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Thread: Need help/advice: broken tibia

  1. #1
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    Red face Need help/advice: broken tibia

    Hi Guys:

    I came home today to find that Don (my hubby) had fallen off his commode chair and was on the floor with a probable broken leg!

    Went to the doc, xrays showed a complete break at the end of the tibia (close to the knee).

    orthopedic doc said we could try casting it or do surgery to put a plate in... we opted for the surgery with a brace and this is scheduled for Monday.... I didn't want it cast because of the risk of pressure sores...

    Does anyone have experience with anesthesia for this surgery.... he's a T11 complete so fortunately he can't feel the break.... the surgeon said that he didn't think any anesthesia would be needed and that this will be done in outpatient surgery...

    I need some feedback here... thanks for any help you guys can give!

    Sieg

  2. #2
    Won't he need a cast post-operatively? I did.

    I had surgery for multiple bone breaks in my lower left limb and had screws placed to hold things together. I was in cast after cast for a lengthy time after the operation. My doctor utilized serial casting as the swelling subsided and smaller casts were needed.

    Even with multiple fiberglass casts and frequent exams by my doc as he changed each cast and with x-rays to check healing, I still had a couple of pressure places develop. Fortunately, these were reasonably small and never got too bad.

    As for surgery minus anesthesia, does he get AD? That would be a huge concern for me, feeling or not.

    I hope the surgery is successful, that he heals quickly and well.

    Sending the best to you both.

  3. #3
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    Luckily Don has never had AD... but I would like to have some sort of anesthesia given.... I agree with you.

    The ortho doc said that a cast would not be needed but I will ask about the serial casting.

    Thanks so much...

    Sieg

  4. #4
    Hi Sieg,

    I've had some experience with post-injury break to my leg bones (Right and left femurs, and multiple tib-fib fxs) but so far (knock wood) none of my fractures have required surgery.

    I used a KAFO with a slide lock at the knee for a cast. The slide lock allows me to turn to pass through doorways and get in and out of the car. I would not be able to do these things if my leg was fixed out in front of me. The KAFO allows for skin checks.

    A friend made a detachable brace for my chair that has a saddle to hold my straightened leg out in front of me. That, coupled with the slide lock at the knee, allows me to be as mobile as possible.

    I needed a seating eval as the weight of the KAFO and the angle needed for my leg heal properly changed the way I sit in my chair. I got a little sore before I figured it out.

    While Don's brain may not feel pain, his body may. I had my toe nails removed without pain management and learned by experience that doesn't work. I'd be very careful to make sure that Don's body pain is managed even if his brain doesn't feel it.

    In the first week after each of my fractures, I have used pain killers because my legs react to the pain my brain does not process. Watch for AD even if he's never had it before. The pain affected my BP, tone, spasicity, etc. even though I did not "feel" it.

    Good luck to you both. HTH.

    Jen

  5. #5
    With a fracture like this I assume they are doing either rodding or plating. A cast should not be needed, and I would strongly recommend against it for the very reasons that you stated. A knee immobilizer (soft splint with reinforcing battens) should be sufficient.

    He will need to keep his leg elevated though, so you need to plan for an elevating leg rest wheelchair for a while. This may also impact riding in the car and using the commode and bathing, depending on his set-up.

    How much spasticity does he have? This can be a major consideration in the need for anesthesia or not. If they don't do anesthesia, at least ask them about moderate sedation (Versed). It would not be a procedure I would want to remember having to listen to!!!

    My mother had hers done as an inpatient and was in the hospital for several days, but she was in her 70s at the time. Fortunately he is at very low risk for AD.

    Is he having this done at Swedish??

    (KLD)

  6. #6
    When I broke my femur they knocked me out, they didn't even offer an alternative. I'm not sure I'd want to be awake even if I couldn't feel it. Does he get any spasms at all? Seems like that might be an issue, it would have been for me. I asked about it even with the anesthetic and they said it would prevent the spasms.

  7. #7
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    KLD...

    No... it will be at Presbyterian.... I will definitely ask about the moderate sedation... They have put him in a knee immobilizer already and we are keeping it elevated.... He has no spasticity and I have not noticed any increase or change in that area. I have him on ibuprofen 400 mg every 4-6 hours while awake.... his BP and pulse are ok...

    They are planning to plate him... I have viewed the films and luckily it is a very clean break.

    Thanks!

    Sieg

  8. #8
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    Thanks Jen and Zero....

    I think just bracing without plating would not be an option... I think that even though he's a low complete SCI that some level of anesthesia would be good... we'll meet with anesthesia before the procedure on Monday.... I will keep you posted...

    Thanks!

    Sieg

  9. #9
    Stop the ibuprofen IMMEDIATELY. It and other NSAIDs and aspirin should not be taken within 3-5 days prior to surgical procedures as they can cause excessive bleeding. Tylenol is safe. The surgeon should have told you this.

    (KLD)

  10. #10
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    Yikes.... I'll stop it right away.... Tylenol it is!


    Nope... they didn't say anything... but now we know!

    Thanks again!

    Sieg

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