Cannulated Screw hip repair

liffy99
Posts: 20
Joined: 11 Jul 2009, 8:19am

Re: Cannulated Screw hip repair

Post by liffy99 »

What a great discussion thread, albeit for mostly younger peeps than I.
Eight months ago I broke my neck of femur ( complete, displaced fracture) and had the bone screwed together with three cannulated screws. I had lost 1cm of femur length. The operation seemed to go well and the recovery over the first three or four months progressed slowly. By the end of four months I had lost the crutches and was walking up and down Glastonbury Tor to try and regain muscle strength etc.
However over the past few months the pain and discomfort has steadily increased and I find it extremely difficult with any twisting or turning movement. Getting in and out of a car, a seat, twisting and turning are all a challenge. Putting my left sock on is becoming impossible.
Consequent X-ray and MRI scan have shown that the bone has shortened whilst healing (so I have now lost at least 2cm) and alignment at the hip joint is not good (sorry, I can’t recall the name of the angle betwixt pelvis and femur, but it’s more of a right angle than a smooth curve like it should be). The shortening has meant that one screw head protrudes more than it did and I have a lot of inflammation around the whole area.
Next step is to have an anaesthetic injection into the hip joint as part relief, part diagnostic - if I can then mobilise with far less discomfort the problem is the hip, if not the problem lies elsewhere.
The consultant seems pretty sure the hip joint is the problem and that I will probably need a hip replacement. At 61 though it is disappointingly early as I would need another when I reach my mid seventies.
But I struggle to understand why the bone has shortened whilst healing and why the operation was seen as a success if the X-ray post-op clearly showed poor alignment.
In the meantime I want to try to replace some muscle wastage ( there is a quite marked difference now between left and right leg) - an indoor cycle would be good - any suggestions ? I have tried my touring bike with a turbo trainer but cannot straddle the crossbar.
I am not a competitive cyclist but just tour and commute. This year I retired early with a view to cycling across France but two weeks after handing in my notice, I broke my leg - what a start.
Aaaaggghh
Vorpal
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Re: Cannulated Screw hip repair

Post by Vorpal »

I suggest talking to your medical professional, but I don't see any reason that you cannot use an indoor trainer, or even cycle. One thing to be cautious about is that many medical professionals are not familiar with cycling. A physio, or sports physio might be more help, as long as they are aware of the history of your injury.

I know three people who cycle despite difficulties with their legs and/or hips; one had a severe injury to his leg and hip, and has limited use of his leg for walking, but he cycles well, and says it helps his hip and lower back problems. Another has MS and one leg that is substantially shorter than the other. She has a special shoe that she wears with a platform on her short leg, but cycling is her main form of transport. The third person only has one leg. He carries crutches on his bike.

It might be worth using a platform on the pedal for the short leg to help your hip alignment.

Another exercise that you might be able to manage is a rowing machine. If you needed it, it would be quite easy to stick a book or plank on one foot rest to accomodate the shorter leg.
“In some ways, it is easier to be a dissident, for then one is without responsibility.”
― Nelson Mandela, Long Walk to Freedom
DerekJ
Posts: 3
Joined: 1 Jun 2016, 3:35pm

Re: Cannulated Screw hip repair

Post by DerekJ »

Hi liffy99,
This reply to your post is well late, but I've only just read what you posted.

Like you, I had three screws in the head of my femur and the recovery seemed to go well at first. But I too lost about 2cm of length and one of the screws was very dangerously close to poking through the end of the bone. I had the screws removed, hoping things would improve but they did not. And an MRI scan revealed that the head if the femur was dying. All this followed a bike accident when I was 55, so I finally go a hip replacement at age 56.

Was worried about its longevity, but the ceramic on ceramic are much better these days and could well last many decades - no one really knows as the longevity data on the new replacement obviously does not exist yet.

I paid privately to get exactly the replacement I wanted, but I could have got the same on the NHS, with the same surgeon, but would have had to wait three months longer.

More than two and a half years on, things are still going fine.

One factor that worsened the shortening was that it turned out I have osteoporosis.
devonboy
Posts: 2
Joined: 15 Apr 2019, 9:42am

Re: Cannulated Screw hip repair

Post by devonboy »

Last June I was knocked off my bike by a jogger and fractured the neck of my femur about 3/4 through.Initially they wanted to give me a replacement hip (at 69 I am apparently geriatric and that is the policy) but after a robust exchange this was changed to a three screw repair.

