EC

[Whyte Noise]

What is the name of your state? Missouri

Not really a med-mal question, but as this is the board you frequent, I thought I'd post here.

What can you tell me about transverse humerus fractures? I have surgery Friday morning for placement of screws and plates inserted into the bone to facilitate healing. Currently, I'm in a splint that's not really doing anything but stabilizing the arm to keep it from just hanging down. I'm terrified of anesthesia, and agreed to go this route first before deciding on the surgery for sure.

The break just happened yesterday, about 2 PM. Finally got seen by the ortho and was splinted at 6 PM. It was very obvious that it was broken even though it was a closed fracture. Grapefruit sized knot on my upper arm, and it just dangling there.... hanging out.

It's obvious that the splint isn't going to work though. Any upper body movement that requires the slightest use of that bone (and I never realized that it was used so much!) is agonizing. The ortho called it 'floating' I believe. If I bend over, the bones shift forward and scrape against one another, if I turn my upper body to look in a certain direction, the same result. I can't sit in any chair with arms on it because if I try to, my arm gets 'crowded' and I have to move it. Sitting down or getting up makes the bones shift. I can't lie down at all, too painful. I'm wrapped from my shoulder to my fingers with this plaster splint (no, not a cast), and ace bandages, but my fingers and hand are swollen so badly that I can't even make a fist. I can barely touch my index fingertip to my thumb tip.

I was told that the procedure itself takes between 1 and 1 1/2 hours. How long is post-op recovery room time usually?

Like I said, I'm terrified of anesthesia. I don't relish the idea of being 'put to sleep' like an animal. I know, it's not the same, but the thought still scares me. I also have other health issues that make me wary of anesthesia as well, and I'll inform the anesthesiologist about those. What types of anesthesia do they normally use for this type of procedure? Is there a post-op hospital stay involved with this, or is it an 'in-and-out' type of thing?

Yup, I'm a 37 YO woman with her first ever broken bone, and I'm scared sh*tless about the surgery. Guess I'm looking for some reassurance and guidance from someone that knows what's going to go on. The surgeon wasn't in his office today, and the woman I spoke with wasn't very forthcoming with information other than how long the procedure will take. I have been up since 6:30 AM Tuesday morning. Like I said, I can't lie down because the bones shift and it's too painful (even after 2 500mg Vicodin), and I'm not one of those people that can sleep sitting up. Never have been. Even if I were, I don't hink my steel straight-backed armless computer chair would afford the most comfortable accommodations! lol

Any info you could give me would be appreciated EC.

[ellencee]

MG
You must have one heck of a tolerance for pain! How in the world are you functional enough to type?

What can you tell me about transverse humerus fractures?

--Usually caused by falling, landing on open hand in an effort to stop fall. Transverse fracture means it broke the bone 'half-in-two', the break is at a 90 degree angle to the length of the bone.

Other than a swathe and splint, one method of treatment is with a hanging cast, for its weight to correct the displaced fractures. It is important that the hanging cast never be propped or supported and you have to sleep in an upright position to keep the cast 'hanging'--and, you have to do pendulum swing arm exercises to prevent frozen shoulder complications and finger exercises to keep the hand and fingers flexible and usable.

I don't have your x-rays or any data to review, but if you are afraid of anesthesia and you would prefer not to have any hardware installed into your bone, ask your ortho about a hanging cast. Be aware that a hanging cast will greatly impact your life, your activities of daily living, your sleeping, your just about everything--but, it is a worthwhile option.

Open reduction, internal fixation (ORIF) is the surgical fixation of the bone with plates and screws or whatever hardware is required. Sometimes the hardware is permanent; sometimes it is removed after a year or so. One thing worth mentioning is that if you have the hardware placed, you will no longer be able to have MRIs and will have to have CT scans only. You may experience some discomfort in the bone later on, like during cold weather or if your body makes excess calcium deposits around the hardware. Generally speaking, most people have few (if any) real problem(s) from ORIF procedures.

