1,5 years after complete hip fracture

18  MONTHS  POST  OPERATIVE

 

Funny cute dog celebrating his birthday party

 

Some of you might be wondering why I was  MIA  for the last few weeks. I had major security issues with my blog and had to shut it down.

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Much has happened since I last had the pleasure.

About a month ago I felt a big push in my recovery. It really feels like pieces are falling into place. Finally.

 

I went on a pretty far away trip which involved a lot of sitting, just getting there, and once there, we walked and walked and walked. All day long. Up to 11 miles/ 18 km a day and on a “slow day” a minimum of 6 miles/ almost 10 km.

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At home I am back in my garden and can do 1-2 hours of garden work a few times a week. I try to take turns with one day garden work, the next day gym, to not stress things out too much.

I can do so many things again , it’s amazing. On an average day, I just do my things and most of the times I am pain free and not even aching. (The cortisone shot from beginning of May still seems to work too.)

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A few things are still difficult for me, like sports. That progress is reeeal  s-l-o-w.

 

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My gym status is right now:

  • Elliptical, 13 minutes/ level 1
  • stationary bike, 15 minutes/ level 1
  • treadmill – walking,  NO  incline, 20 minutes/ medium pace

 

Not spectacular but not bad for where I am coming from either.

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I tried tennis again, after having to take a 6 months break because of a frozen shoulder (also super fun!), and that would get the headline “felt great while I did it…”

 

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The aftermath was not pretty. The following night my hip and the surrounding soft tissue was deeply throbbing away and kept me awake till 5 am. Good times… Till everything had calmed down again took about five days.

I guess the pounding on cement was not ideal and my hip & the soft tissue is not used to doing “real” workouts anymore. In comparison, skiing was easier. That I did nicely already at 13 months PO.

Next time I will bury my hip under ice and take Ibuprofen afterwards. On purpose I didn’t do this last time, to “see” where my hip is at. If I numb it up with ice and a handful of Ibuprofen right away, I can’t tell how it truly feels. Makes sense?

I still have soft tissue issues in my hip, groin and thigh but it’s getting better too.

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Overall I am really happy, life has picked up again and even though sports are still quite limited, except for that, I can finally say… I feel like  ME  again!

That’s all I ever wanted.

 

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PT is getting started

6.5 weeks PO and I have my first physical therapy under my belt. Tadaa!

 

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The good news – the place makes a really good first impression on so many levels. It is the biggest and most serious looking therapy place I have ever been in, with a lot of gym equipment, many tables for patients to lay on and also lots of physical therapists.

 

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My PT is a young guy, who has a doctorate in physical therapy and really seems to know what he is doing.

He already gets a bonus point for not being creepy (I had other PT’s at other places who were), is very professional, efficient and focused.

Today I was there for almost two hours; for evaluation, measuring things like strength, range of motion, flexibility, gait ect.

He also worked on two other patients during this time but I never felt left alone. He was either with me or close by and kept an eye on me and my exercises.

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And here the bad news – my op side leg is a mess.

Whatever he measured was either almost non existent, very limited, extremely weak or very tight. Super.

 

  • Internal and external roation – limited
  • Gluteus medius – weak
  • Quads – weak
  • Hamstrings – very weak
  • Hip flexor – very tight
  • Adduction – oooookay
  • Abduction – very weak
  • TFL band – tight
  • Around the hip flexor and the incisions – adhesions and scar tissue

 

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Somehow I did not expect it to be just  THAT  bad. I guess I underestimated the whole thing a bit.

I told him I am a  v-e-r-y  slow healer and he is fine with it but urged me to put a bit more weight on my op hip/ leg, for compression of the fracture and to snap the cells who are responsible for putting down minerals and bone out of it and put things in second gear.

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I was shown seven new exercises which I have to do 1x day, 3 sets of 10 plus twice the stationary bike for five minutes. No resistance and very gentle.

The other day I tried 10 minutes in the morning, 10 in the evening and regretted it big time at night. My hip and soft tissue was angry, like a 5/10. Lesson learnt.

 

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I have now PT twice a week for about a month and then we will go down to once a week.

