Wednesday, 7 November 2012

Frame removed!

So, the reason for the lack of updates since August is simply that not much has happened! Until this week on Wednesday, when the metal frame was taken off my leg. Basically the last 2 months we've been reasonably sure the bone was healed enough but erring well on the side of caution.

Last time I posted, I had just relocked the struts because after they were unlocked I started to notice a bit of a bend again in my leg using the position of my foot on the ground. In September I got a badly sprained ankle after one of my friends picked me up and dropped me on it! We had just won a game of pool by 7 balls, but still! So I had to take the weight off my left leg for a little while after that. However, I used that as the opportunity to unlock the struts again, and gradually ease back to weight-bearing as my swollen ankle got better.

No frame, no cast! November 7, 2012.
After a while my ankle returned to 'normal' and that's been the situation for the last 2 months. Last month my consultant sent me for a CT scan, and if the results of that looked OK, he would book me in for the frame removal. I had the CT scan on October 26, and sure enough, it looked healed enough now to take the frame off. We had a bit of an email conversation about dates and about anaesthetic. I think the default must be to have a general anaesthetic for this sort of thing, but I was a bit surprised because last time (December 2010) he just unscrewed it out of my leg while I was awake and with no anaesthetic. I asked him about it and he said that if I wanted to I could have it without the GA, so I said that was what I wanted because firstly the GA makes you (me, at least) feel awful for a day after, and secondly because I wanted to see what was going on! I also had a 9am lecture on the Thursday morning and a pretty busy day at work, so I didn't want to be groggy or feeling unwell for that. He said it was no problem.

Wednesday November 7 is therefore one of the red letter days in the story of my leg. I went in at 11am and was gowned up and pre-opped as usual for an operation. At about 1330 I saw the consultant and he asked me if I still wanted to do it without the anaesthetic. I said yes and he said they'd give me something to bite down on. I asked if that was a joke and he said no it wasn't :) OK, I thought, a bit of pain never hurt anyone!

In hindsight I probably could've got away with taking my phone in and getting some pictures, but I didn't know beforehand exactly where I was going or what was going to happen, so I left my phone in the locker room. So I'm afraid there are no pictures, but for some of you that will probably be a good thing! It is a shame, but then I guess it's only me who knows exactly what happened and it is my leg after all. I will however try to describe the procedure now - the squeamish scroll down a few paragraphs, until SAFE!

The procedure took place in the kind of ante-room where usually you get anaesthetised. I suspect this was because they were about to do a bigger more serious op in the theatre, and mine would only take 10 minutes, but I don't know for sure. Anyway, I got hooked up to the blood pressure and pulse monitor while the consultant sorted out his tools - he asked the theatre nurse to bring him pliers, wire-cutters, spanners and the T-handle, which is basically an adjustable spanner with a handle for turning the pins. Cool! Everything was ready, gloves on, begin. First, a good clean of everything, makes sense - don't want to get an infection in a hole that goes right through my bone. Next on to the frame removal proper.
Frame, for reference. 10 points where metal enters my leg.
Referring to a picture of my leg with the frame on, here goes. There are 4 bigger pins which are right through the tibia - two near my knee and two near my ankle. Then there are 3 wires which stabilise the frame - these run right through my leg and out the other side. There are 2 near my knee and one near my ankle. He began by unscrewing the pins from the frame. Of course these guys have done this loads of times, and in hindsight it makes sense, but at the time I thought that was a strange place to begin. Anyway, once those pins were disconnected from the frame, he  unscrewed the top nuts that fix the wires in place. Until this point I didn't know for sure that these wires went right through my leg, but you could twizzle one end and the other end moved! Of course, the ends are bent up and bolted to the frame, so when they put these on they must be straight and bent afterwards. How to get them off then? Wire-cutters. Carefully cut the wire on one side, then pull through from the other. That felt very odd, sort of a feeling you've not felt before, maybe as if a wire was pulled right through your leg quite quickly! So far so good. Same procedure for the next wire down. OK that's 4 out of 10 holes with no real problem. The work so far was being done by another consultant I've met before but who is not 'my' consultant, but now my consultant came in and joined the fun. That made me a bit happier because I've grown to like and trust him. He looked after the wire near my ankle. Strangely I didn't feel anything at all when that one was pulled through, says something about my nerves down there I suppose.

