Cannulated Screw hip repair

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

Re: Cannulated Screw hip repair

Post by goatwarden »

snibgo wrote:
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.


Particular thanks to you, Snibgo, your detailed account is very useful in lieu af any clear advice from the powers that be. It has got me thinking as I have had a back problem for years whereby something tiny (e.g. putting on a sock) appears to tweak a tiny muscle in my lower spine; the injury is nothing but all the lumbar muscles go into spasm and my back is painful for up to ten days as a result (my wife calls me "banana man" whilst I am suffering as I seem to lean to one side when walking.) Using crutches is fairly stiff on the lumber muscles anyway, so at present I constantly feel on the verge of pulling my back - especially when leaning over a washbasin. Clearly immobility of my back would compound my current difficulties at present so I would like to avoid it. Before the operation the anaesthetist bent several needles attempting to give me a spinal injection, saying my spine was calcified (it appears I have my father's spine - at least he has the excuse of having broken his as a reason!). I suspect the calcification and my ongoing back niggles may be related, so it may be worth building this into the picture for any future physio. I like the idea of a physio working towards a goal (thanks AWP, mine is to be able to run, swim and cycle at least as well as before).

I think I will make a GP appointment whereby I can give him the hospital paperwork that they don't seem to have sent him, ask him to try and fill in the details of questions unanswered by the hospital, get me in touch with my local hospital services and I may even wave the health insurance trump card to try and get an early introduction to a physio to at least plan for my future recuperation.

Some years ago I worked in South Korea. The people there were lovely but there is a big Korean cultural issue called "Kibun". This refers to "group feeling", similar to "good karma", and it is very poor etiquette to upset the Kibun. This has the unfortunate effect that they leave it until the last possible moment to give you bad news, by which time it is too late to plan around a problem which they may have known about for weeks. My experience of Swindon hospital was very similar, and similarly dispiriting. I hope now to take control of my destiny a little more firmly; although I really don’t want to upset the NHS as every individual person appears truly dedicated.
brickatius
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Joined: 23 Nov 2010, 9:39pm

Re: Cannulated Screw hip repair

Post by brickatius »

Hi. I too have fractured the head of my femur and have had it repaired using 3 cannulated screws. I did this on 19th Oct, falling off a 'Boris Bike' in the West End of London, so am about 3 weeks ahead of you. You didn't mention whether the fracture was displaced or not. If the break is just a crack and the bone didn't separate the prognosis is good. If it was displaced, as in my case, things are not so simple due to the damage caused to the blood supply and soft tissues. I transferred from St Thomas's in London to my local hospital and as a result have seen the people at the fracture clinic locally at 2 weeks and 4 weeks post op. Originally I was told to go back to St Thomas's at 6 weeks but having had an x-ray last week (at 4 weeks post op.) I have now been told that it is too early to say how things are going and I have another 2 months non weight-bearing before they want to see me again!
I had a referral to the physiotherapy department at 2 weeks who said to give them a call back when I had got the go-ahead to be weight-bearing and to carry on with the exercises I had already been given, as follows.
Lying on back on bed
1 flex ankles vigorously 10 times
2 Draw up the foot on your bad leg towards your bottom, thus bending your knee. Don't go further than 90 degrees - you run the risk of dislocating you hip. 10X
3 Put a cushion under the knee of the bad leg. Bend your good leg, then straighten your bad leg, raising your heel off the bed, with toes pointing upwards. Hold 5 sec and relax 10x
4 With straight leg and toes pointing upwards, tighten thigh muscle and lift your heel off the bed and hold for 3 sec and lower gently down 10x ( I really struggle with this and have only just got the muscle at the top of my thigh to 'fire' at all)

Sitting
1 Put your foot on something slippery and slide your foot back and forth 10x.
2 Keeping your knee bent, lift your foot up off the floor a few inches and hold for 5 sec 10x
3 With foot bent up (toes not pointed) straighten your leg out in front of you so that your heel comes off the floor. Hold and relax 10x

Standing (Holding on to the back of a chair)
1 Keeping your knees more or less together and not bending forward, bend your knee, lifting your foot up behind you so your heel is trying to touch your bottom
2 Swing your leg gently round in a small circle.
3 Bending your knee gently forward and raising thigh, lift your foot off the ground. (Basically same as No 2 of lying down exercise)

These to be done 3x a day Don't overdo it.

Please, please listen to what the medical people say to you. Every case is different and you run the risk of doing more harm than good if you are not careful. Whatever happens this is a serious injury and it is going to take us several months before we are anywhere near back to normal.
Good luck.
goatwarden
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Joined: 20 Nov 2009, 12:03pm
Location: Bristol

Re: Cannulated Screw hip repair

Post by goatwarden »

Thanks Brickatius, the detail of exercises is very helpful.