I discharged myself after one day and was left home alone for the next 6 weeks.I got no help from my surgery ("we have neither the budget or the resources to offer physiotherapy")This left me with the internet to provide exercises to work through but also led me to a site with a new twist on post operative care.Essentially the theory was that that 78% of patients feel little or no pain after the operation so these were cored out and and asked to progressively load more weight onto the injured leg.The subplot was that this also aided in the formation of new bone cells.On average their patients were walking without support in 4-6 weeks.In my case I was walking after 5 weeks and ended up trotting into my 6 week review holding my zimmer in my hand,which was promptly confiscated by the aggrieved surgeon who had performed the operation.

I lost remarkably little fitness or muscle mass due to the constant exercise but suffered a massive loss of confidence,so in August I bought a recumbent trike from KMX figuring that I could neither fall nor be knocked off while on three wheels,which has proved correct.This got me out and about and eventually in January I bought a mountain bike and I use this on long slow runs away from the main cycle tracks and roads.This a far cry from my CF Roubaix which I sold but better than nothing.

Physically the bone has healed well with no signs of necrosis or arthritis(two xrays so far).I had problems bending the affected leg at the hip and could not put my sock on or cut my nails until this month when things have finally started getting better in this respect.I get the occasional ache over the operation site which goes away with exercise,which my chiropractor suggests is muscle inflamation as it rubs over the screws and plate.Bottom line is that this is a major injury which will take a long time to heal.I also think that I was lucky in that my bone did not fracture right through which means that my leg is the correct length and there was still a blood supply to the femur after the accident.

Good luck with your recovery.
Jos Ann
Posts: 1
Joined: 2 Aug 2019, 11:16pm

Re: Cannulated Screw hip repair

Post by Jos Ann »

I am Jos A nn and I m 47 yrs old. I had a fall 5 months ago and was operated on the same day. 3 cannulated screws were inseted in my hip to repair the fracture. I was non weigh bearing for 3 and a half months as I had a bit of dislocation and the surgeon told me to not bear any weigh. Finally after my last visit and xray the surgeon told me that fracture is healing well and to start weigh bearing with physio. The physiotherapist told me I I m doing fine and 10 days ago I started using only one crutch.Now the problem is that when i am finding it hard when i stand up from a sitting position. I feel that my injured leg is extremly heavy. I have to make a huge effort when i take the first few steps after the sitting position. Then it is ok, afterwards i walk jusr fine with one crutch. Has someone experienced the same thing pls as I am worrying.I would like to hear if someone had the same experience and share it.
I would also like to have the screws removed once the fracture is completely healed as I find discomfort while sleeping and make certain movements. Hope all of you are bettter now.
devonboy
Posts: 2
Joined: 15 Apr 2019, 9:42am

Re: Cannulated Screw hip repair

Post by devonboy »

Sounds a little like my experience.Sitting down for so long is not natural and you lose muscular strength and tone which translates into weakness as you try to get moving.

It all resolves with time and effort,since getting on my trike last August and buying my MTB in January my bike computer is telling me that I am coming up to 3000 miles split between the two.Currently bouncing like an Easter Bunny and feeling good.

I am also going to be requesting screw removal as I do still feel an ache over the operation site after a period of inactivity which goes away when I start cycling,suggesting inflammation caused by the muscle rubbing on the hardware.

Good luck
Regor
Posts: 2
Joined: 16 Nov 2019, 1:49am

Re: Cannulated Screw hip repair

Post by Regor »

So glad I found this forum and post, I've just read it start to finish and feel a lot better about my situation.

Three weeks ago today I and the 20 other rides in my bunch were met with an oncoming 4wd on the wrong side of the road as we crested a turn, thankfully we all moved over enough to not get hit by the 4wd but in doing so 6 of us went down after wheels were touched. I hit the bike in front of me when it hit the ground and did a forward flip at 20kph onto my left hip. 4 riders escaped unscathed short of some skin lost.

Two of us went to hospital, other guy went down head first so was not in a good state when the first ambulance turned up, with a face covered in blood and a hand crafted brace made from jerseys around his neck the ambulance crew naturally saw him as the priority, his glasses that exploded on impact made a few entrances to his face, thankfully he got away with some plastic surgery and some small scars that will heal well. I was assessed by the ambulance person and deemed to be No2 of importance, that was fine as I was sitting up and chatting with people I just happened to have no use of my left leg. As someone that raced motorbikes for 15 years has been racing pushbikes for 10 it's the first time I've not been able to get up post crash, this seemed like a omen of what was to come.

Shot off via ambulance to hospital I was ushered to ER and assessed, had some xrays to check things out and then waited for the doc and my wife to turn up. My wife is a theater nurse, specializing in orthopedics............ she walked in, lifted up the blanket, looked at my left foot hanging off to the side like a dead rubber and said "ahhh bugger shoot" and got on her phone. Doc turned up and confirmed I had a non displaced FNF, seems the in vogue hip fracture to have.

