What to expect from tibia repair surgery?
February 28, 2020 11:23 AM Subscribe
A relative is having screws put in their tibia early next week. We have a surgical consult coming up the day before but need to know more details ASAP to prepare.
How mobile is the average patient in the first day after surgery? The next few days? When can people climb stairs?
What are possible complications?
Is this usually done under general anaesthetic?
How much and what kind of assistance does the person need in the first days after surgery?
What has been your/a relative's/a friend's experience?
How mobile is the average patient in the first day after surgery? The next few days? When can people climb stairs?
What are possible complications?
Is this usually done under general anaesthetic?
How much and what kind of assistance does the person need in the first days after surgery?
What has been your/a relative's/a friend's experience?
Did this person break their leg, or are they getting hardware in their tibia for another reason? I have relevant experience for tibia IM nailing which involves a titanium rod and screws that I needed to fix a spiral fracture.
posted by capnsue at 11:31 AM on February 28, 2020
posted by capnsue at 11:31 AM on February 28, 2020
Response by poster: The tibia is fractured - the injury was almost two weeks ago but no appointments (other than the first one) were available until yesterday).
posted by Frowner at 11:34 AM on February 28, 2020
posted by Frowner at 11:34 AM on February 28, 2020
I think the usual course is 4ish weeks non-weightbearing, then 2-4 weeks of partial weightbearing.
Stairs: there are 3 ways to climb stairs safely with crutches. Ask or make sure you get a PT to instruct you on them. But it's gonna be a while, like weeks, before it's not a struggle, honestly.
The possible complications are constipation (Mirilax!) and infection.
It's usually general anesthetic, and often with a nerve block. Make sure the patient is loaded (the f*) up on pain meds for when the nerve block wears off, usually 20-24 hours after surgery, even if that time falls in the middle of the night -- set an alarm and take the meds. Don't do what I did.
Patient needs will depend a good deal on their overall fitness and strength, and their experience level. They'll need a shower chair, and possibly help getting onto it. They'll need a lot of food prep/help, because standing around a kitchen isn't easy, and carrying a pot to the stove is not possible. They'll need transportation help.
posted by Dashy at 11:36 AM on February 28, 2020 [1 favorite]
Stairs: there are 3 ways to climb stairs safely with crutches. Ask or make sure you get a PT to instruct you on them. But it's gonna be a while, like weeks, before it's not a struggle, honestly.
The possible complications are constipation (Mirilax!) and infection.
It's usually general anesthetic, and often with a nerve block. Make sure the patient is loaded (the f*) up on pain meds for when the nerve block wears off, usually 20-24 hours after surgery, even if that time falls in the middle of the night -- set an alarm and take the meds. Don't do what I did.
Patient needs will depend a good deal on their overall fitness and strength, and their experience level. They'll need a shower chair, and possibly help getting onto it. They'll need a lot of food prep/help, because standing around a kitchen isn't easy, and carrying a pot to the stove is not possible. They'll need transportation help.
posted by Dashy at 11:36 AM on February 28, 2020 [1 favorite]
I had a tibial tubercle transfer a few years ago. Not sure how similar this is to your relative's procedure but some of this might be helpful.
- I had two screwed placed and was non-weight-bearing for a week and then gradually increased the amount of weight-bearing over the next 7 weeks.
- I could slowly climb stairs as soon as the nwb phases ended. Step down on the injured leg. Step up with the healthy leg.
- My surgery took about 2.5 hours and I did not have general anaesthetic. I don't remember the surgery at all except for one moment when I looked up at the anesthesiologist and she told me I was going to have another little nap. Next thing I remember I was wide awake in the operating room and the surgeon was taking off his gown and telling me everything went well.
- I needed quite a lot of help for the first week after the surgery. More because I was bad with the crutches than because of pain. I definitely needed a shower bench and help stepping into the tub.
- I rented an ice machine, which I cycled 20 min on / 20 min off pretty much all the time for the first week.
Also, no one warned me about the possibility of shoulder tendinitis caused by the crutches, so I'll warn you. It was more painful than the knee surgery.
posted by subluxor at 11:45 AM on February 28, 2020
- I had two screwed placed and was non-weight-bearing for a week and then gradually increased the amount of weight-bearing over the next 7 weeks.
- I could slowly climb stairs as soon as the nwb phases ended. Step down on the injured leg. Step up with the healthy leg.