Due to the apparent ban on giving useful information at the hospital, I don't actually know whether my fracture displaced or not. My suspicion is that it did, as I made vallient attempts to stand on the leg after the fall. However I doubt that there was much soft tissue damage as my blood pressure was healthy and stable and there was very little pain from start to finish.
snibgo
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Re: Cannulated Screw hip repair

Post by snibgo »

When the consultant came to my bedside waving an operation consent form, I had to get him to explain what damage I had actually done to myself. Until then, no one would tell me.

goatwarden: before your operation, did you lie down with your legs straight? If so, was your bad leg shorter than you good one? If it was shorter, your fracture was certainly displaced. Otherwise, it might not have been.

A couple or three weeks ago, I had huge lower back pain, accompanied by spasming of muscles. The cause seemed to be a weakness in the font pelvic muscles, caused by the time on crutches. Exercising those removed the problem.

I suggest you raise your back problem with your GP and physio. I would expect the exercises for your hip, which will include general strength-building, should take this into account.

All the advice I have heard suggests that early physiotherapy and exercise after a broken hip is important. The muscles will inevitably weaken until the leg can bear weight again, but exercise should limit the muscle loss.

All the best (and to brickatius)!
goatwarden
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Location: Bristol

Re: Cannulated Screw hip repair

Post by goatwarden »

snibgo wrote:goatwarden: before your operation, did you lie down with your legs straight? If so, was your bad leg shorter than you good one? If it was shorter, your fracture was certainly displaced. Otherwise, it might not have been.


No, my foot was dropped to the outside, and the ambulance ladies commented that my bust leg was about 2" shorter than the less bust one. As I was sitting waiting for the ambulance I was looking at my dropped toe, aware that I couldn't rotate it to be parallel to my other foot, and in the back of my mind my (lapsed by over ten years) first aid training was screaming at me that this was indicative of something. Of course, once they gave me the answer from the X-ray, I remembered that it is indicative of a fractured femur; "funny how you always remember right at the end!"

On re-reading the scant information on my discharge summary, it does actually refer to my injury as a "displaced intra-capsular right neck of femur fracture", although the previous similar entry doesn't include the word "displaced"; I assume the first report is based on the X-ray taken from above in A&E and the second draws on additional information gained from a transverse shot taken later.

Either way, it was clearly displaced, so I am even angrier that nobody at the hospital talked to me about the possibility or implications of soft tissue damage, even when I asked about it.

I suspect I succumbed to Stockholm Syndrome in the hospital. I had three days of pretty good care (although no information) followed by three completely unnecessary days of effective holding against my will at huge unnecessary expense to the NHS. Yet I didn’t want to offend any one at the hospital and remained largely polite and cooperative. The more time passes, the angrier I become about my experience. I just hope my visit to the GP tomorrow redresses some of the balance.
Kirst
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Location: Edinburgh

Re: Cannulated Screw hip repair

Post by Kirst »

goatwarden wrote:I suspect I succumbed to Stockholm Syndrome in the hospital. I had three days of pretty good care (although no information) followed by three completely unnecessary days of effective holding against my will at huge unnecessary expense to the NHS.

Believe me, as an occupational therapist who used to work in orthopaedics, if they felt it was unnecessary for you to be there, they would have discharged you. The fact you had to self-discharge is an indication you still needed to be there. But there's no point arguing about that now, what's done is done and you're home.

First thing you should be doing is requesting an urgent referral to physiotherapy.
I can handle bars and cycle paths but I can't handle cars and psychopaths

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goatwarden
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Location: Bristol

Re: Cannulated Screw hip repair

Post by goatwarden »

Kirst wrote:
goatwarden wrote:I suspect I succumbed to Stockholm Syndrome in the hospital. I had three days of pretty good care (although no information) followed by three completely unnecessary days of effective holding against my will at huge unnecessary expense to the NHS.

Believe me, as an occupational therapist who used to work in orthopaedics, if they felt it was unnecessary for you to be there, they would have discharged you. The fact you had to self-discharge is an indication you still needed to be there. But there's no point arguing about that now, what's done is done and you're home.

First thing you should be doing is requesting an urgent referral to physiotherapy.


Actually, I didn't self discharge. I continued to play their game to avoid upsetting them. I was no more healthy, mobile or suitable to go home on Monday than I had been on Friday. The OT and Physios had been entirely happy with me (to the extent that one Physio, who came to see me on Thursday, spent five minutes showing me how to put on a pair of pants, in spite of the fact that I was patently wearing clothes which I had put on unassisted that morning, then chatted about running for 45 minutes) they simply failed to sign some bits of paper and were not represented over the weekend. When they signed those bits of paper on Monday morning they made no further assessment of me or gave me any advice. I deffinitely did not need to be there over the weekend, I was simply blocking a bed from use by somebody who was ill. This is the main reason for my anger. I used to be a Manufacturing Engineer, so have a pretty good eye for maintaining flow through a system. By having no OT or physio cover at weekends, and no means by which their input can be circumvented or brought forward, the hospital appears to have no ability to release patients over a weekend. So, unless they can prevent new patients from coming in at weekends, it is pretty predictable that they will have a bed crisis on a Monday morning.

