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.