ow ow ow

April 4, 2008 6:31 AM

My broken humorous is hilarious. Well, not really. Please help me understand what I can expect from my shiny new pins and plate in my arm.

I pulled a superman off some stairs into a bar in Paris. I was already flying to Frankfurt the next day (later the same day by the time I was out of the second hospital) and on the advice of Paris doctor, decided to see some orthopedic specialists there instead of in Kiev, where I'm currently living. I was told that surgery was pretty much my only option, and went under the knife last Thursday. I got out of the hospital on Tuesday, and it seems to be getting a tiny bit better each day, but wow, does it still hurt.

The amazing this is that I'm typing this with both hands (with my laptop in my lap, I can't raise my arm up to put it on a table yet) and I'm not in a cast, or a sling, or anything. I put my hand in my jacket pocket when I'm out walking around, but the hardest part is sleeping. Other then that, compared to the horrible agony I was in pre-surgery, I'm feeling like a million bucks (which is only like 40 Euro with the weak dollar).

Here are a few questions I have, however, since this is my very first surgery, broken bone, stitches, etc. If anyone has had anything similar - about how long did it take to get mobility back? Did you need to get the pins/plate out? I'm doing physical therapy currently, and will continue next week when I get back to Kiev and as long as I need to, of course.

Stitches in general - they told me at the hospital to not get them wet and keep them covered for two weeks, but online it says to put antibiotic salve on them and you can get them wet - what's the best way to make my scarring as minimal as possible? I also has a "pain catheter" from my neck going into my arm, and as they were taking it out it snapped, so they had to go in through my neck to find it (good times). This means I also have a few stitches in my neck, and both those and the ones in my arm have hard bumps underneath them. Normal? They are they dissolvable type.

In case anyone wants to see the bones here's a photo (blog self link) of the before and after. Thanks in advance. I'm keeping my fingers crossed that I'm not going to hear "and I was never the same again" over and over.

posted by monkey!knife!fight! to health (15 comments total)

I asked a similar question a couple of years ago. I'm happy to report that my son got through it fine and while he has an awesome scar there were no other lasting effects; he's totally fine. Kids scar worse than adults; he was 13 when he had the surgery, but, since he is a teenager, he is actually quite proud of his scar and has been planning a "way, totally epic" tattoo to go around it when he's 18. YMMV. You can try putting vitamin E on the scar several times a day, which is supposed to minimize it and is good for your skin anyway. With my son, the plate stayed in; the surgeon told us that right off the bat so I'm surprised that your doctor didn't let you know whether your metal is the stay in or the take out type. My guess is the stay in, but IANAD by any means. Apparently once you have the stay in kind of plates, flying becomes a huge hassle at least in the US. We haven't tried it, but I've heard that you will need to have a copy of your X-rays and a letter from your surgeon any time you fly.

It took several weeks for the pain to go away completely. For my kid, the medication soon proved to be worse than the pain itself and once we stopped that he got better pretty fast. He had a cast as well though and had to go another six weeks before that came off.
posted by mygothlaundry at 7:14 AM on April 4

Well, it was a long time ago, and kids heal differently, but I've been there.

Broke my arm - both bones, a few inches above the wrist. One didn't mend right which was obvious when the cast came off - there was a bump on my arm, and I couldn't fully pronate my wrist. I had surgery; the bone was rebroken, and a plate and pins were put in. These were removed within a year, since they were on or near a growth plate, and the docs were afraid I'd end up with one arm shorter than the other if they were left in. All I've got now is a wicked scar, mostly faded but quite wide, but I'm a keloid-former, so YMMValot.

After the first (and second) surgeries, I didn't have a cast either. It was bandaged for a while, and I was instinctively very protective of it. I remember that I had to keep my arm in a plastic bag when I bathed for a couple of weeks, or possibly until the stitches came out (it was years ago, so I don't quite remember that part).

