ORIF Surgery/ Open Reduction with Internal Fixation

Sometimes, you just need a new part....

Because I have the Intrathecal pump for spinal pain, my orthopedic surgeon was concerned about my post-op pain. I am opiate tolerant due to the morphine in the pump, and there is only so much oral opiate pain medication he can give me— to be effective, the dosages would be too high. Ergo the On-Q pump would be used, running a non-opiate local anesthetic directly into the surgical/fracture site for three days. He would place the catheter of the pump towards the end of surgery.

The orthopedic surgeon’s planned second method of post-op pain control for me, was a nerve block. These two methods needed should give an awareness of just how much post-op pain was expected. The nerve block would be done also during surgery towards the end.

When it came time to go in for surgery, everything happened so fast! The surgeon does his cases in my area on one day of the week and he is very busy. Word came down from the OR that I was up next, and I was quickly taken into the pre-op surgery area. Then it calmed down once I was there and I met with the Nurse Anesthetist. Then another sudden flurry of movement and my surgeon came in, checking on me and rustling through the paperwork. He disappeared and my Anesthetist wheeled me into the cold operating suite. I was not looking forward to transferring onto the operating table. I still had the full leg immobilizer on and there was talk about taking it off. The anesthetist’s voice from above my head said no, not to take off the immobilizer yet, that he was going to put me to sleep right where I was, then they could remove the immobilizer and position me for the surgery.

The next thing I remember was waking up with my eyes closed, I couldn’t open them even a tiny bit. And wham the pain hit me. Someone was doing things to my leg and even though I was very, very groggy, I asked if they were doing the nerve block. Someone said yes and I was moaning, each time something was moved in my leg and a wave of intense pain rushed through. A kind female voice said that it was almost over, and she was holding my hand. Nerve pain is unique—it reminded me of having a nerve ablation and having to be awake enough to give feedback for the placement. I remember this happening about 5 times, each time the nerve pain flooded through and I cried out, there was a few seconds of respite before something was moved in my leg and I’d cry out again. Then I was out.

When I woke up in my room, I had an instant sensation of my leg being tightly wrapped, I could immediately feel that my femur was not split in two pieces anymore. I cannot express the absolute difference from 8 days with an acute fracture, to this post-op feeling. I felt whole again. I knew that my surgeon had done a LOT of repair work on and inside my femur. The pain did not overtake the joy I felt—he had fixed my very badly broken leg. The ER doctor had said that femur fractures are 'No Joke', and he wasn’t kidding.  Distal femurs are one of the most painful fractures, and I had experienced mine for 8 long days.  I was more than happy to have my new leg!  

My surgeon had first reduced the fracture, meaning the pieces that were split apart had been realigned and clamped back together. This is the Open Reduction part of the ORIF surgery. He then used 3 very long screws directly into the femur in the distal portion to hold the reduction, followed by a plate which lined up along the bone, with 4 more screws put into the holes in the plate. This was the Internal Fixation portion of the ORIF surgery. It was a long operation with multiple layers, fixing the bone then focusing on the post-op pain.

Back in my room, I looked down to see what state my leg was in. A bandage was tightly wrapped from my ankle to the top of my thigh. At the top, a catheter came out and was attached to the tennis ball shaped On-Q pump, which was held in a black bag. There was also a very thin black wire coming out the top of the bandage and was taped to my leg. This was the nerve block wire.  A lot going on!

I slept of course, exhausted from the surgery, and felt so blessed that my surgeon was both knowledgeable and compassionate, doing everything he could to relieve the worst of the post surgical pain, and tailor that to my exact situation.  This fracture has a healing time of one YEAR.  I had just begun.  

I have a new leg, held together by a plate and seven screws. I stayed in the hospital for three more days, for a total of 12 days. When my physical therapist came in the day after surgery to have me ‘walk’ in my room, the sensation was night and day from before surgery to after. It was actually tolerable pain, and I was able to get farther on the first day after surgery, than I had with the acute fracture. It felt so stable! It felt protected. The full leg immobilizer was back on again over the tightly wrapped bandage. Now this I could deal with! Oh, I had pain, no doubt about that, but it was a different type of pain. I could tell that the nerve block was very effective, as was the On-Q pump.

The day after surgery, the discharge nurse came in and we started discussing what was going to happen next. She would be finding and arranging my care at a Skilled Nursing Facility that had a robust physical therapy program. One place in particular sounded amazing and I prayed about going there. As it turned out, she got me into that care center, and three days after surgery I was heading to my new ‘home’ for the next two months.

Then the real hard work began.

Gentle Hugs....and a tolerable pain day.

One Step Changed It All

One simple step can change your world.  

I had just gotten home from an intrathecal pain pump refill.  Yes, I got the pump!!  I wrote multiple times  about that years ago, and it finally happened.  I will write about the pump, the insertion surgery, recovery rules, living with a pump and how it is refilled.  How it has absolutely changed my life for the better.  But this is the time now to write about that one step.