He said hard callus should form by PO week 12 and then bone. So I am for sure another 6 weeks on crutches, minimum. Amazing for how long I have to pay for a “slip and fall” that took less than two seconds.

 

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Nevertheless, I have a good feeling with this new PT guy and I will do it. I have already upgraded my walking speed from a sloth to a turtle. I have not gone through two tough hip surgery recoveries before to wimp out now.

 

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Getting closer! (5 weeks PO)

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Nothing super new with me. Still on crutches/ “toe touching only” and still not getting far.

I am mostly at home, trying to find a balance between resting the hip and moving, to get the circulation going. A great help in this is my fitbit which tells me how many steps I am taking. I can monitor it and adjust it for the next day. At the moment I can say, if I stay below 1,300 steps, I am probably good.

The hip still gets irritated very easily. Just a tiny bit of crutching around too much and the hip, soft tissue and where the incisions are get angry.

Ice usually helps and is still my best friend.

 

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Over the last few weeks I did  A  LOT  of research about hip fractures, fracture patterns, complications, hip pinning etc. and it feels like I read every single article on the Internet.

And  STILL, there are hardly any personal blogs about this out there. I see a lot of mentioning of hip “stress fractures” but a hairline fracture is completely different than a complete fracture.

My husband had a good point. He said “young people don’t have this kind of fracture and old people don’t write blogs”. That would summarize it.

 

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Here are some interesting facts I found out:

  • Of all hip fractures, only 2% are in young people < 50 years of age
  • Hip fractures are the most expensive to fix on a per person basis
  • A medical article called my injury the “neglected femoral neck fracture in the young adult”.
  • The femur is the strongest bone in the body. It takes approximately 4,000 newtons (~ 407 kilogramm/ 897 lbs.) to break it with a sharp, quick blow.
  • The subcapital femoral neck fracture is the most common hip fracture (in old people).   (Purple)

 

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  • The closer the fracture to the femoral head, the higher the chance of developing AVN
  • Femoral neck fractures are divided in different categories

 

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  • An impacted fracture is the opposite of an avulsion fracture
  • There is an art of doing hip pinning the right way. The screws need to go through the fracture, they have to be inserted parallel to each other; they need  to be in the femoral head but not in too far, otherwise they go through the cartilage and cause arthritis. The whole procedure takes place inside the joint and does not go through the capsule.

 

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  • Adding too much bodyweight too quickly or walking for too long, too soon can lead to stress fractures and needs to be avoided

I am trying to learn as much as I can about this.

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On youtube are several videos of the actual “hip pinning surgery”. I can not watch the whole thing in one take otherwise I am hugging the toilet. It looks quite rough but at least it explains the very high pain level I had for the first two weeks.

I don’t recommend the video to anybody with a weak stomach.

 

 

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When I was in the ER, my husband overheard people saying “there must be an underlying issue going on”. A young, healthy person simply does not fall from a standing height and end up with a hip fracture like this. Osteoporosis was mentioned  BUT  my OS said after the surgery, my bones were nice and strong. No sign of osteoporosis.

Just to be sure I will get a bone density scan once I can drive again and walk better.

 

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Next week I will have my six week follow up appointment which will be absolutely crucial! My OS will check how I am healing and look for complications.

 

There is the possibility of:

  • The blood circulation to the femoral head was interrupted and I am developing AVN
  • Malunion (the hip did not grow together as desired)
  • Nonunion (the hip did not grow together at all and there is a gap in the bone)
  • The screws have shifted
  • I am developing “too much” bone, which would end up as FAI (femoral acetabular impingement) again and then it’s just a matter of time when it shreds up the labrum  and I need another arthroscopic surgery.

 

I don’t need any of those. All I want to hear is “your bone has started healing”. I will gladly do more time on crutches but please no AVN!

How my recovery proceeds and the future of my hip depends on the verdict of next week. Either all is good or the shit has hit the fan and I am heading towards a hip replacement which would suck on several levels.

 

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Things I really miss these days are – doing my Elliptical, going for walks, cooking new Gordon Ramsay recipes and making plans for the future. At the moment dreams are on hold because I don’t know what the recovery will be like.