- My surgery took about 2.5 hours and I did not have general anaesthetic. I don't remember the surgery at all except for one moment when I looked up at the anesthesiologist and she told me I was going to have another little nap. Next thing I remember I was wide awake in the operating room and the surgeon was taking off his gown and telling me everything went well.
- I needed quite a lot of help for the first week after the surgery. More because I was bad with the crutches than because of pain. I definitely needed a shower bench and help stepping into the tub.
- I rented an ice machine, which I cycled 20 min on / 20 min off pretty much all the time for the first week.
Also, no one warned me about the possibility of shoulder tendinitis caused by the crutches, so I'll warn you. It was more painful than the knee surgery.
posted by subluxor at 11:45 AM on February 28, 2020
Broken knee here, repaired with seven screws and a steel band.
How mobile is the average patient in the first day after surgery? The next few days? When can people climb stairs?
Not very mobile. Eight weeks for me before I could put my full weight on it, and even then, that was still pretty tender. Four weeks of no weight at all, another four of being able to drag your leg around like a sack of meat. The doc predicted eight weeks, and that's what it was. There's no getting around that through will power or drugs. Stairs will be most easily done sitting on your bum, pushing up or down with your arms.
What are possible complications?
Blood clots? Pain. Unbelievable swelling. Needing lots and lots of sleep, but sleep being difficult as there's no good position to be in.
Is this usually done under general anaesthetic?
I would guess so. It was for me.
How much and what kind of assistance does the person need in the first days after surgery?
A lot. There's not a lot they can do for themselves. Moving around by themselves is possible, but it takes a lot of effort and a lot of planning of every body movement.
What has been your/a relative's/a friend's experience?
It's going to be a while, and the only way forward is to suffer through it. There are no shortcuts or workarounds. The body is going to impose its will, and what it wants is to rest.
posted by Capt. Renault at 12:38 PM on February 28, 2020
How mobile is the average patient in the first day after surgery? The next few days? When can people climb stairs?
Not very mobile. Eight weeks for me before I could put my full weight on it, and even then, that was still pretty tender. Four weeks of no weight at all, another four of being able to drag your leg around like a sack of meat. The doc predicted eight weeks, and that's what it was. There's no getting around that through will power or drugs. Stairs will be most easily done sitting on your bum, pushing up or down with your arms.
What are possible complications?
Blood clots? Pain. Unbelievable swelling. Needing lots and lots of sleep, but sleep being difficult as there's no good position to be in.
Is this usually done under general anaesthetic?
I would guess so. It was for me.
How much and what kind of assistance does the person need in the first days after surgery?
A lot. There's not a lot they can do for themselves. Moving around by themselves is possible, but it takes a lot of effort and a lot of planning of every body movement.
What has been your/a relative's/a friend's experience?
It's going to be a while, and the only way forward is to suffer through it. There are no shortcuts or workarounds. The body is going to impose its will, and what it wants is to rest.
posted by Capt. Renault at 12:38 PM on February 28, 2020
I had a screw put in to repair a broken fibula several years ago, so my experience may or may not be helpful to you and your relative.
My surgery was done under general anesthesia. It was pretty painful for the first three or so days after the surgery, and it was managed as much as possible with vicodin during that time. (TBF it was about equally painful for the three days between breaking it and the surgery.) After that, the pain was managed with ibuprofen alone, although I got maybe a week of prescription-strength ibuprofen (which is just a higher dose than the OTC version).
My recovery was:
- on crutches and off work for two weeks;
- back to work but still on crutches for four weeks after that;
- then down to one crutch for a week or so.
I had a walking cast, even before I was starting to walk on that leg at all. I was instructed to wear it at all times, excluding bathing but including sleep for the first week after surgery. After that I could take it off to sleep but was to wear it during waking hours, except for bathing. A relative had a shower chair they weren't using, which they donated and was absolutely necessary. I was able to get in and out of the shower without assistance, but YMMV.
I was fortunate that I didn't have to deal with stairs - I have none at home and elevators are readily available at work. I can only imagine how difficult it must be to navigate stairs on crutches.
Grocery shopping was the biggest thing that I needed help with from other people. And we're talking ready-to-eat or microwaveable foods; cooking (other than using the microwave) wouldn't have been feasible during that time. As for other household chores, some of them I just let slide, the things that had to be done (e.g. laundry) I somehow managed on my own, because I am Very Bad At Asking For Help, but those are things I could have used help with, and probably should have asked friends & family to help out with.