Now for the big pins. Of course, I knew these would be worse. The bottom two near my ankle were unscrewed by my consultant by hand, not much resistance, maybe they were quite loose after 7 months - that would explain why the bottom of the frame moved about so much in the last few months. A bit of  a strange sensation but not much feeling in that part of my leg anyway. The top two pins, near my knee: completely different story. I could tell when he was fastening on the T-handle that this was not going to be pleasant. The first one to go was the one closest to my knee. Wow that hurt! But it came out quite easily once the handle was attached. Quite strange to think that a hand on that handle is connected directly to the inside of my tibia, twisting a piece of metal out of my bone. The last pin was far and away the worst. Maybe they knew this and saved it until last. Serious breath control needed, was offered gas and air but I don't like that either - it's like being completely and utterly out of control of your body - awful - so I gritted my teeth for the two minutes or so it took to twist it out. Tried to think about what I'd be doing at work tomorrow, didn't work - what was that thing on the ceiling - almost worked. In truth, it was very difficult to disconnect it, something I've become pretty good at. Just too much I guess. Again it was a kind of indescribable pain, something you're not supposed to feel. The sight of this guy doing it too made me think that this was what it must be like being tortured, but it wasn't torture, it was a necessary thing to get through to get the frame off so I could ride my bike again. Focus. The nurse tried to distract me a bit by asking a question about something - I can't even remember - and then someone said something about tea and toast afterwards which I just managed to reply to - that I'd be getting a beer instead. My consultant agreed that would be better. I told you I liked him.

Then it was done. A big sigh of relief. a bit of a giggle (endorphins). "Easy."

The frame itself wouldn't come off my leg until all the pins were removed - they tried to get it over the two top pins but it wouldn't go, even after a bit of wrenching. This raises questions about how they fit it in the first place. I think that they must put the pins in after the frame is slid up your leg - otherwise I can't see how they could do it. I must remember to ask next time about that. It'd be amazing if they had a video of my op from March, but I guess they're fairly common (~3/year I think for my consultant) so they probably wouldn't have bothered. After it was removed, and during the removal in fact, it was clear that my leg was not moving at all (in a way that it shouldn't) and that the bone had completely calcified, as the CT scan probably showed. I was happy to see that, though.

Dressings were applied - little Mepores to the pin sites (now holes), a soft bandage then a crepe bandage to hold it all together. 

SAFE: The squeamish come back now :)

I have to leave it covered up in the bandages for two days, then inspect. Hopefully that's enough time for the wounds to have scabbed over, then I can just leave them open to the air. Otherwise, I might have to dress them up again, or if any are weeping I might need to go to the doctor and get some antibiotics. Still, been through all that before so no problem.

I was shown back to the bay where I had a sit down. I quickly got up and crutched to the locker to get my clothes back on, and pick up my bag. Back at the bay I did some texting (Mum, Rebecca, Alison) and the nurse made me a cup of coffee. I didn't see my consultant again, no doubt he was busy starting another procedure in another theatre, but later on I sent him an email saying thank you. I have to go back on November 28 for an X-ray and check up. What a life the orthopaedic surgeons have - any surgeon for that matter. Before this accident I could never have considered becoming one - too squeamish or something - now, I can totally imagine being able to do it.

I thought it would be difficult psychologically to put weight back through it, after the frame had gone. Actually though it was easy. I guess you just know somehow when things are fixed. By the evening I was back one crutching around the house, going up and down stairs etc.. Maybe I was right a couple of months ago, the corner has been turned. Fingers crossed.

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