I was very lucky to go from sitting in ER at 8m to being in surgery at 11am, I had a Stryker Omega 3 inserted (https://ibb.co/Bzk6Wdc) and by all accounts the surgery went very well. As per other peoples accounts it was a strange thing being on the ward post op where I was a junior to say the least, I'm a young looking 41yr old to the point that when the physio turned up she opened the curtain, looked at me, closed the curtain and walked off asking where I was because surely this young man couldn't have broken his hip. The physio came back and had a giggle, I laughed too, you have to see the funny side of these things. My instructions as per others were to not bear weight and do two measly exercises per day, the physio did apologies and say that the exercises are aimed at people in their 70s, not a very active person in their 40s.

So, three weeks down on crutches, three to go before I can weight bare. Like others here I went and saw my personal physio that is cycling specific and have a range of exercise to help keep range of motion and some semblance of muscle tone. I've already lost 2cm diameter from the quad / thigh and calf, eeeeek.

For me the worst thing isn't the loss of time on the bike, the lost week of work or the random pain I get via a nerve in my groin twinging when the leg goes from bent to straight (this only happened once the swelling went down post op, anyone else?) it's that I have 1y old twins that for the next few months I'm useless at helping with and unable to play with them as I was before. All because of a careless driver..... we have footage of the car via Fly6 so hopefully the Police will actually do something.

Anyway sorry about the long post, I've been sitting here feeling a bit sorry for myself due to not really finding anything about people my age and interest having the same break. It's given me great pleasure to read about other peoples triumphs long term as it is and getting back on the bike. I know it's going to be a hard road but I feel more equipped go through it now.

I've already got a great trainer setup at home with a Kickr, Climb, big screen and Zwift so am aching to get back on in hopefully another 3 weeks and start spinning.

Thanks again all, I will post with updates as they happen and am happy to receive a pm if anyone has any questions or just needs to chat, it's a hell of an injury that can leave you feeling a bit isolated that's for sure.

Cheers
Roger
Cyril Haearn
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Re: Cannulated Screw hip repair

Post by Cyril Haearn »

Welcome aboard, you could browse and search these fora, there is more interesting stuff :wink:
Entertainer, juvenile, curmudgeon, PoB, 30120
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francovendee
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Re: Cannulated Screw hip repair

Post by francovendee »

I've found this thread very interesting and sometimes a bit upsetting hearing of the accidents.
I worked for nearly 40 years in the industry making these products.
It have always thought that the success of the operation largely relied on the surgeon rather than the implant. All the major orthopaedic companies products were very similar.
Removing bone screws that had been in place for a long time could prove very difficult and various patented head designs have been offered to help get a grip on a very tight screw. Very much like carpentry in a butcher's shop. :lol:
Regor
Posts: 2
Joined: 16 Nov 2019, 1:49am

Re: Cannulated Screw hip repair

Post by Regor »

francovendee wrote:I've found this thread very interesting and sometimes a bit upsetting hearing of the accidents.
I worked for nearly 40 years in the industry making these products.
It have always thought that the success of the operation largely relied on the surgeon rather than the implant. All the major orthopaedic companies products were very similar.
Removing bone screws that had been in place for a long time could prove very difficult and various patented head designs have been offered to help get a grip on a very tight screw. Very much like carpentry in a butcher's shop. :lol:


Ive been advised that mine is staying in, this is with the Ortho knowing I will be back to riding and racing as soon as my body will allow it. With the design of mine though as the bolts aren't proud (being recessed into the plate) i shouldnt have an issue with them.

Due to various other injuries through the years I know when it's going to rain anyway so the hip will just be another indicator haha.
francovendee
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Joined: 5 May 2009, 6:32am

Re: Cannulated Screw hip repair

Post by francovendee »

Regor wrote:
francovendee wrote:I've found this thread very interesting and sometimes a bit upsetting hearing of the accidents.
I worked for nearly 40 years in the industry making these products.
It have always thought that the success of the operation largely relied on the surgeon rather than the implant. All the major orthopaedic companies products were very similar.
Removing bone screws that had been in place for a long time could prove very difficult and various patented head designs have been offered to help get a grip on a very tight screw. Very much like carpentry in a butcher's shop. :lol:


Ive been advised that mine is staying in, this is with the Ortho knowing I will be back to riding and racing as soon as my body will allow it. With the design of mine though as the bolts aren't proud (being recessed into the plate) i shouldnt have an issue with them.

Due to various other injuries through the years I know when it's going to rain anyway so the hip will just be another indicator haha.

