First few weeks with an Ilizarov frame - Story of a broken leg: Part 4

A personal account of living with an Ilizarov spatial frame

This is the fourth part of my broken leg story and covers details of the first month following the frame surgery. Background to how I broke my leg and events leading up to this point can be found by clicking the links below:

Part 1 - How it happened etc.
Part 2 - Ilizarov frame surgery.
Part 3 - First few days post Ilizarov frame surgery.

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.

Month 1 Post Surgery - June 2019

At home, I soon settled into a routine of living with the frame. Walking about the house did not present any problems. I was well versed in using my crutches and could move about the house with little problems. I Just needed to remember to give objects and people a wide berth, so has not to wack something or someone with the frame. The latter is quite painful, apparently! When I sat down I had a comfortable stool placed in front of me so that I could raise my leg above hip height to help reduce the swelling in the leg and if that didn't cure the swelling then lying on a sofa with leg raised above heart level (and a subscription to Netflix) would do the trick.

What goes up, must come down - beware of stairs!!

My first problem I encountered at home, was the negotiation of stairs. Going up was OK: step at a time with the crutches, a bit risky at first given my balance was not brilliant. Coming down however was a a major issue. The frame's rings, going all around the leg, meant that the rings even when pushed right up against the back of the stair's vertical risers, caused my foot to be only touching the step at the point of my heel - the rest of the foot perilously overhanging. The risk of my foot sliding forward and me then falling down the stairs was too great for me. I therefore initially came down stairs on my bottom. As the days progressed and with a little lateral (obvious in hindsight?) thinking, my wife suggested I might want to try coming downstairs standing 'sideways'. It is strange how sometimes the obvious alludes us.

Nigel, where's your trousers? - or what to wear in public

Up to now I had lived in shorts, not because I'd been basking in the heat of an english summer (far from it!) but because there are no standard, off-the-peg, long trousers that will fit over the rings of the frame. Believe me I feel like I have tried all of them including 1970s flares! So after a couple of days at home and almost a week from the operation, I felt ready to venture out into the great outdoors - only a little outing to the local garden centre, but I was conscious the public at large might not be quite so ready for the sight of me.

A nurse had said to me in hospital that venturing out in public with the frame should be for others to have to cope with/ deal with. It shouldn't be my problem if they didn't like it: they aren't the ones that have to put up with it for months on end. She may have a point but I couldn't help thinking that young children, especially, might find metal wires protruding both sides of a leg a little off putting. Let alone the occasional drips of blood that run down my leg if the metal rods (pins) weep/bleed!
So what was the solution? Well my wife and my son's fiancee are both dab hands at sewing, so between them, as an experiment, they took a pair of jogging bottoms and inserted into the relevant leg extra material taken from a similar coloured pillow case, turning the one leg into an extreme flair that started from the top of the leg (rather than just below the knee). This allowed me to get the material of the leg over the frame rings (just). The picture shows the finished garment. OK I might not be the trendiest person out there (not that I ever am) but it was functional and did the job. I now own a pair of long trousers that fit! Armed with these I made my first forage into the great out doors, which I'm pleased to say went well, using the crutches to walk around.

Over the course of the next few weeks, another pair of jogging bottoms were adapted and as I write, two pairs of jeans have been ordered in an attempt to make one good pair similarly adapted. At the end of August, my son gets married and a tailor has been employed to adapt a hired wedding suit. My wardrobe is growing!

Cleanliness is next to .... - make sure those pin sites are clean!

One potential problem that I have been warned about is the very real likelihood of incurring an infection where the metal rods enter the skin through the leg. These are known has pin sites and it is very easy for bacteria to get into the leg around the wires, so the skin becomes inflamed and starts to hurt. If this is the case then it is likely that they are infected and only a course of antibiotics will cure. To help prevent infection, it is essential that the pin sites are cleaned once a week, first by washing/showering and then when dry, using a alcohol based antibacterial cleaner and applying new dressing/pads to cover the pins. However in between this weekly cleaning, any showering of the leg or bathing should be avoided.

Keeping the leg and hence frame/pin sites dry for a week is in itself a problem, as to take a shower involves wrapping the leg/frame in plastic, taping up any areas that water could seep in etc. It is so good on those days once a week, when a full shower can take place, even though it means taking a good half hour after the shower to thoroughly disinfect the pins sites and change the dressings.

Hi Ho! Hi Ho! it's off to work we go - well not exactly I'm retired

Its been 3 months since I retired from full-time work, recent enough that it still feels like I'm just on leave (be that 'holiday' leave or 'sick' leave) and since the operation I have thought about if it would be possible or when would it be possible to go back to work. (I'm thinking hypothetically here as I have no intension!), but others reading this, in a similar situation, might need to return to work quickly and so an assessment might be useful here.