Even once I was off crutches and out of the boot and walking, it was probably 4-6 months before I felt like I was walking completely normally. Stairs were still difficult during that time; going down was harder than going up.
My orthopedic surgeon told me about 20% of patients undergoing the procedure had ongoing pain from the screw itself, and if that was the case the screw could be removed once the healing was complete. I was not among that 20% and the screw is still in my fibula.
Oh, and those first two weeks at home, besides the physical pain and managing (or skipping) household chores, the other thing that was hard to deal with was the sheer boredom. If you have recommendations for engaging shows or movies your relative hasn't seen yet, this would be the time. But it turns out no matter how good it is, I only wanted to watch so much TV in a day and found it difficult to fill the rest of my time. Come to think of it, that's probably another reason I didn't ask for more help with household chores; figuring out how to do laundry on crutches is at least a mildly interesting problem.
posted by DevilsAdvocate at 1:03 PM on February 28, 2020
My surgery was done under general anesthesia. It was pretty painful for the first three or so days after the surgery, and it was managed as much as possible with vicodin during that time. (TBF it was about equally painful for the three days between breaking it and the surgery.) After that, the pain was managed with ibuprofen alone, although I got maybe a week of prescription-strength ibuprofen (which is just a higher dose than the OTC version).
My recovery was:
- on crutches and off work for two weeks;
- back to work but still on crutches for four weeks after that;
- then down to one crutch for a week or so.
I had a walking cast, even before I was starting to walk on that leg at all. I was instructed to wear it at all times, excluding bathing but including sleep for the first week after surgery. After that I could take it off to sleep but was to wear it during waking hours, except for bathing. A relative had a shower chair they weren't using, which they donated and was absolutely necessary. I was able to get in and out of the shower without assistance, but YMMV.
I was fortunate that I didn't have to deal with stairs - I have none at home and elevators are readily available at work. I can only imagine how difficult it must be to navigate stairs on crutches.
Grocery shopping was the biggest thing that I needed help with from other people. And we're talking ready-to-eat or microwaveable foods; cooking (other than using the microwave) wouldn't have been feasible during that time. As for other household chores, some of them I just let slide, the things that had to be done (e.g. laundry) I somehow managed on my own, because I am Very Bad At Asking For Help, but those are things I could have used help with, and probably should have asked friends & family to help out with.
Even once I was off crutches and out of the boot and walking, it was probably 4-6 months before I felt like I was walking completely normally. Stairs were still difficult during that time; going down was harder than going up.
My orthopedic surgeon told me about 20% of patients undergoing the procedure had ongoing pain from the screw itself, and if that was the case the screw could be removed once the healing was complete. I was not among that 20% and the screw is still in my fibula.
Oh, and those first two weeks at home, besides the physical pain and managing (or skipping) household chores, the other thing that was hard to deal with was the sheer boredom. If you have recommendations for engaging shows or movies your relative hasn't seen yet, this would be the time. But it turns out no matter how good it is, I only wanted to watch so much TV in a day and found it difficult to fill the rest of my time. Come to think of it, that's probably another reason I didn't ask for more help with household chores; figuring out how to do laundry on crutches is at least a mildly interesting problem.
posted by DevilsAdvocate at 1:03 PM on February 28, 2020
My teenage son's experience with a fractured tibial tubercle: general anesthesia during surgery to install 2 screws. 2 days in the hospital post-surgery, completely bedridden (meaning: bedpan). Mostly wheelchair-bound for 2-3 weeks with only the tiniest amount of crutching. Needing full assistance with literally everything: getting to the bathroom, dressing, navigating from wheelchair to sofa or bed. Just...everything.
After that, several weeks of crutches only. All of that was with no weight bearing on the leg -- this can be extremely difficult and painful at first as you still have to use a lot of muscles to be able to lift your leg at all, eventually easing up to doable. Slowly transitioning to a small amount of weight bearing, going from cast to straight brace, to brace that could slowly be adjusted to bend at the knee, to that brace bending freely, to finally no brace. Finally, a second, easy surgery to remove the hardware (he walked out of the hospital for that one). It was a 10-month recovery from massive injury to walking freely. Final ongoing (and probably permanent) side effect: not being able to kneel with weight on the fixed leg.
