/ode-to-a-bicycle Ode to a bicycle
http://cycleseven.org/a-big-little-ride A big little ride
http://cycleseven.org/brown-bike-comes-home Brown bike comes home
http://cycleseven.org/let-me-eat-cake Let me eat cake
http://cycleseven.org/papworth-everard Papwoth Everard

Get well soon.
Last edited by snibgo on 23 Nov 2010, 7:38pm, edited 1 time in total.

goatwarden
Posts: 692
Joined: 20 Nov 2009, 12:03pm
Location: Bristol

Re: Cannulated Screw hip repair

Postby goatwarden » 23 Nov 2010, 7:30pm

Nutsey wrote:A broken femur is a serious injury that is VERY costly for the NHS. It is the second most resource-gobbling diagnosis in terms of bed-days, second only to schizophrenia. (IIRC)


It almost certainly is if they all keep patients virtual prisoners for three unnecessary nights!

Nutsey wrote: so listen to your doctors and do what you're told!


As soon as they actually give me some advice, I wiill be glad to follow it.

531colin wrote:She says that the Vastus Medialis loses tone etc. alarmingly quickly when its not being used. This is an important muscle for cyclists, if its not up to scratch the knee-cap doesn't track straight. (I think thats what 4millsix is re-habilitating now)


I can vouch for that. In my late teens I dislocated my left patella twice. Each time I was slapped in a thigh-to-ankle cast for a month. When the cast was removed it was clearly filled with someone else's leg, with rubber bands where my huge quadriceps used to be! It took many years to get them back properly. Thanks for the offer of the books, it's very kind. I have one fitness therapy book which my wife swears by, but hope to get some proper advice sooner rather than later. I actually have medical insurance through my wife's job, so can get it through that; I am just keen to give those involved so far a fair chance to help me and don't want to offend them. As I said above, my problem appears to be that the system just doesn't work; every individual I have spoken to has been very caring and worked hard, they just don't seem to be very good about giving out information (it took a fight to get someone to show me my X-rays and it seems the days are gone when the great man who cut holes in you comes round the next day to admire his work and explain what he did.

Thanks to all for the good wishes, as Rheon said, by late winter I should be back on a bike, I just hope I manage to avoid the ice!

User avatar
Mick F
Spambuster
Posts: 45854
Joined: 7 Jan 2007, 11:24am
Location: Tamar Valley, Cornwall

Re: Cannulated Screw hip repair

Postby Mick F » 23 Nov 2010, 8:18pm

Ouch.
Sympathy to you, but no particular advice. Sorry.

Listen to what you're told, and take it easy and get well soon.
Mick F. Cornwall

DavidT
Posts: 1216
Joined: 13 Jan 2007, 2:05pm
Location: East Midlands (Originally from Devon)

Re: Cannulated Screw hip repair

Postby DavidT » 23 Nov 2010, 8:34pm

Sorry to hear of your incident.

Best wishes.

(Nothing to contribute on the medical side I'm afraid)

snibgo
Posts: 4604
Joined: 29 Jun 2010, 4:45am

Re: Cannulated Screw hip repair

Postby snibgo » 23 Nov 2010, 8:36pm

531colin wrote:... but I don't see why you shouldn't do exercises that dont hurt, as long as you go very gently at first, and dont put weight on it

I was told that pain wasn't a reliable limit to my exercises, as I could damage the healing of the bone around the screws without realising it.

But I did (and still do) more exercises than have been suggested to me. There seems to be a conflict here: the healing bone wants no exercise, but the muscles do want exercise.

gilesjuk
Posts: 3270
Joined: 17 Mar 2008, 10:10pm

Re: Cannulated Screw hip repair

Postby gilesjuk » 23 Nov 2010, 11:37pm

My brother broke his femur in a wakeboarding crash. It took him quite a few months to recover as the break wasn't fusing, he wasn't putting his weight on it enough.

I'm sure you will have some physio sessions as you start to heal and they will tell you what you need to do. Walking is the best thing for it as cycling isn't a weight bearing exercise.

awparker
Posts: 159
Joined: 11 Jan 2007, 2:34pm

Re: Cannulated Screw hip repair

Postby awparker » 24 Nov 2010, 8:16am

Can I just add a bief note to all the other comments particularly regarding physio?

I broke my arm in a fall from my bike a few years ago at the age of 60. The NHS surgeons were excellent apart from saying that I my age it would take some time to heal - pointing to a young lad seemed to be on the way to full recovery in a couple of weeks.

However they did not push for me to have any physio so I arranged this privately and was pleasantly surprised at the reasonableness of the cost. Get an initial contact as early as possible even if the treatment is postponed a little until sufficient healing has taken place.

As noted in a previous post the physio I saw was very happy to work towards a particular goal. Mine was to be able to lift my bike onto the roof rack on the car. She commented that too many of her patients were not involved in sport had limited aims for return to activity. Specific aims helped both her plan the treatment and my speed of recovery.

A word of warning! Do not be deceived if you get a young slip of a girl as your physio. You will not have an easy time. They know all the places to poke with their delicate fingers and I needed my wife to drive me home after each treatment.

Hope all goes well.

Alan

The Mechanic
Posts: 1922
Joined: 23 Jul 2010, 1:38pm
Location: Scotland

Re: Cannulated Screw hip repair

Postby The Mechanic » 24 Nov 2010, 9:01am

My experience of people (family members) who insist on leaving hospital against medical advice is that they often end up back in there in a worse state. Hope you recover soon and listen to medical advice. That is the only advice you can rely on on this forum.
Cancer changes your outlook on life. Change yours before it changes you.

User avatar
tykeboy2003
Posts: 1040
Joined: 19 Jul 2010, 2:51pm
Location: Swadlincote, South Derbyshire

Re: Cannulated Screw hip repair

Postby tykeboy2003 » 24 Nov 2010, 9:07am

Ow. Sounds painful.

In april this year I broke my shoulder blade when I carelessly hit a kerb at about 20mph, went over the handlebars and hit the post of a road sign.

My visit to hospital thankfully didn't include an overnight stay. I found the A&E nurses and doctors to be very good, but the fracture clinic wasn't quite such a good experience until my last visit. Up to then they had been very uninformative and I had to constantly ask questions otherwise I would have been told nothing. The last visit was completely different, the consultant took the time to explain the extent of the injury thoroughly and showed me the 3-d cat-scan images and X-rays. He told me how much longer I'd have to wait before getting back on my bike and was generally very pleasant and helpful. It was a pity I hadn't seen him on my first visit.

Anyway I hope your recovery was as quick as mine (6 weeks) and you get back on the bike soon.