I can't sit in any chair with arms on it because if I try to, my arm gets 'crowded' and I have to move it. Sitting down or getting up makes the bones shift. I can't lie down at all, too painful. I'm wrapped from my shoulder to my fingers with this plaster splint (no, not a cast), and ace bandages, but my fingers and hand are swollen so badly that I can't even make a fist. I can barely touch my index fingertip to my thumb tip.

Follow the procedure above for managing a hanging cast. Do not allow your arm to be propped or supported (as on the arm of a chair) and sleep sitting up with your arm hanging down. Do not attempt to do pendulum swings for your shoulder. Do exercise your fingers to keep the circulation moving. Most people tend to hold their fingers very still and this causes increased swelling in the fingers.

These instructions are for now and after you have the ORIF:

Do not drink milk, eat cheese or yogurt, or take any vitamins or supplements. With a broken bone, calcium is released from the bone into the circulating blood. Calcium effects heart muscle tone and action and too much circulating calcium is a dangerous thing.

If you have any of these symptoms, call your ortho at once or go directly to the ER as these symptoms could indicate an embolus from either fat released from the broken bone, a bone fragment in the blood, or a blood clot: painful breathing, whether on inspiration or expiration; any bloody sputum; rapid breathing; mental confusion, restlessness or irritability (above normal ); elevated temperature; small spots of bruising (petechiae) on or in your mouth or lips, the back side of your upper arms near the arm pit, chest, or in or around your eyes.

Like I said, I'm terrified of anesthesia. I don't relish the idea of being 'put to sleep' like an animal. I know, it's not the same, but the thought still scares me. I also have other health issues that make me wary of anesthesia as well, and I'll inform the anesthesiologist about those. What types of anesthesia do they normally use for this type of procedure? Is there a post-op hospital stay involved with this, or is it an 'in-and-out' type of thing?

I have a healthy respect for anesthesia and a healthy respect for the management of patients under anesthesia. Although you will be induced into a deep sleep, your breathing and your heart function will be safely guarded and protected. I have no idea what type of anesthesia will be used, but it will be only enough to induce the level of sleep necessary for the procedure. Be sure to tell the anesthesist if you take or have recently taken any vitamins, herbal supplements, medications whether OTC or by prescription, and any recreational drugs like alcohol, tobacco, or whatever. Be sure to tell the anesthesist about any and all allergic reactions you have had, even to soaps or plants, not just to medications. Most anesthesia agents are relatively compatible with just about anything, but as you are afraid of anesthesia, be sure to go into detail so you can go into the OR with confidence.

Usually surgeries last exactly how long you are told they will. If they told you an hour and a half, that's about how long the surgery itself will take. You may go to the OR holding area for up to 45 minutes prior to the surgery and then to the recovery room for a time equal to the time of the surgery, sometimes less, sometimes more. Most people never remember the holding area before surgery or the recovery room. Anesthesia produces an amnesia for events immediately prior to and after surgery.

I would hope there is a hospital stay associated with this. Primarily, you need to be monitored for any known complications of orthopedic surgery. You also need to have adequate management of your pain.

Between now and Friday, if your pain is not being managed by Vicodin, please do not hesitate to request or demand if necessary a different medication for pain relief. I would have expected for you to be receiving Demerol and Phenergan for the pain and not Vicodin.

After surgery, take your pain medication before you get into pain. Once you allow the pain medication to wear off and the onset of pain to develop, it is most difficult to gain relief from the pain.

Drink plenty of fluids from now until you go NPO for surgery and as soon as you can after surgery, keep drinking those fluids. It helps with management of pain, with reducing inflammation, and speeds the healing process.

I hope you have someone to take care of you and help you with the children and everything that goes along with managing a household and life in general!

When you are able, let us know how you are doing!

EC

[Whyte Noise]

No EC, I don't have a high pain tolerance at all! I'm typing one handed. lol Takes me a while to say what I wanna say.

I slipped on ice and fell.... that's what broke it. I heard the 'snap' when I landed, so I knew immediately spmething was broken, but didn't know what until I went to lift myself up, looked down, and saw my arm hanging there lifeless and couldn't 'feel' it.

