First few days with an Ilizarov frame - Story of a broken leg: Part 3
A personal account of living with an Ilizarov spatial frame
This is the third part of my broken leg story and covers details of the first week following the frame surgery. Background to how I broke my leg and events leading up to this point can be found by clicking this link:
and details about the actual surgery can be found here:
Part 2 - 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.
DAY 1 Post Surgery - Tuesday 21st May 2019
The first morning after my surgery, I awoke at 5.45am to the sounds of the nurses moving about outside the ward. Before I knew it, the nurses were in my room to hook me up to the first lot of IV antibiotics of the day. Not much can be done during the 2 hours it takes the IV drip, so I make myself comfortable in bed and consider my situation. I had had a relatively good nights sleep with no pain (pain blocker from surgery still having an effect?).
The frame on my leg had surprising not given me any problems. I then remembered, I hadn't actually seen what the frame looked like.
I pulled my legs out from under the blanket. I was not surprised by what I saw, it was similar to others that I'd seen on people around the hospital. As this picture (and the one further down this page) shows, it consists of 3 concentric rings connected to the wires (pins) that pass through the leg (through the bones) from one side of a frame ring to the other. Gives the film "hellraiser" a run for its money!
By 9am the 'IV' had finished, and basic observation measurements of blood pressure, pulse and oxygen levels all taken and deemed good. Shortly afterwards a very young looking health care assistant (HCA) walks in to my room offering to give me a wash. She looked like she'd just come out of school. No way I thought, there was a washroom no more than about 5 yards from my bed, "It's alright, I can go to the bathroom and wash myself" I quickly respond. even if I have to fly there! I twisted my legs over the side of the bed, in readiness to stand. Clang! - the sound of metal leg frame hitting metal bed frame. Wow! - It didn't hurt, but lesson 1, to self: need to allow and check for much greater clearance around my leg. From a sitting position at the side of my bed, I put my feet to the floor and gingerly pushed my self up into a standing position. The HCA came running round the bed to help. but I signaled I was Ok as I fully stood upright. Ok it was somewhat painful, at first to have full weight on my bad leg, but surprisingly not that intolerable. It was more from tightness of not moving and the bandages covering the stitches. I managed to 'slide' my way to the bathroom, where there was a seat next to the washbasin. I was grateful to be able to sit to wash. The HCA brought me my wash bag and towel and I aso asked if she'd bring me my day clothes.
I had prepared myself in regard to the difficulties the frame would present in respect of being able to wear certain clothes (trousers etc.), so I had come prepared by bringing a pair of baggy shorts to wear. 
Even so, it wasn't easy pulling and stretching underwear and then the shorts over the frame rings (I have since measured the rings to be 9 inches [230mm] in diameter). Half an hour later I'm refreshed, dressed and back lying on top of my bed, feeling agreat sense of acheivement. When I originally broke my leg, it took weeks to get to this stage.
I hardly had time to dwell on my acheivement, when a physiothrapist arrived at my bedside. "What do you think of the frame?" she'd asked after introducing herself. She looked keenly at me, to guage my reaction. She probably wanted to assess my mental attitude towards it. I shrugged. "It's what I expected, I have seen plenty of them beforehand and if it gets the job done then great!". She smiles. "That's good" she says, "do you want to try and stand?" I explained how I already had stood and even managed to get to the washroom and back. She sounded quite surprised and said she will get me some crutches - "They will help you to control the weight on your leg and give you better balance", she explained. Within minutes she returned with a pair of crutches. Under her watchful eye I walked a few yards down the ward corridor and then back to my bed. The Physio was impressed: she explained that it can often take some patients a week from the surgery to get to a point they can walk. Her words were welcome and encouraging, but to be honest, for the best part of the 2 previous years I'd spent using crutches - as they say practice makes perfect! I do think that having lived with a broken leg for so long, did help greatly here. I am naturally an active person, not in the sense of taking part in sports or doing fitness training, more just I'm not one to sit still for too long. I would easily do 6000 steps a day, before this surgery, which might not sound that many, but remember that is on a broken leg, where pain would become the limiter.
DAY 2 onwards - Weds 21st to 24th May 2019
During the next few days in hospital, I settled into a routine: up at 6am for blood to be taken away for testing, (this allowed the antibiotic dose to be adjusted), quickly followed by a 2 hour dose of IV antibiotics. Lunchtime a straightforward shot of different antibiotics followed at 6 pm with an injection, into my stomach, of enoxaparin (to reduce risk of blood clot). This was followed by a further 2 hours of IV antibiotics (dosage adjusted based on the morning's blood test) and then finally at about 10pm another antibiotic injection (similar to that at lunchtime). The purpose of the antibiotics, especially the IV drip, was to kill any infection present in the bones. When the bone tissue results are complete they identify the precise type of infection and confirm that the antibiotics so far administered, would kill the infection, otherwise the antibiotics would have to be changed and a new set administered for a furthr 7 days. This explains why my predicted stay in hospital had been estimated as anything between 7 and 14 days.
In between the IV drips, I would have general observation measurements (BP, temp, oxygen levels) taken every couple of hours or so. I would try and walk around my room as much as I could during the day, lying on the bed raising my leg if it started to get painful or started swelling. Doing this quickly alleviated the problem.