As to recovery, I didn't get physical therapy or anything, but kids are remarkably resilient. Everything healed up fine, and I could pronate my wrist without trouble. There were a few things I couldn't/wouldn't do - play volleyball, for instance - for some years afterwards, because I was afraid of hurting that arm. I'm not sure how much of that was physical (the surgical area was quite a bit more sensitive than the same place on my other arm) and how much was psychological. It definitely still feels "different", at least on the skin-side, but I assume that some nerves got rewired during surgery/healing, and so transmit information differently than they used to.

I won't speak to getting the area wet or not, but if your docs say don't, I'd follow that rather than the advice of people who have never examined you or your arm.

Oh, also, re: scarring - when you're allowed to, yes, rub vitamin E on it, and slather it with sunscreen when you're outside and in short sleeves. Both will help minimize the scar.

Good luck!
posted by rtha at 7:18 AM on April 4

I'm very sorry about your accident - this sucks for you.

I have/had pins in my elbow, a plate in my foot, pins in my femur, and a screw in my other foot (different accidents). The plate and screw are permanent. The pins are not. The surgeon should have told you whether and when you needed the pins and plate out. I've had pins taken out within a year of the initial accident but I also had to wait a few years. Getting the pins out was little like getting hurt all over again in terms of mobility and pain.


My doctors always told me vitamin E cream and absolutely not touching the scabs or getting them wet was the best way to keep scarring minimal. I've got some pretty good scars so I don't know if that was successful or not. My surgery scars all eventually faded to a thin line with spots where the stitches were. Your scarring will probably depend on the stitch line size and how delicate your cutter was, not to mention YOUR personal factors. Some people scar well, some people don't.

As for your mobility, that depends on your injury and you. IANAD but based on a few accidents I think it varies a lot and it's hard to make a prediction. Don't overdo it and don't underdo it. Working with it helps to recover but not too much work. In terms of activity, my PT always said that discomfort is good but pain is not when recovering - that pain is your body telling you to stop. When I've overdone it I've always found my recovery time longer. For me, long term it always takes about a year before I'm ~100% recovered, but much shorter times (6-10 weeks) for general every day stuff. You may find it's awhile before you can do certain things but everything else is fine.

For most of my accidents I haven't been the same again, but it's very minor little twitches and aches occasionally. The metal bothers me in the winter, but I can't tell storms are coming or anything. Did you sprain your arm too or just break it? I would prefer to break something than sprain it. I have old sprains that still bother me, but most of my broken bones, not really.

Good luck recovering!
posted by barchan at 7:40 AM on April 4

The hard bumps may be vein irritation, if that was where the catheter was. After having a week in the hospital on at least three or four different antibiotics simultaneously, the IV site vein was pretty displeased and hard. It went away after some period of time, although I can't tell you how long it took.
posted by that girl at 7:46 AM on April 4

Wow, thanks for the very thorough answers. Just a quick answer - the pins and plate are meant to be permanent, but the doctor said that if I'm having problems with mobility in a year, he'd take them out. I'd like to never have surgery again (knock on everything) so I'd prefer that they just stay in. I'm getting a note and x-rays for my passport, but yeah, my days of breezing through security are over. And as an American, I'm really looking forward to trying to get through security with a note from a German doctor...or better yet, trying to get on a plane in Moscow. Sigh.
posted by monkey!knife!fight! at 7:46 AM on April 4

About the flying thing - for a couple of years after 9/11 it was wicked bad and I spent some uncomfortable moments with my pants off. It's gotten a lot better since then and the last few years I've breezed through, including 2 international flights. The bigger the airport the easier it is; most times I just have to show the scar if it beeps at all. Bored, smaller airports give me the most hassle, but I always allowed extra time just for that reason. Good luck.
posted by barchan at 7:55 AM on April 4

Some anecdotes:
I have a screw in my hand from breaking it at age 20 - the surgeon didn't tell me it was going to stay in until I asked him at a followup visit when it was coming out, and then he was surprised I didn't already know that it would stay in permanently. I had a cast for 8 weeks and then I had to do a lot of physical therapy and it was at least 4-5 months till I had normal strength again, but you lose a lot of strength being immobilised in a cast. The metal doesn't bother me at all, although I've noticed when writing reminders on my hand that the skin around the scar is still more sensitive (~3 years on). The scar itself is basically invisible, even though it's 2 inches long on the back of my hand, and my hand is completely normal.