Yes, the bone is broken clean in two, across the bone. I'm no radiologist, but the 2 x-ray films that were taken didn't need an education to read. lol This link shows pretty much how it looked:

[url]http://www.gentili.net/image1.asp?ID=165&imgid=humerusmidshaftfxapx1600.jpg&Fx=Humeral+Shaft+Fracture[/url]

except that mine is more of the 90 degree angle type. The top of the bone on mine is pointed more to the outside of my arm, and the bottom more towards my body. It's not a break where the bone pretty much stayed in place after impact and just shows up as a line straight across. oh no.... I had to do it up good.... lol

If a hanging cast is anything like what I've had for the past 30 hours or so.... no thanks. I'd rather go through the surgery and get the bone repared and get rid of this pain and bone shifting going on. The pain really isn't too bad.... until I move wrong and the bones shift in there. Otherwise, it's just a dull, aching pain in my shoulder area, the site of the Fx, and my elbow. It's actually not bad to deal with 'normally'. I just have to be very careful how I move because if I'm not, I pay for it.

Another thing I didn't even think about asking in my previous post.... will they do this if I'm sick? I'm coming down with a cold... sniffling, sneezing, coughing, stuffy nose.... this won't impact the surgery date, will it? I hope not, because as scared as I am of going under anesthesia, I'm even more scared of having to tolerate this arm in the condition it's in for now and possibly have to have it rebroken to insert the plates and screws at a later date. Now I wish I hadn't been so damn adamant about trying a non-invasive technique first, before agreeing to the surgery. He could have done it yesterday afternoon.... but noooooo... my chicken butt just had to try and postpone it....

The Vicodin is doing it's job, I guess.... until I move that arm and the bones shift. Otherwise, it's just that dull, achy pain. Demoral doesn't do much of anything for me except make my head feel like I just got done smoking pot or something. The pain level isn't affected though. Instead of just hurting, I'd be hurting and feel high. lol When I had a gall bladder episode back in 2001, they gave me Demoral thru my IV. They piggybacked 2 bags into my arm... and I was high as a kite, but still hurting so bad I was in tears.

I just got about 2 hours sleep... by sitting on my bed and leaning back on about 7 pillows... where I was in a sitting/semi reclined position. I apparently turned wrong while I was asleep, because a sharp throbbing pain in my shoulder is what woke me up. It then took me 30 minutes to manuever myself out of bed. I'd move a bit, the bones would shift, I'd have to manipulate them around manually to where they weren't touching and hurting so bad... then move a little more, manipulate the bones again... lather, rinse, repeat.

I actually WANT that surgery now. This is excruciating at times. And I do have a friend that's coming to stay for a few days to help out my fiance' around here. I'm going to be out of work at the restaurant for a few months, but I still have to run this motel and take care of my house and kids in the meantime.

Why couldn'y I get a broken arm when most people do... when they were kids and didn't have to worry about 'adult' life?? lol


Thanks EC

[ellencee]

MG
The cold shouldn't be a problem for the surgery. Just be sure and get approval from the surgeon before taking anything for the cold.

I agree with your choice of treatment. I'd have the surgery, too. I don't think I could deal with the hanging cast and the sleeping upright for weeks and weeks.

Be a good patient and if they give you any trouble, tell 'em you have a friend that's a legal nurse consultant and you'll be telling her everything! LOL (that should get you dismissed as soon as you wake up from anesthesia!)

Take care and when you can, let us know how you are,
EC

[Whyte Noise]

Just came from pre-op bloodwork and all...

Surgery is still on. He gave me a prescription for Zithromax to take.

It's a one day deal EC, and I will be released tomorrow after I'm out of recovery. If I'm not able to post because of medication, I'll have my friend that's staying over the weekend or one of the girls from our other board post to you. (LMSP, VeronicaGia, kidoday, Grace, etc.)

[ellencee]

I'll be thinking of you and keeping you in my prayers.
All of the posters that you mentioned have my private email address, so they can email me directly and keep me posted.
You should have my private email address...check and see...
EC

EC,
I just about fell out of my chair when I read your statement regarding MRI and CT scan. Are you saying if someone has metal parts in their body an MRI would not be appropriate?

