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Old 02-11-2010, 02:31 AM   #1
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Orthopedic Surgical Experience-Recent

Hi,

I'm posting this with the hope that sharing my experiences will help others who are considering surgical orthopedic procedures (outpatient and inpatient). At the beginning of Jan. this year, I underwent my sixth orthopedic surgical procedure. This was for the surgical correction of a progressive equinas foot deformity (complicated by a history of Cerebral Palsy). My surgery involved correction of hammertoes 3, 4. and 5 on my left foot, and a posterior tendon release on my left leg (Achilles and one additional tendon). Originally, I was admitted to the Day Surgery Unit, and scheduled to be admitted to hospital afterward for 24 hours. But, because of pain and additional complications, I remained in the hospital for three days.

My surgery under general anesthetic itself took a little over two hours and was unremarkable. I also had a nerve block placed in my left leg and foot before surgery. I woke up in the PACU (Post-Anesthesia Care Unit) on o2 via mask, a PCA demerol pump, IV fluids and heart monitor. I remained on all of this for the first 36 hours, and then, as I improved, these were gradually reduced. I also experienced a 'pain headache' and developed urinary tract and ear infections while in the hospital, which made for quite an ordeal for me, overall. The nerve block lasted about 12 hours, after which my pain was not so great. Again, complicated by my CP. My foot/leg was initially placed in a split plaster cast, with the three toes pinned. I left hospital in a wheelchair and have stayed that way since (5 weeks post-op)

At 14 days post-op, sutures were removed, the foot and leg were re-positioned as per the surgeon's instructions, and a fiberglass cast was applied. No weight bearing permitted at all during this time, and I have not been allowed toe-touching, nor getting any part of the dressing wet. No physical therapy ordered, either.

At the moment, it's another week until the pins are removed. After that, the wounds will be checked, and my foot and leg will once again be re-manipulated and re-set in yet another cast-hopefully some kind of a 'walking' cast.

In terms of pain, I'm not on any pain medication at the moment. I discontinued my Percocet 10 days post-surgery, and have taken nothing since. Periodically, I get some burning sensations where my sutures were, but this is generally only at night.

Realistically, this surgery should have been carried out 10 years or more earlier, instead of my waiting until my situation became so acute. However, any surgical procedure should not be entered into lightly, in my long experience. Be prepared to make adjustments in your lifestyle and expectations-or, be prepared to have them changed for you. I'm not anticipating being able to wear the same shoes as before the surgery, nor am I oblivious to the long road to recovery that is ahead of me, yet. My surgical team has done their part. It's now up to me to follow their every instruction, to ensure that I can recover to the best of my ability. It's important that you are realistic about your post-op expectations. Complete healing takes time. Everyone is different. No one surgery is identical in results.

It's important that if you have pins in your toes to make sure that you protect them from being knocked or bumped. Not only can it be physically painful, but it can actually push the pin deeper into the bone, complicating their removal later on.

Regarding showering and bathing-there are a # of options-hospital grade body wash cloths are good. I have found that cling-film is an effective solution to the standard garbage bags (for fiberglass casts)-as are some basic home modifications like grab-bars, bath boards, etc. You can also buy airtight sealing bandage covers online for bathing purposes.

I'll keep updating here with my progress. I'm pleased, so far with my results (if a little bored). Here's to a happy outcome. Feel free to ask questions. I have a lifetime's personal experience of dealing with orthopedics and all of the allied professions (PTs, OTs, etc).

 
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Old 05-10-2010, 02:54 PM   #2
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Re: Orthopedic Surgical Experience-Recent

Rainbowapple,
I hope things have gone okay for you.
I was in an auto accident in Feb. and had a compound Fx of the right leg at the ankle. Right before the accident I was to have a "mild" dorsal flexion repaired but now after being in a splint for several weeks my Achilles tendon has become basically inmoble. I had the other foot done about 5 months before the accident and it was done by an ortho with a fellowship in foot and ankle surgery. Now, however, he doesn't want to do the surgery because he sats the dorsal flexion is so bad and he wants it "stretched". However my PT has said the tendon is the tightest he has ever worked with and last Friday discharged me. My trauma surgeon wants to do the surgery now. So I am in a dilemma of sorts. But I am now leaning towards the trauma surgeon as he does the surgery differently than the other surgeon and it makes more sense to have it done by the ortho trauma surgeon. I can only walk on my toes with a walker right now and can't go very far this way, so have been stuck in a w/c most of the time. The first ortho surgeon wants to just go in on either side of the ankle and cut slits in the tendon, while the trauma surgeon goes directly into the back of the tendon and cut it that way.
Any suggestions or recommendations would be greatly appreciated. I see the trauma surgeon in a week and would like to make a decision at that time. Of course, I have a lot of questions to ask, now that I have been reading about other tendon surgeries. I just want to get on with my life and the way the first surgeon wants to do it could make it go on for a year or more. He has me in a Dynasplint at the present time and I see no progress at all.