I've also had stitches a few times, and the hard bumps are normal - i think it's actually little knotted bits of thread. They'll go away. As far as care goes, I'd suggest you follow directions given at the hospital - I've always been told not to get them wet as well. Once the stitches are gone, then I might put vitamin e and stuff on it - I was given a saline(?) patch to put over the scar on my hand in order to try and smooth it over and make it heal as well as possible, and told to massage the scar in order to break down scar tissue so that it didn't end up lumpy (with vitamin e lotion or something to avoid chafing).

My friend broke her humerus in January while skiing in Canada, had a plate/etc inserted in Vancouver, then on return to Australia a couple weeks later the doctors said it wasn't healing properly because the plate was too big, so re-operated and replaced it with a smaller plate that will stay in. She had no cast, but when I saw her around February 24th she couldn't extend her elbow fully or exert any force with that hand. By March 24th she was able to drink and write and throw a ball using that arm and had full extension.
posted by jacalata at 7:58 AM on April 4

As a teenager, I had pins-and-plaster when I broke 2 bones in my leg in a few places. I was fine after it came off, except for puckered scars below my knees and below my ankles.

If you have the kind that stick out and are wicked sharp, be careful. I fell asleep in the back set of a friend's mom's new Lexus for a few hours. By the time I woke up my pins had ripped huge gashes in her nice leather seats. I never told her and feel bad about it to this day.
posted by charlesv at 8:07 AM on April 4

Also look on the bright side: if you have a scar you can turn it into a really cool scar with a cool story about how you fall down in a bar in Paris and flew to Frankfurt the next day.
posted by barchan at 8:24 AM on April 4

*fell*, not fall
posted by barchan at 8:25 AM on April 4

I had some botched oral surgery that ended up with them accidently shattering my jaw and then fixing it. I have a plate and a bunch of screws on both sides of my jaw. My jaw was pretty sore for a few months but since then I don't even notice any difference from my original non-messed-up jaw.

They put a huge stick bandage over my jaw area after I left the hospital, which I didn't take off or get wet for about a week (I kept it on for whatever time they told me to keep it on). After I took it off, I had stitches on the lower part of both sides of my face. I don't remember if there were any bumps around the stitches, but the whole area was very swollen and irritated. The main thing I remember was that the bandage was incredibly sticky, so that the whole lower part of my face was covered in a thick coat of sticky glue, even after I washed my face a bunch of times.

I'm getting a note and x-rays for my passport, but yeah, my days of breezing through security are over.

I was worried about the same thing when airport security got tighter, but I'm able to walk through pretty much any metal detector without setting it off. I'm not sure if that's because the plate is relatively small or what.
posted by burnmp3s at 8:27 AM on April 4

Apparently once you have the stay in kind of plates, flying becomes a huge hassle at least in the US. We haven't tried it, but I've heard that you will need to have a copy of your X-rays and a letter from your surgeon any time you fly.

I got a screw in my ankle last September. I asked my surgeon about this, and he said just the opposite--since 9/11 a doctor's note or X-rays don't help any at security, since they're too easily faked. They'll supposedly check you out thoroughly with or without a doctor's note or X-rays. (I can't confirm this myself, as it turns out my screw is too small to set off the metal detectors.)

The surgeon said that the screw would stay in unless it was continuing to cause me pain months afterwards, in which case he could take it out--I think he said for the particular surgery I had, about 20% of people decide to have it taken out. Mine's still in.

