Ilizarov frame surgery - Story of a broken leg: Part 2
A personal account of Ilizarov frame surgery
This is the second part of my broken leg story and covers details of the day of the frame surgery. The background to how I broke my leg and the events leading up to this point can be found by clicking this link:
Please note: I have little formal medical knowledge and this is my story, it is as factually correct as I can make it, but I cannot be held responsible for any errors or differences in what others might know or experience.
SURGERY DAY - Monday 20th May 2019
I arrived, with my family, at the admissions ward of the QE University Hospital Birminghm just after 7am for the frame surgery. A couple of quick routine discussions with the Nurses to discuss the events of the day and before I knew it I was meeting the Senior Anaesthetist and my Consultant/Surgeon. We discussed the surgery: It would be conducted under general anaesthetic, including a pain block, the old metalwork to be removed and external frame to be fitted. The surgery was scheduled to take 4 hours or so. I was told the risks and what might go wrong: the surgery may not work, meaning further surgery required, risks of blood clots and a worse case scenario: leg amputation. All sobering stuff for 8.30am on a Monday morning, but I accepted it, agreed and signed my life away. No going back now?!
At 9.30am I said my goodbyes to my family, they in turn wished me well. I was then escorted to Operating Theatre No. 19 to meet the Anaethetist team (who I always find manage to combine pofessionalism with a good sense of humour - perfect for me for putting me at ease). I was hooked up to various monitoring sensors, a cannular was inserted into a vein in my hand and at just after 10am I was taking deep breaths into an oxygen mask and being told I will shortly go to sleep. I count 4 deep breaths, then....
... I awoke, there was a large clock in front of me, it said 4.20pm. A nurse was sitting at my side, I was aware of being connected to various monitors and an oxygen line. One particular monitoring machine, decided it needed to automatically take a blood pressure reading every 5 minutes or so. If you have ever had your blood pressure taken, then imagine that clamping feeling around your arm, being on a continuous 5 minute loop! The nurse began asking questions, assessing my responses. I was conscious I felt cold, very cold, I began shivering uncontrollably. I'm not the type of person that normally feels cold, but this more than made up for it - the cold was more intense than I'd ever remember experiencing. I told the nurse and within seconds I'm wrapped in warm blankets and a warm head hugging pillow. It felt so good but I was still shivering, then a few more seconds and hot air was blown between the bed sheets enveloping me in a warmth that felt so incredible good. I soon stopped shivering and took some sips of water. I wasn't really thirsty, but I knew it was important to drink as I hadn't done so since yesterday. The cold reaction, my nurse told me, as I drank the water, is not unusual as Operating theatres are kept cool and being in theatre for over 5 hours, with just a flimsy gown to wear, doesn't help! Interesting comparison to the operation 2 years ago when I awoke sobbing my eyes out, feeling incredibly sad - another common reaction to general anaesthestic/surgery.
Once I was feeling a little more comfortable, I could assess my situation. I knew the frame had been fitted as I could see the metal rings within the contours of the sheets and I could feel some pain/soreness emerging from my leg. The nurse enquired about any pain. From what I'd read and been told, I anticipated quite a bit of pain. This wasn't has bad as I expected, although it was painful - on a scale of 1 to 10 (1 being no/hardly any pain to 10 being excruciatingly unbearable), I'd assess it at about 5 to 6. The nurse considered it bad enough to give me a couple of shots of morphine and within minutes the pain subsided to a manageable 3. For reference, I'd assess the constant leg pain I experienced when I was mobile, with the broken leg, immediately before the surgery, at around 2 to 3.
Over the next hour, I became more alert as the anaesthetic wore off. The nurse read the surgeon notes and summarised them to me. From what the nurse told me and later conversations with the consultant and his team, I learnt the following: The surgery had taken a little longer than expected; nearer 5 hours than 4, but it was deemed successful. The internal metal plates had been removed together with the sheared screw heads. The threads of the screws however were too deeply embedded in my bones, to make their removal viable, so they remain. The tibia (shin) bone looked in good health, visually, but bone tissues were collected for analysis to determine the type of any infection present. The tibia was cleaned and two new screws inserted into the ends of the tibia to join the broken bone. To facilitate joining the two ends of the tibia, the fibula (the smaller of the two leg bones) had to be cut (broken). The two new screws would stop any vertical movement. The external (ilizarov) frame, would hold everything in place, stopping any lateral movement and permit full weight bearing (FWB). The FWB element, although I had been told it by the nurse that afternoon, didn't fully register with me at the time, the consequences of that would come to haunt me later that day.
By 6pm I had made sufficient progress in the theatre ward, that it was now time to move me to one of the main wards for the duration of my stay at the QE. I knew my stay was expected to be about 10 to 14 days. This relative long time in Hospital was not because it would take that time to be fit to move etc. but because the potential bone infection needed to be attacked with some specialist antibiotics that could only be administered, by trained medical staff, intravenously (an IV drip via the cannular in my hand). It could take up to 14 days to get the tissue results and ensure suitable antibiotics administered.
At 7pm the bed on the main ward was available, before I left the theatre ward, my nurse connected me to the first of my antibiotics drips. It takes 2 hours to pump all the fluid into my body, but as the drip is attached to my bed, it is bed mobile and able to come to the ward. Half an hour later. just a little more than 12 hours after arriving at the QE and 10 hours since my family last saw me, I was in the main ward with my family around me - they had sat in the waiting room, nervously waiting for me all the time. We had a quick catchup, I ate a sandwich and a yoghurt (the first food I'd had in 24 hours - no food or drink permitted since the previous midnight). My family looked tired - through nervous exhaustion and I told tem to go home and get some rest as I would be alright. They reluctantly left just after 8pm.
I had not yet seen the frame attached to my leg, it remained under the bed sheet and I decided that was where it would stay until the next morning, I would take my first look then. The antibiotic drip had finished dripping its way into my body and the feed pipe disconnected from the canula by a nurse. I didn't have any more pain (in fact it had completely subsided) and I was quite tired, so at about 9pm I decided to try and get some sleep. It was only moments later, however, that my bad leg suddenly had a mind blowing cramp like pain shoot down its length from my calf to my toes. I shot bolt upright and was transfixed in a vice like agony for what felt like an eternity. I lifted my bad leg as high as I could to try and alleviate the pain. For the first and my only time, whilst being a hospital patient, I pressed the nurse's call bell that was attached to a cable next to me in the bed. I was in a panick, this didn't feel right.
The nurse was with me within a minute or two and as I explained the cramp pain, she said it was my leg objecting to being in one place too long and not being moved. She emphasised the importance of bending my leg and ensuring I moving it from time to time. "You cannot do any damge", she said, "you are in theory full weight bearing, so do whatever you'd normally do to alleviate the cramp". I had forgotten I could FWB and had been lying their motionless thinking I'd daren't move. I wriggled my leg and bent it at the knee and the cramp soon went and thankfully never came back. I soon went to sleep and I can remember waking a number of times in the night thinking how good it felt to be pain free (the pain blocker must have still been working). It also felt so novel to turn on my side or my back, even with the frame attached, and not to feel any discomfort, as I twisted and turned. It bought home to me how, during even what I thought was pain free times during the last 2 years, I must have had a background pain bubbling along in my leg all the time, especially at night. If only it would stay this way, I remember thinking to myself as I dozed back to sleep...
The next part of this blog, Part 3, continues with this account of my first few days living with an Ilizarov frame. See here: Part 3 - First few days living with an Ilizarov Frame.