Days 7-9 - Open Reduction Internal Fixation

I am not generally an anxious person, but found that on the morning of my surgery I was anxious bordering on panicked. My care team comprised of nurses, physical therapists, doctors, and anesthesiologists were sympathetic and understanding. They gave me extra Ativan (a drug to help with anxiety) before surgery to help with ease my fears, described the surgery in great detail, and even played my favorite songs in the OR before they put me to sleep. I had originally been quoted surgery lasting four hours. I was in the operating room for well over eight hours. When I awoke in the PACU (post-anesthesia care unit) I was shocked by the gluteal cramp I had. I flagged down a nurse and she got the surgeon. He told me that much of my surgery was spent facedown with my affected leg up in a sling so they could get to the posterior of my leg which had "exploded" with the impact of the injury. I was surprised by that fact and also shocked by the cramp I had after surgery. Be prepared that you will likely be in odd positions in the operating room and might be sore in places besides your affected leg. 

My pain management approach was different than most people with this injury. I tried a myriad of pain medications. I had Fentanyl, Dilaudid, Oxycodone, Torodol (ask for this to be diluted and slow pushed or it will burn), Gabapentin, Baclofen, Venlafaxine, Acetaminophen and Ibuprofen*. I am very sensitive to pain medications and spent much of my time puking when I had the external fixator. After many conversations with my care team, we decided that a nerve block would be the best course of pain management for me. This is very unusual because after surgery one of the largest concerns is compartment syndrome. The main symptom of this is a sudden, drastic change in pain. Other symptoms are decreased perfusion (blood flow) and hardening of the tissue as it gets more swollen. My team allowed the nerve block under the agreement that I would be checked hourly for compartment syndrome. The first 24 hours after surgery I was woken up every hour and made to wiggle my toes if possible. The doctors would squeeze my toes, foot, and calf. The nerve block worked wonderfully for me and I was able to cut down on the amount of pain meds needed. Your surgeon may be open to the idea so inquire, but be prepared that this absolutely is not a common course of action. 

I was discharged two days after the open reduction internal fixation. Before getting into the car, I asked to have one last dose of pain medication so that I was able to tolerate the bumpy city streets for the 30 minute drive back to my house. 

Things I learned from the open reduction internal fixation:

1. Try different types of pain medicine if one isn't working for you. 
2. DO ANKLE PUMPS. I didn't move my foot/ankle at all during my entire 10 day hospitalization. This caused major setbacks in my healing process and I still am frustrated with myself for not following PT orders. 
3. Get up with physical therapy many times before discharge and make sure you can safely use the toilet. This will be one of the most important things when you are home. 
4. If you have stairs in your home, live alone, etc. ensure that you get the help of a home health nurse. This injury is monumental. You will need WEEKS of help. More on this in the next part. 

*Some studies say that Ibuprofen slows bone healing. I was allowed to use Ibuprofen for three days and found that it helped my pain immensely.