I don't know if my fibula is really analogous to your humerus, but if it helps, I was on crutches for about 7 weeks--2 weeks of "stay off the foot completely," 4 weeks of "gradually put more weight on the foot," and 1 week of using one crutch only. Probably took a month off of crutches after that before I was walking completely normally. Completely pain-free now, and the only difference I notice any more is if I've been sitting for an hour or more, my ankle feels a bit stiff when I first get up, but that dissipates within a minute of walking around.
posted by DevilsAdvocate at 9:02 AM on April 4

Seriously, do everything physical therapy tells you. Both my friend & I broke our arms in elementary school in roughly the same places, though mine was worse (I had pins, she didn't). I followed physical therapy and she didn't, and now she can't completely straighten her arm, even 9 years later. It was awhile ago, but took me about 6 weeks to be back to normal, but my pins were temporary so yours might be different.

Whenever I break something that doesn't merit a cast I ace wrap it up at night. It helps keep it a little bit more secure, but mostly it just reminds me, even in a half-asleep state, to favor that appendage.
posted by lilac girl at 9:03 AM on April 4

I broke my humerus in 1990, along with the wrist in a high speed horse fall, and because of the cast on the wrist had to sit around for a few weeks with the top half of my arm looking like half of a swastika, whilst the wrist healed before I had the humerus plated with 8 screws and a bone graft.

I was told to keep the wound dry until stitches came out. The surgeon was insistant that I left the scar alone for a year before starting to put vitamin E oil on it. Scars need time to settle apparently. My fracture was a messy spiral one with lots of jolly fragments stuck in the muscles, so my surgeon told me he was going to leave the plate in forever, unless of course I had problems with it. Apart from the pain of new bone growing (ache, twinge, groan) and nerves mending (small electrical shock twinges) healing was quickish, and paracetamol worked just fine once I was out of hospital and off the post op opiates. Disappointingly I have never set off an alarm at an airport. This is probably because the plate is now totally covered in new bone growth.

The biggest help to me was physiotherapy. Mainly to keep the shoulder joint mobile and to avoid frozen shoulder and also to undo a bit of fibrosis in the elbow joint - the fibrosis happened because I'd had to keep the arm in a sling for so long before surgery. Once surgery was over, I started physio the next day. Physio will speed up your return to full mobility. Most importantly DO the physio as often as you can, several times a day is good. Don't miss out on it at all if you can help it. My physio gave me a set of ceiling slings to use at home which helped build up the arm again. If you feel your arm or shoulder getting stiff, bend over and allow your mending arm to just hang down for a few minutes, then make some small circles with your hand - this is bliss when your shoulder is stiff and really stretches out everything. Don't over do the physio, aches are good but real pain means stop. Making new bones is hard work for the body, so make sure you get plenty of proper rest, especially in the first few weeks. Eat well, it does make a difference.

Everything healed fine, and although the arm is bumpy around the plate where new bone has grown, this isn't visible and can only be felt when I podge it with my fingers. Sometimes when there's a big change in air pressure I get the occasional twinge in the upper arm, but the met office have not yet offered me a job predicting when it will rain. Once the plate surgery was done, I was driving again within 3 months, this may have been longer than you need but I had some radial nerve damage that needed to settle. My arm is fully functional again, and as my work is physical, it needs to be.

Happy healing!
posted by Arqa at 9:20 AM on April 4

I broke my humerus at age 15 and recovered relatively easily to 100% mobility. I did no damage to shoulder, elbow, or other joints. Recovering from just a bone break is easy compared to recovering from a joint break (I broke my wrist several years later and that never healed back to 100%).

Here's a tip: don't run on slippery surfaces. I slipped and fell on the ice a few days after my cast (an open cast that I wore for 4 weeks after the original break) came off. Turns out I re-broke my arm, but the docs and x-ray techs in the emergency room could not see the new (hairline) fracture. I had a decent bone guy and he saw the rebreak 4 weeks later at a routine follow up. Oh well. Healed anyway.

The atrophy when the cast came off was horrifying. My range of motion was severely limited at first due to the second rebreak but a slow early recovery did not adversely affect long-term results. I was a swimmer at the time and I believe that swimming was very helpful in rebuilding the arm muscles. I passed a lifeguard qualification course within 6 months of the break.

I am optimistic that you will have a similarly easy recovery. Just don't fall!!!!
posted by crazycanuck at 11:28 AM on April 4