On the morning of day 2 (Wednesday), I had a visit from the consultant and his team, to check my progress. The consultant informed me that he'd had my interim tissue sample results back (48 hour point) and they were showing no organism growth (i.e. no infection). We just needed to await the full results which could take a few more days. If the final results showed the same negative organism growth (hence, no bone infection) then there would be no further need for antibiotics and given I was fairly mobile, I could be discharged. I kept my fingers crossed, for no infection and an early release!
My family visited me each day in the afternoon as soon as they finished work. The QE hospital has an open visiting policy from 11am to 8pm. These visits provided much welcome relief, from the constant stream of doctors, nurses and HCAs, whom always seemed to have something they felt the need to poke into me or clamp on me! The only hospital staff that called by my bedside, without anything specifically medical to do, were the orderlies bringing water, hot drinks and 3 meals a day. These were very welcome visits, second only to the family visits! The food at the QE is top class and there is a constant flow of hot drinks available if you wanted. Food menus (for breakfast, lunch and tea), are delivered around midday for choosing the next days meals. The choice was fantastic all all types of diets catered for. Even if not on the menu you could ask for any special dietry requirments to be catered for. To be honest, I'm not sure you'd get this choice or service in a hotel (certainly not for free - we have a lot to be thankful for with the NHS and not just for the medical side of the service).
I tried to walk, using my crutches, as often as I could over the next few days. Only within the room I was in, as I wanted to balance doing some exercise, but not overdoing it, with then being able to quickly lie on the bed and elevate the leg when exercise started to get painful. During these exercises, I did learn a further valuable lesson: When walking, keep your legs slightly further apart than normal or else you'll find the frame has a tendency to hit the ankle on the good leg. Ouch! - Not nice and the last thing needed is the good ankle to be bruised!
In respect of pain, I had been during these first few days, extremely fortunate. Apart from the pain blocker during surgery and a shot of morphine immediately following surgery, I had hardly took any pain relief. Now for the first 24 hours or so, I believe the pain blocker was having some effect, as my leg felt somewhat numb. In the early hours of day 3 (post Op) I did awake at about 3am to pain that I can only describe as a "hot poker" like burning/stabbing sensation (probably about 6 or 7 on the 1 to 10 scale). A nurse passed my bed, so I explained the pain; she gave me some codeine, which quickly did the trick and the pain subsided over the next 40 mins or so. The nurse also gave me some good advice: "Pain is like a forest fire, attack it quickly and you can get it under control quickly, let the pain take hold and it's much more difficult to extinguish! - So don't be afraid or delay in asking for pain relief as soon as it's needed."
When I awoke at 6am on Thursday (day 3 following the Op), I did not have any noteworthy pain, maybe the codeine was still having an effect, I'm not sure. I did at lunchtime that day, heeding the nurses advice, take some paracentemol, just to keep that 'forest fire from re-kindling', but that was the last I felt I needed. The pain I felt when I exercised was manageable and soon diminished when I lay on my bed and elevated the leg. As I said, I think I had been very lucky up to that point, with respect to pain.
Days can pass slowly when in hospital, but I'd admit there was so much toing and froing by the hospital staff during the day, the boredeom wasn't has bad has it could have been. The afternoons were however the quietest so I did take the opportunity in the quieter moments to either read or catch up on films/netflix series etc. which I had downloaded before my stay in hospital onto a kindle, brought for me as a birthday present, just a week or so before. I had stocked up on downloads to keep me going for the whole 14 days, just in case and I was thankful I had brought my Kindle with me, otherewise it would be very easy to have started climbing the walls!
I had prepared myself for the long haul. On Friday (day 4 post Op), after the usual IV drip/breakfast/wash/dress etc. I sat in a chair next to my bed reading my Kindle. This was the start of the late May bank holiday, weekend so I was anticipating the toing and froing would begin to reduce a little and that time may begin to drag more. Mid-morning, I was interupted from my reading by a young Doctor/registrar from the consultants team, she had come to give me an update. The final tissue analysis results had come back and they were negative for organism growth, therefore there was no bone infection. Imagine my delight when she went on to say that they would be stopping the antibiotics and if someone was available to show me how to care/clean the frame pin sites, then there was no reason I shouldn't go home! Fantastic News!
An hour later a frame specialist nurse was showing me how to clean the frame and pins. I will save the details of frame cleaning for the next part of this blog. By lunchtime, my discharge papers were being prepared together with a prescription for the pharmacist. At 3 pm my wife arrived from work and we sat and patiently waited for the prescription to be made up and the ward staff to give me the green light to go. It seemed to me unbeliveable that just a few hours before I thought I'd be in hospital for another week or more, and now I'm just minutes from going home.
At 5pm my wife was pushing me in a wheel chair out the hospital and to our car in the car park. Although I could walk Ok, especially with my crutches, I couldn't walk the distance to the car park, so the wheel chair was a lifesaver. It felt so good to be heading home.
In next part (part 4) of this story, I will cover my experience with the frame once I was at home, especially how and why it is importanat to clean the frame and pin sites.