 
Old 05-10-2010, 11:56 PM   #3
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Re: Orthopedic Surgical Experience-Recent

Hello,

Thank-you for your response and message regarding your pre-surgical dilemma and evaluation. My first sense of your situation is that the advice of an ortho trauma surgeon could certainly prove to be useful-in particular, one that is well-versed in Achilles and related dorsiflexion issues. One of the difficulties that my surgical team encountered was that AFOs, dynasplints and related devices did not really do much, once the Achilles had tightened beyond a certain point. However, this is a determination best made by a skilled surgical trauma surgeon. Because you have a Hx of a compound fracture at the ankle, seeking the advice of a trauma surgeon would seem to be a sensible approach. The same applies to the surgical technique and approach. I have had both types of incision-but, again, I think that part of that is dictated by the condition of the Achilles at the time of surgery, and what the surgical goal and treatment plan is. I have had six different Achilles surgeries over the years, and the older that I get, the longer the recovery time-in part because I now have a 'history'.

Please be sure and ask lots of questions of your surgeon(s)-even seemingly unimportant questions. No question or concern of yours is too small. Be sure and get a good understanding of the reality of your surgical situation and of the results that you can 'reasonably' expect. Some idea of a recovery timeframe is not an unreasonable ask on your part, either (although be prepared for that to change, too). In addition, make sure that you have in place a good after-care plan-for a minimum of at least the first three months post-op. Most of all, you must be patient with yourself, and with your medical team. Orthopedic issues often take a longer-term view and approach to resolve themselves satisfactorily. Often, communicating your goals and expectations to your surgeon can help them offer the appropriate level of guidance and input.

I am four months post-op, and still have good days and bad days from my most recent surgery. At 37, I'm not sure how many more times that I could/can keep doing this surgical treatment. All going well, this most recent surgery should be the last for me for a few years, yet.

Please feel free to post here again, and let me know how you're doing. Happy to answer your questions (as far as I can)-or to simply offer moral support and an understanding ear. Good Luck!.

 
Old 05-12-2010, 01:21 PM   #4
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Re: Orthopedic Surgical Experience-Recent

Hi,
Thanks so much for responding. Since I last posted my trauma surgeon's nurse called me and said that the two surgeons had talked and that my foot surgeon, who does have a fellowship also, will probably be doing the surgery. However, I do want it done from the back and not the sides. I think that there is too much scar tissue on the sides from the other surgery to repair the compound fracture. So I will keep you informed in about two weeks (my appt. is on May 27) what transpired. I do know that I have a "thousand" questions to ask the surgeon and I see the trauma surgeon before the other surgeon, so I can find out exactly what was said.

 
Old 05-12-2010, 05:34 PM   #5
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Re: Orthopedic Surgical Experience-Recent

Good luck on the 27th. That is the same day that I am having a Brostrom procedure done.

 
Old 06-01-2010, 01:34 AM   #6
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Re: Orthopedic Surgical Experience-Recent

Thought I should let you know how the 27th went!
I am scheduled for surgery on June 23. This will be perhaps the first of two surgeries, if the first surgery can't completely correct my problem. The ortho foot specialist plans to go in release both tendons to my ankle area and also release the ankle capsule. Because my plantaar flexion is so severe, it will depend in how much my skin will stretch. This would be the reason for the second surgery, if it becomes necessary. I also might have an external ring fixator placed on my ankle area to be tightened slowly to help increase my dorsal flexion. I will be in the hospital at least for one day and depending on how I am doing will determine if I go home the following day.
There sure isn't much time between now and the surgery day to get everything I would like to get done. It is very difficult to get things done when you have only a wheelchair to get around and so many things really require more mobility.
I am looking forward to finally being able to get my foot flat on the ground again but I also know that I have a lot of work ahead of me after the surgery itself has healed. Since it is my right foot, I haven't been able to drive now for 4 months and I do not like this dependency on others to do so much for me.
Well, that is it for now. Will let you know how the surgery went, once I am home and able to get my emails caught up, etc.

 
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