I was outside my apartment, simply walking, on a slight slope that's very sandy.  I stepped forward and the next step was suddenly on uneven ground, I slipped on the sand and down I went.  I passed out and woke up on the ground, crying.  I was not sure exactly what had happened, but it became very apparent that something was horribly wrong with my right leg.  Both my knees were bent under me which was weird because I can't bend my right leg under me due to two past knee surgeries.  I tried to move that leg, and I felt and heard a grinding unlike anything I've heard before.  I could feel bone against bone, I knew there were two bones where there should have only been one.  

I just cried and knew that I could not get up.  I was very disorientated.  Just when I was realizing I would have to call out for help, my neighbor walked out.  I called his name and said, "Help me", and he ran over to me.  I asked him to pick me up--I don't know why, I just wanted to get off the ground and off my bent knees.  He lifted me up under my arms and my legs unfolded.  I screamed.  I cannot explain the pain in my right leg.  He helped me to a place to lean against a couple steps away and I just kept crying, the pain was so bad.  I could not bear any weight on my right leg.  He went and got another neighbor who called 911 and we waited for the paramedics to come. My other neighbor came over and I asked her to go into my place and grab my purse and phone and lock my door.  When the paramedics arrived it was an issue for them to get me into the ambulance safely, with the sand and uneven surface--for their safety and mine.  They finally found a way and carried me, oh my--the pain with any movement at all was just horrible, I was screaming, it was the worst pain that I have ever experienced.    

The ride to the hospital seemed to take so long even though it is relatively close.  When we arrived to the ER, they transferred me to a bed, and while I waited for the X-ray tech, my leg was swelling and bruised, also on my ankle, but above my knee it was very swollen, like another knee above my knee.  That's the best way I can describe it.  They gave me a bag of ice for the swelling.  The tech came over to me with the X-ray machine and the X-ray was taken. The tech said, "You broke it, and you broke it good."  I wasn't surprised that a bone was broken, I just needed the doctor to clarify it for me.  When the ER doctor came to talk to me, he said that I had fractured my femur.  I was shocked--my femur?  From a fall like I had taken?  Then he informed me that I had fractured my distal femur, which is the 'end' of the thighbone near the knee.  It is part of what forms the knee joint, and it is the longest and strongest bone in he body.  Most femur breaks are proximal, otherwise known as a broken hip (which is actually a broken proximal femur.)  To fracture the distal femur, it is normally done in a car accident, a gunshot wound, or a fall from a height.  Being older, breaks like mine are usually seen with Osteoporosis.  The ER doctor said that femur fractures are 'no joke', the pain is some of the worst of broken bones, and that he had ordered an aggressive pain management protocol for me.  He told me I was going to be admitted, and they started giving me IV Morphine right away.  It felt like it barely touched the pain.  Any movement of my leg at all was terrible pain.  He said that an Orthopedic Surgeon would be in to see me in the morning, that I would most likely need surgery, and would need help around the house, home health nursing, physical therapy, possibly time in a facility.  That was a lot to take in.     

By the time I got into my room, I was exhausted.  It had been hours and I wanted to sleep but the pain kept me awake, and I had so much on my mind.  Everything had changed in such a short time.  So much to think about.  The nurses were so wonderful, kind and caring, telling me that the minute I felt pain, I was to call them.  I was taken in for a CT scan and being transferred onto a gurney then onto the CT bed was horrible.  Got back to my room and waited for the surgeon to come in.  Because they didn't know if I may go in for surgery that day, I had no water or food allowed.

The Orthopedic surgeon came in after reading the CT scan.  He said I had an oblique fracture with displacement, meaning the fracture was not linear, it had broken into two separate pieces apart from each other.  The fracture was long, from the end of the distal femur to the middle of the thighbone in an oblique line.  I had severe swelling that is called a Lipohemarthrosis.  This is a mixture of blood, water and fat that has leaked from the bone marrow.  A surgeon can not cut into a leg with that present, it needs to go down all the way before safe surgery can proceed.  The surgeon told me that I needed a plate and screws, a surgery called ORIF, open reduction with internal fixation.  The reduction is to line up and close the broken apart pieces, then the internal fixation is putting in the plate and screws. Later, my physical therapist likened my fracture to splitting a log, the bone is literally split in two.  It didn't look like surgery would be done that day, due to the swelling, he left it that a week from then he'd perform the ORIF.  He told me I would need to go to a SNF after surgery for inpatient physical therapy, and I would be in the nursing facility for 'quite awhile', that my safety was paramount.  Living upstairs just added to the time, needing to be able to navigate the stairs.  I would need nursing care and physical therapy once I was able to go home.  He said that my fracture takes over one year to heal fully.  He was a bit unclear on the time I'd be in the inpatient physical therapy care center, saying my fracture is a 'long road' to healing, that it was months, not weeks.  