Just to summarise my position at the time of writing this section of the blog: It is now 3 weeks since the operation to fit the frame. I consider my self fairly mobile, I can get about outside using two crutches and just one crutch/no crutches (full weight-bearing) within the house. I have virtually no pain, but my leg will swell if I attempt to do too much, which is usually occurs when moving around for more than half an hour. My assessment therefore on prospects of work based on this mobility as follows:

First and foremost, if you do any kind of manual job that requires any length of time standing or kneeling or moving constantly inbetween those states, then thinking about a return to work is not even on the horizon, unless you want to find yourself back in hospital within days: Your leg won't be in any condition to move or stand for any length of time - just my opinion.

If you have a 'desk' type job, then I would assess that there is some hope on the horizon for a return to work at some point probably in the next 4 to 6 weeks, that would very much depend on how much pain you experience, how clean the work environment is (to avoid pin site infection), how relaxed an employer would be in respect of the clothing you wear and having time off to attend outpatient appoints with consultant/physio. You will also need downtime during the day to elevate your leg (it can take an hour for swelling to start to subside). Also travel arrangements to work, need to be considered: Public transport for me (due to my height and the amount I'd have to bend my leg to sit down) is out of the question. Also ask yourself, could you safely drive if you travelled by car? There is also the health & safety aspect of being a liability at work if you are not sufficiently mobile to evacuate a building in an emergency etc. All this doesn't bode well, but again just my opinion.

Realistically, my assessment would be that working from home is probably the only way you will get an early return to work.

A stitch in time saves nine - time to have 30+ stitches removed

My first outpatient appointment takes place 3 weeks and 2 days after the Operation (13 June 2019). I first have an X-ray taken (which was unexpected) and then I have the stitches removed around the regions where the old metal work was taken out. Always a joy, especially when a stitch or two have decided to embed themselves and the nurse has to dig (literary) them out with a sharp blade.

The frame specialist nurse visits me, checks I'm cleaning the pin sites OK and that I have no issues. I mention that I get swelling and ask if I'm doing too much? She is surprised I have no pain, given the amount I'm mobile, but says to keep going as I've been doing and keep elevating the leg to reduce the swelling and take pain killers if required.

Even the consultant paid an unscheduled visit to see how I was doing. He said he'd looked at the X-rays, everything looked as it should, be obviously early days in respect of any signs of bones healing. He would see me in another 3 to 4 weeks to check progress.

All seems to be going to plan, if not better! (or is it? read on...)

Houston, we have a problem - the luck of Apollo 13 strikes

14th June 2019: Just a few days after my outpatient appointment and 4 weeks since the operation. I awoke on Monday morning after a quite a bad nights sleep. My leg had been quite painful and I had resorted to painkillers the first time since leaving hospital. As that day progressed and the day after, I didn't think any more about it, but found myself taking painkillers quite regularly.

On the Wednesday morning I awoke to a very swollen leg, any swelling will normally subside overnight, but last night it didn't and my wife commented, when I got out if bed, on how red the leg looked compared to my good leg. She said something isn't right and I should contact the hospital. I knew she was right. At 11am I spoke to the frame specialist nurse, who said she could really do with seeing me. Although there was a clinic that afternoon at the QE for scheduled appointments only, she would try and see me, if I could get there. My wife left work at lunchtime to take me in the car to the QE. We arrived at 3pm to a very busy clinic. The frame specialist was excellent, true to her word, she saw me straight away and examined my leg and asked a few questions about the pain and when it had started. She left the room to speak to the consultant and within a minute came back, saying they were sending me for an X-ray.

I found it quite remarkable and a testiment to the National Health Service, that I arrived at a busy out patient clinic for which I had no appointment, the nurses and consultants were willing to take time out to see me and within 15 minutes of arriving I'm having an X-ray taken. After the X-ray I await the nurse and consultant to review the X-rays. Whilst I wait another nurse comes to me and my wife and asks my wife to ask the receptionist to book a formal appointment for me immediately. She specifically said I should remain seated and my wife see the receptionist. I knew then, if I didn't suspect already, something was definataly not right.

The frame specialist nurse then called us to see her and the consultant. I could see the nurse watching me closely as I walked and made a fuss about me having a seat to take the weight off my leg - definataly something wrong. Indeed she went on to explain that the X-ray showed that two screws that had been inserted to help the frame hold all the bones in place had broke - both of them, broken!

The consultant explained that because I had been progressing so well and had been pain free, I "may have gotten a little ahead of myself", "but to be honest", he continued, "given the angle of the fracture the amount of movement that will generate has you you walk, it might be it's just been too much for screws to withstand. We might have to consider adding more external metal work/wires, as I see little point in using more screws,as those that have broke are pretty big". It was still very early days though and the consultant felt we needed to give things a couple of weeks to see how it all settles down and review the pain levels etc before contemplating having to go back into the operating theatre. So on the advice of "take it easy but move about as much as you can", I now await an appointment with the consultant on: 3rd July 2019.

The saga will continue in part 5 of this blog... (Yet to be written)