My injury is typical of older more vulnerable people. I am very fit, have excellent balance and upper body strength and previous experience of depending on crutches. There was nothing I was told by the Physios or OT that I was not already aware of. This shows that I must have been ready, by their judgement, to go home when medically ready, i.e. on Friday. I do feel that there is probably a lot more that the Physios could have done to help me but they weren't forthcoming, despite my specific requests for detail of exercises during the first six weeks and do/ don't do advice.

I hope that the performance I experienced is a-typical, but I am hoping to redress the balance with a visit to the GP tomorrow from where I sincerely hope I will be referred to some initial physio and some proper explaination of the operation and anything they discovered whilst doing it.
snibgo
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Re: Cannulated Screw hip repair

Post by snibgo »

I was also a bed-blocker. Only for 5 hours, but I found it highly frustrating. I was told they couldn't get hold of a doctor to sign my discharge form. I kicked up a minor fuss, and they eventually found a doctor. A fellow patient who was also ready to go didn't make a fuss, and he was still there when I left. Perhaps he still is.

I had problems at the other end, being admitted to a ward. Hardly surprising if they have delays discharging patients.
nez
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Re: Cannulated Screw hip repair

Post by nez »

Did any of you have to watch Dr Who from behind the sofa? I didn't, but this thread is having that effect on me. I find it terrifying. It's making me feel old and fragile though I haven't fallen off the bike in years (unless you count sideways when wearing clip-ons for the first time). :shock:
snibgo
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Re: Cannulated Screw hip repair

Post by snibgo »

Ah, yes, sorry about that.

Mine was just a simple sideways fall. But I regard cycling as beneficial to my health, despite this.
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531colin
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Re: Cannulated Screw hip repair

Post by 531colin »

Take a look at people your own age who dont go cycling.......that does it for me!
goatwarden
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Re: Cannulated Screw hip repair

Post by goatwarden »

nez dans le guidon wrote:Did any of you have to watch Dr Who from behind the sofa? I didn't, but this thread is having that effect on me. I find it terrifying. It's making me feel old and fragile though I haven't fallen off the bike in years (unless you count sideways when wearing clip-ons for the first time). :shock:


Sorry about that, I apologise. If it is any consolation, I hit a man-hole cover square onto my hip from normal road bike saddle height (60cm frame, I am about 1.87m tall and 95 kg) and I suspect I also had some forward momentum, imparted as a result of parting company from my bike on the ice. It was a hell of a crack and I thought at the time I would be lucky not to have done some damage. I have had very similar falls many times off-road, removed far more skin in the process, and note done any long term damage. It could be that age is creeping up on me and I am getting fragile, but I prefer to think it was just a coincidence of conditions which dictated that I hit the ground very hard and so was unlucky. Ironically about 30 minutes earlier I had been riding along in beautiful sunshine musing, in reflection upon the fate of various family members who have been having health problems recently, how lucky I was that, apart from dislocating a knee a couple of times in my late teens, I had never had any serious illness or injury. Pride comes before a what?

531colin wrote:Take a look at people your own age who don’t go cycling.......that does it for me!


I quite agree, activity is the best protection against ill health in general. What depresses me is to look at lounge lizard contemporaries and observe their fragility to minor infections compared to me; it is particularly worrying as I am not quite 45, so those contemporaries are either not going to last long or be very high maintenance.
canonboy.nuneaton
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Re: Cannulated Screw hip repair

Post by canonboy.nuneaton »

Maybe I can be of some assistance.
I had a rather dramatic accident involving me coming of at about 30 m.p.h and parting company from my bike.
I was luckily with my local C.t.c. group and they called for an ambulance.To cut the story short I had snapped the neck of my femur off.
They told me the options I had were a bit limited, they wanted to replace my joint .It was only after a change of surgeon they relented and put screws and plated it up.
I do not think yours was as damaging as this but I spent 3 weeks in the severe trauma unit in Leic. Royal.I was only let out with surgical aids to assist me at home and the assurance that there was going to be 24 hour care for me, otherwise it might have been months.
They also repaired my thumb with micro surgery and I was none weight bearing for 6 weeks, using 2 crutches.After 7 weeks I got back on the bike.I was not able to lift my leg over the cross bar for about 3 months after the accident.Only now am I nearly back to the same fitness level as pre accident.I found it easier to cycle than to walk!
Depending on the damage you have done a good guide might be 12 weeks before you are fit again.
I did a lot of damage to the joint and surrounding muscles.
I can not praise the care I was given in hospital too highly, they had me up and using my leg 3 days after my operation.
snibgo
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Re: Cannulated Screw hip repair

Post by snibgo »

Welcome to the forum, canonboy.

canonboy.nuneaton wrote:I found it easier to cycle than to walk!

Same here. There is a pavement between the road and the Sheffield stands for the supermarket, and I used to walk it but now I cycle it (like everyone else). If challenged, I would point to the crutches strapped to the rack and claim the bike was an invalid carriage.

I reckon the NHS should lend us recumbent trikes along with crutches, perching stools and the rest.
larfingravy
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Re: Cannulated Screw hip repair

Post by larfingravy »

Hope your recovery goes well goatwarden.

One important bit you've missed though - how's the bike doing :wink:
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