Strange as it seams the countersunk type of screw was often the ones that gave the most problems.
Stainless steel used for the screws is relatively soft. After a number of years they can become very stuck.
I've been retired for 16 years so things may be different today but having attended a number of operations I can still remember the ' crudeness of seeing a surgeon hitting a chisel with a mallet to trim some bone when fitting a new hip joint.
Christw
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Joined: 18 Dec 2019, 2:06pm

Re: Cannulated Screw hip repair

Post by Christw »

Thanks to everyone who's shared their experiences on this thread.

I joined the club a few weeks back. Hit a patch of black ice on my commute into work, a low speed fall onto my right hip. I was clipped in but happened very quickly and all 14.5 stone and 6ft 4 of my frame can crashing down on my hip followed by my ribs.
Couldn't move my right leg and was stuck on the road, paramedics took 1hr 30 to arrive and when they did, they didn't think there was any break.

I'm 36 (was 35 at the time) and had the same spiel about being 50 years too young and the wrong gender for the injury.

Took 6 hours from the accident for them to have x-rayed and diagnosed and I was due to be operated on that evening. Made it as far as the anaesthetic room and then wheeled back out due to an emergency. The next morning I was first on the list and then had almost the same experience... It was finally my turn at lunchtime 28 hours after my incident.

Found out a few days later that it was a displaced neck of femur fracture and have the 3 cannulated screws to repair as per others. Left hospital a couple of nights after surgery. Initial 8 weeks non-weight bearing due to the risk of AVN.

Had my first session of physio and they were very pleased with progress and range of movement, but can't give me anything else to work on until I'm weight bearing.

As it's my right leg, I can't drive for the foreseeable future either.

Before the break I was cycling to work and back 2-3 times per week (15 miles each way), plus some extra rides and running 10k to 10 miles at least once a week too. I'd done the Great North Run back in Sept and also dance regularly.

It's certainly set me back, but it's good to hear of positive recoveries. My plan is to stick to the NHS advice and physio until weight bearing and then utilise private physio to push my recovery. I'm already looking at options of getting a turbo trainer but won't be in a position to use it until I'm given the all clear to weight bear.
goatwarden
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Joined: 20 Nov 2009, 12:03pm
Location: Bristol

Re: Cannulated Screw hip repair

Post by goatwarden »

Assuming you have no complications such as cartilage damage, dislocation, etc. i.e. the joint is working normally but the bone is reknitting then there is no reason to wait until you are weight bearing to ride on a turbo trainer. Cycling puts very little load through the hips provided you remain sitting on the saddle. So using a turbo is good for retaining limb movement whilst you can’t weight bear fully.

I broke mine at the end of November, so my wife changed her mind and, instead of getting me the planned unicycle for Christmas, she got me a turbo. It allowed me to do some fairly good cardio work so that I didn’t entirely lose fitness whilst not weight bearing.

The biggest danger of using a turbo is getting on and off the bike, where it would be easy to stumble and accidentally load the broken bone. It is important to build a safe route on and off; I think I used a step-stool.

Also don’t kid yourself that riding on a turbo is preserving all movement in the leg; you need to concentrate on remembering your previous range of movement in all planes and working to maintain these. A physio can help a lot here but they can also overlook aspects which become restrictions you only fully appreciate years later. Private physios can be particularly problematic here as they often operate in rooms too small to allow full range of movement of a leg; if they don’t have a gym or similar available then you may well do better with someone who has.
gbnz
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Joined: 13 Sep 2008, 10:38am

Re: Cannulated Screw hip repair

Post by gbnz »

Sorry for reopening the post, wanted to ensure it's marked for later reading (Nb. Surprised I hadn't found it earlier)

Had 8 weeks with a dozen broken bones (Including the leg/hip in five pieces), but need to get out for a walk now (Nb. Bike is still tempting, but having only made the 1st partial non crutch, country walk on the 24th, may be "sensibly" obliged to leave the bike until a later day :? (Nb. Can't help thinking, a 2-3mph, level, one leg purely rotating ride may be possible soon, supplemented by an exercise bike?)
Pebble
Posts: 1934
Joined: 7 Jun 2020, 11:59pm

Re: Cannulated Screw hip repair

Post by Pebble »

gbnz wrote: 26 Dec 2022, 9:48am Sorry for reopening the post, wanted to ensure it's marked for later reading (Nb. Surprised I hadn't found it earlier)

Had 8 weeks with a dozen broken bones (Including the leg/hip in five pieces), but need to get out for a walk now (Nb. Bike is still tempting, but having only made the 1st partial non crutch, country walk on the 24th, may be "sensibly" obliged to leave the bike until a later day :? (Nb. Can't help thinking, a 2-3mph, level, one leg purely rotating ride may be possible soon, supplemented by an exercise bike?)
sorry to hear all this, I had noticed that you hadn't been on the forum for a while, but did not know why. Was it a bike accident? Hope you mend well and get back out on the road.
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