He ordered a full leg immobilizer, which felt a bit better being tight on my leg from ankle to thigh.  It never came off--I wore it for over 4 weeks, wrapped in a plastic bag for showers.  No weight bearing.  Physical therapy came the next day to get me out of bed, even though I was on bedrest.  Now that was painful.  Really, really, very painful, log rolling to the side of the bed then very very slowly bringing my legs to the floor, then using a walker to take a few one-leg steps, then repeat to get back in bed.  The physical therapist and I made sure I had pain meds before I did all that. It really hurt.  A lot.  Weird guttural yells would come out when my leg was moved--in any way.  Quite a few swear words were screamed, all these were simply automatic.  But I did it, I pushed myself very hard and got up and out of bed.  I was determined to do anything I could to start on the road to healing.  Little did I know, I would not go back home for 2 1/2 months. 

I was receiving anti-clot medications, being in bed, on my back, for 23 1/2 hours a day.  I ate everything they brought, I knew I needed protein, calcium, Vit D and lots of veggies.  I eat a lot of veggies and a salad every night with dinner.  I had not been inpatient in the hospital for more then a few days, back in 1977 for a big knee surgery- I was in for a week-things were much different then, after surgery doctors kept the patient in bed; no physical therapy for a few days and insurance didn't boot you out like most surgeries now.  I stayed just one night for my cancer surgery/total Thyroidectomy, and the two open spine surgeries, I stayed a few days.  For this fracture, I was in the hospital for 12 days.  I came to know just about all the nurses on every shift--a couple would come in after 3 days off and say, "Are you still here?"  As a nurse, I saw things through a different lens and I will say that the nurses at my hospital were amazing--every single one of them.  I was absolutely blessed.  There was talk about having me go to the SNF while I was waiting for surgery (insurance of course) and just the thought of all the transferring and movement really scared me.  In the end, thank God, I stayed in one place.  And I just so happened that night to be brought into a private room!  Timing.  God was with me from the minute I fell until this moment.  He is always with me, and He got me through some very tough days to come.     

Next is the surgery.  I find this all so fascinating and what the surgeon planned for pain control after surgery was new to me, and I am so grateful I had the surgeon I did.  Keep reading for the next leg (haha) of this journey.                                    

Gentle Hugs....and a tolerable pain day.

A Great Loss

As I return to my blog, I realize the last post I wrote 10 years ago, starts with Dr. Jeffrey Fudin.  It is with a heavy heart that I relate that we have lost Dr. Fudin, B.S., Pharm D., FCCP, FASHP, FFSMB, creator and author of Pain Dr.com.  

Dr. Jeff and the information in his site, made me feel that I was not alone, and I was on the right path regarding my stance on the use of responsible opiate use for chronic pain management.  His superior knowledge on the subject and his ability to convey his deep rooted belief to his blog was unique and drew an audience of pain patients, physicians, pharmacists, nurses, advocates and many more.  I was fortunate to interact with him and a guest author on the subject of Walgreens Good Faith Dispensing Policy.  He had the ability to make me feel like he really heard me, and truly cared about what I was expressing.  His blog is still up and kept current by an impressive team.  I highly encourage you to head over to Pain Dr. and look around.

He will be greatly missed. My deepest condolences to his family. 

Dr. Jeffrey Fudin

October 1958-May 2022   

**Update: It seems that his website is down.**

Gentle Hugs....and a tolerable pain day.

Coming Home

There's No Place Like Home

I stepped away from my blog for a minute--well, 10 years to be exact.  

After 6 years of writing, 128 posts, 761 comments, and a lot of work here, it was time to take a break.  Also the timing shows just what was going on in my life that led to the break.  

I focused here on chronic pain and all that goes along with it.  Living every day with severe spinal pain was exhausting.  Looking back, I truly don't know quite how I did it, how I functioned in my daily life.  My exhaustion was starting to affect my ability to come here and write, think of subjects, interact with my readers, and keep the blog up.     

Also during my absence, 10 years held many significant events that would change my life.  Change me.  One gave me my life back.  One threatened to take my life.  And one threatened my very safety and sanity.  

I will address each one as I get back to writing.  It is time.  I am in a good place and I am safe.  You will see why I say that when I write about each situation.  I am certainly not lacking in subject matter.  The last 10 years have held the most interesting yet confusing, elating, scary and happy times of any other decade.  Just 4 months ago something very significant happened that again has changed my life.  

I am happy to be writing here again, I look forward to sharing the last 10 years.  As I did before, I hope that each subject will move the reader, educate, let you know that you are not alone.  That was one of the most talked about, positive outcomes of my writing--people wanted to know that someone else was also going through the same situation, that they could read here and relate to what I was saying.  On the subject of chronic pain, many readers said they felt alone, isolated when it came to others understanding what they experienced every day.  They said they felt judged, when all they were trying to do was to be able to live as normal of a life as was physically possible.  When I read another's words of a familiar situation, something I have gone through, I feel validated, heard.  I like knowing that someone else has experienced what I have gone through.  There is a kinship there.  I hope in sharing again here, that readers will understand and learn from my experiences.

The thing I will start with is the most recent.  I am 4 months into this experience and it dominates my every waking moment, ergo why I will begin with it.  

It's good to be back, and as I signed off on every post for 6 years:            

Gentle Hugs....and a tolerable pain day.