Surgical Fracture Repair

WHAT YOU SHOULD KNOW

Risks

IF YOU'RE HEADING FOR THE HOSPITAL...

• You'll probably need to stop taking aspirin and ibuprofen; the doctor will let you know.
• You may need to have blood drawn for tests.
• You may be given a pill to help you sleep.
• Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.
• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
• Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The doctor will check this picture of your lungs and heart to make sure they can handle the stress of surgery.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• Anesthesia: You'll need a painkiller during the operation. For this type of surgery, the following options are available:
• General Anesthesia: This alternative puts you completely to sleep throughout the operation. The anesthetic is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.
• Intravenous Regional Anesthesia: This approach leaves you awake. A pressure cuff is first put on the limb, then painkillers are given through an IV. The cuff keeps the medication from spreading throughout the body.
• Spinal Anesthesia: If you're having leg surgery, you may be a candidate for this type of anesthesia, which involves a pain-killing injection in the spine. You will be awake during surgery but will be numb below the waist. Feeling will return in about 2 hours.
• Epidural Anesthesia: Also useful for leg surgery, this method employs a tiny tube positioned near the spine, allowing administration of additional medication during the operation. You will be awake during surgery but will be numb below the waist. Feeling will return to your legs when the anesthesia wears off.

During Surgery

After Surgery:

• Oxygen: After the operation, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
• Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Incentive Spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Drains: Thin rubber tubes may be put into the area around your incision to drain off excess fluid. They will be taken out when no longer needed.
• Ice: For pain or swelling, you may put ice in a plastic bag, cover it with a towel, and place it over the incision for 15 to 20 minutes out of every hour as long as necessary. Do not sleep on the ice pack. Treatment with ice is most effective when started right after the operation and used for 24 to 48 hours.
• Heat: After the first 24 to 48 hours you may use heat for pain or swelling. Apply a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the operation and helps it heal faster.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Bandage or Cast: You will need a bandage, sling, splint, or cast to protect the bone while it heals. If the protection is too tight, it can hinder circulation. Tell your doctor if your fingers or toes become swollen, cold, numb, or blue.
• Medicines:
• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Stool Softeners: To reduce the need to strain, and help prevent constipation---you may be given one of these medications for a while after the operation.
• Blood Thinners: Especially after leg surgery, blood clots can pose a danger of stroke or even death. These medications keep clots from forming. They may first be given in your IV, later as a shot or a pill. They increase your chances of bruising or bleeding, so you need to be careful. To prevent bleeding gums, use a soft toothbrush while taking these drugs.
• Activity: You may need to rest in bed for a while. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• To help ease pain and swelling, rest the broken limb on a pillow.
• If you have a cast, be sure to keep it dry. Before bathing, cover the cast with 2 plastic trash bags, taping them to your skin above the cast. Keep the casted limb out of the water in case the bag leaks.
• If you've had leg surgery, you'll need to use crutches, a cane, or a walker while the fracture heals. Ask your doctor or nurse for instructions, or check the entry for "Crutches" in this book.
• Eat healthy meals from all 5 food groups: fruits, vegetables, breads, dairy products, and meat. This will increase your energy level and promote faster healing.
• Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• Slowly start to do more each day, resting as needed. Once you feel stronger, ask your doctor for a regular exercise program. Exercise makes the heart stronger, lowers blood pressure, and keeps you healthy. Do check with your doctor first, however, before starting any exercise; and don't lift anything heavy until your doctor says it's OK.

Call Your Doctor If...

• Your incision is swollen and red, or you see any pus. These are signs of infection.
• Your stitches or staples come apart.
• Your bandage or cast becomes soaked with blood.
• Your bandage or cast feels tighter and your fingers or toes seem more swollen.
• Your fingers or toes look pale or blue, and feel numb or tingly.
• Your cast breaks.
• You are running a high temperature.

Seek Care Immediately If...

• You develop chest pain or have sudden trouble breathing.