The reason I ask is because I've had 2 knee replacements and heart by-pass (I think all that chicken wire is still in their) and have since had 2 MRI's on both shoulders for torn rotator cuffs. Before the MRI's, I do recall being asked to remove all jewelry but no one ever asked me about possible metal parts inside my body.

I tolerated the MRI's fine with no problems. That was in July, 2002. I guess my question is should I, in the future, make it a point to mention the metal inside my body? Again, to the best of my knowledge, I suffered no ill effects from the 2002 MRI.

Been away for awhile so a belated Happy Holiday to you and MR. B.

[ellencee]

dadrummer
You mean no one asked you if you had any metal parts before you received an MRI?!

There are some medical hardware devices that are not affected by magnets and some that are. Persons with any appliance or medical hardware that is affected by magnets should not have an MRI.

Always make sure you reveal any dental hardware or orthopedic hardware or such to any MRI facility/staff.

Belated happy holidays to you and the Mrs., too!

Glad to know you're back..
EC

[pele]

Just checked with my boss, the total knee replacements are stainless steel and cemented with "pegs", he said, yes you can do an MRI. Still, you should notify, if not asked, about any metal in your body. You should have been asked at the time the MRI appointment was made if you had an metal in your body, in fact there is a check list the nurse should go over with you when scheduling the MRI. I had an MRI of my shoulder. I still have a wire in my jaw from a mandibular osteotomy in 1986, dentist said, no problem, it had been in the bone a long time, the screws in my jaw are titanium.

Anybody know what type "wire" is used to close the rib cage in open heart surgery? Also, on one of my knees a upper tibial osteotomy was previously performed, prior to the replacement. To the best of my knowledge that metal part (rod?) is still in my leg. Any ideas what type metal that may be?

Wanna hear something odd? Some airport metal detectors set off the warning bells and whistles when I walk through, others do not. Scary, huh.

[ellencee]

dadrummer
How about courthouse entry scanners? Do the police run towards you with guns drawn?!

Seriously, though--if some airport security scanners alarm when you pass through, it would be wise to contact the appropriate surgical practice or your insurance company and find out what type of metals are in your body. An MRI can be injurous to those with metal parts that are attracted to magnets.

EC

EC-
I think it might be the cuffs that sets off the courthouse scanners when I walk through!

I'm glad I ran across this post regarding MRI's and metal. I'll be sure to check with whomever to find out what metals are holding this old bod together.

I'm sure glad duct tape doesn't mess with these machines!! Or does it?? Never mind, I don't want to know!

[pele]

I think the best person to check with about any metal in your body is your surgeon. For instance, I knew I had 7 titanium screws in my jaw, I did not know, or remember the wire. Good thing I checked with the surgeon, even though it was okay, it's something I did not know. Perhaps you can get an op report, that would be the best thing. I've never set off any alarms, although I have heard that the screening machines at the White House are more sensitive, but this was before 9/11. Just be an informed patient, that's the best thing you can do. Always ask questions, and more importantly, keep asking until you the answer. If you ever worked with any type of metal, then they should do xrays of your orbits, to make sure there is no metal in or around your eyes, or eye sockets, before the MRI.

[pele]

Here is something I found on the internet, it may not be the type of implant you have but it is interesting.


There are more than 150 knee replacement designs on the market today. Several manufacturers make knee implants. The brand and design used by your doctor or hospital depends on many factors, including your needs (based on your age, weight, activity level and health), the doctor’s experience and familiarity with the device, and the cost and performance record of the implant. You may wish to discuss these issues with your doctor.

Implant Construction

The metal parts of the implant are made of titanium- or cobalt/chromium-based alloys. The plastic parts are made of ultrahigh-density polyethylene. All together, the components weigh between 15 and 20 ounces, depending on the size selected. The construction materials used must meet several criteria:

They must be biocompatible; that is, they can function in the body without creating either a local or a systemic rejection response.

pele**************thanks for the info