Depending on your relative's injury and the location of the screws, they may be in a hip-to-ankle cast. If that's the case, it is very, very hard to get around. Legs in casts like that -- whether in wheelchair or on crutches -- frequently do not fit in handicapped bathroom stalls, for example. (The leg will be sticking straight out when the person is sitting.) The person can't sit in the front seat of a car. The back seat may not be long enough to accomodate their entire leg sticking straight out along the seat. The cast itself will be very heavy. Even when pain free, the person may not have the strength to lift their leg.
posted by BlahLaLa at 2:10 PM on February 28, 2020
After that, several weeks of crutches only. All of that was with no weight bearing on the leg -- this can be extremely difficult and painful at first as you still have to use a lot of muscles to be able to lift your leg at all, eventually easing up to doable. Slowly transitioning to a small amount of weight bearing, going from cast to straight brace, to brace that could slowly be adjusted to bend at the knee, to that brace bending freely, to finally no brace. Finally, a second, easy surgery to remove the hardware (he walked out of the hospital for that one). It was a 10-month recovery from massive injury to walking freely. Final ongoing (and probably permanent) side effect: not being able to kneel with weight on the fixed leg.
Depending on your relative's injury and the location of the screws, they may be in a hip-to-ankle cast. If that's the case, it is very, very hard to get around. Legs in casts like that -- whether in wheelchair or on crutches -- frequently do not fit in handicapped bathroom stalls, for example. (The leg will be sticking straight out when the person is sitting.) The person can't sit in the front seat of a car. The back seat may not be long enough to accomodate their entire leg sticking straight out along the seat. The cast itself will be very heavy. Even when pain free, the person may not have the strength to lift their leg.
posted by BlahLaLa at 2:10 PM on February 28, 2020
Yes, forgot to mention kneeling. It's been 5 years since my initial surgery, 2 years since having the screws removed, and I still can't kneel on that knee. I've mostly given up hope that I ever will. I'm getting used to being the youngest person at chair-yoga.
Also, that knee/calf/ankle are always slightly swollen. Always. A little moreso after a lot of activity, but never not swollen at all.
posted by subluxor at 2:31 PM on February 28, 2020 [1 favorite]
Also, that knee/calf/ankle are always slightly swollen. Always. A little moreso after a lot of activity, but never not swollen at all.
posted by subluxor at 2:31 PM on February 28, 2020 [1 favorite]
If crutches prove difficult, get a walker. It's a lot easier to manage and more secure for getting around the house
posted by DarkForest at 3:29 PM on February 28, 2020
posted by DarkForest at 3:29 PM on February 28, 2020
A crutch pouch is also super-helpful. Doesn't have to be as complicated as the one I linked, but just being able to carry a bottle or a phone from one place to another is a big relief.
And, will need help with laundry.
posted by Dashy at 4:14 PM on February 28, 2020
And, will need help with laundry.
posted by Dashy at 4:14 PM on February 28, 2020
I had hardware put into my tibia when I was in my early 20s. It was a huge annoyance at the time and now I rarely think of it.
The few times it does bother me, I mildly wish I’d had the screws removed when the bone had healed (no concrete reason, it just feels psychologically weird to have them) but now I think it’s probably been too long.
posted by nouvelle-personne at 5:34 PM on February 28, 2020
The few times it does bother me, I mildly wish I’d had the screws removed when the bone had healed (no concrete reason, it just feels psychologically weird to have them) but now I think it’s probably been too long.
posted by nouvelle-personne at 5:34 PM on February 28, 2020
Not a tibula, but I had a rod in a compound fractured femur, then later a plate and bolt in a broken hip. The rod was very painful during weather changes.
I fell and landed on the end of the rod sticking up out of the femur, that broke my hip.
The bolt in my hip caused my hip ball to necrose, on crutches/extreme pain for 3 years till I had it removed.
Both of these things my doc told me "would not cause any problems."
A friend who had lost use of her elbow till she had the hardware removed convinced me to get the bolt out. She was a quad, so the elbow was pretty important to getting around.
My advice to you is get the hardware removed when you no longer need it.
posted by rudd135 at 6:29 PM on February 28, 2020
I fell and landed on the end of the rod sticking up out of the femur, that broke my hip.
The bolt in my hip caused my hip ball to necrose, on crutches/extreme pain for 3 years till I had it removed.
Both of these things my doc told me "would not cause any problems."
A friend who had lost use of her elbow till she had the hardware removed convinced me to get the bolt out. She was a quad, so the elbow was pretty important to getting around.
My advice to you is get the hardware removed when you no longer need it.
posted by rudd135 at 6:29 PM on February 28, 2020
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posted by rhizome at 11:31 AM on February 28, 2020