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I also can not believe I forgot to ask my OS  two very important questions, when I saw him last…

A)  will I make a full recovery and b) what kind of timeframe for the recovery am I looking at? I am expecting to be a slow poke healer again but at least I’d like to have a rough idea.

 

 

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1 month PO!

Finally! 1 month post operative. Another hurdle tackled.

Lots has happened in my momentary small world last week. For example, I got my operative report from the hospital. Was an interesting read.

It also stated “no complications.”

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I was lucky that day anyways, the orthopedic surgeon on call was specialized in “trauma and hip”. I could not have had a better OS than that.

This was her and her physicians assistant, “the morning after”.

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We also got the bill for my little adventure.

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Holy smokes!!!! For sure our most expensive three days ever, anywhere, but thank god the insurance paid. Three amen for that.

The bill was two pages long and listed absolutely everything. Cost of the ER, the operating room, anesthesia, all the meds I was given; the screws in my hip are over $ 4,000 and so on.

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Most of it made sense, two things didn’t.

Not sure how they ever got to $ 1,095 for PT services and over $ 300 for “occupational therapy”.

I had exactly four PT sessions. On PO day 1 I was given non weight bearing exercises to do with my legs in my bed and I sat on the edge of my bed. The whole show lasted 20 minutes.

My PT came back the same afternoon and I crutched a few minutes around in the hallway and showed her, I can manage stairs on crutches. 20 minutes.

Same the next day with the differences that my PT put me in a wheelchair to eat my lunch, left and didn’t come back. It was not very nice to sit all alone in the room, trapped in a wheel chair and you depend on peoples mercy. I had to ask for her several times to come back. Pissed me off.

And in the PT room, I almost fainted after doing the steps.

Except for that I had the same 20 minutes four times. How can that end up as $ 1,095??

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And to list the “occupational therapy” with $ 300 is a joke as well. She came in and said, she just wants to be sure I know how to dress and shower by myself. I gave the shower a go and (fainted almost again towards the end) and that was it. I showered without assistance.

(Thank god. That would have been too much for me. It was one thing to have your clothes cut off your body by two guys , to have to use a bed pan was also something I could have skipped but at least I could shower by myself!)

Her whole speech and existance in the room was five minutes.

I find it odd but I am not making a stink about it since the insurance is covering it.

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I am getting very interesting comments regarding being on crutches these days by the way.

The other day I was in the supermarket. I was asked what happened and answered  “I broke my hip”. The first lady asked “if I am in a cast” (how do you put a hip in a cast???) and the second said “did you at least have fun doing it? “ People are weird.

Being on crutches gets two reactions, either people are super kind and help you out with doors ect  OR  they make weird statements. Not a whole lot in between. I am sure I have more comments coming my way as I progress in my recovery, but I have gotten the alien look a bunch of times already when the hip fracture came up.

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Talking about crutches… my mobil legs arrived!

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They are much better for the arm pits but the shock absorbers took a bit of getting used to. They are louder than regular crutches, pretty light but I found the grips very hard on the hands. Not sure why the reviews said, “there is no more fatigue and one can crutch on them forever”. Not me. Crutching is tiring and I am in good shape.

I put my crutcheze pads on the handles  PLUS  got special weightlifters gloves. They have build in cushioning and it helps too.

The gloves are comfortable but made me laugh.

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To me they look like gorilla palms…don’t they?

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The instructions for the crutches were awesome too. Quote “Walk as naturally with them as you can”. Hm, last time I checked there was nothing “natural” about it when you are toe touching!

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My op side thigh keeps shrinking away, atrophy starts on day 11 according to my OS. It’s scary to see it getting skinnier and skinnier every week. Will take me many months to build up again.

I remember this from my last hip surgery rehab. “For every week you are on crutches, your body needs six weeks to build up muscle mass again.” (Fun little spring and summer project right here…)

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Pain wise I am doing pretty good. It’s around 2/10 during the day, the hip  WILL  start throbbing quickly though if I do too much and end up like a 4/10.

Nights are mixed. Not really bad but some nights I can’t find comfortable positions for my op leg or I am aching. I can sleep on my back, my left side is okay, tummy feels great but the right is not there yet.

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Taking a shower is still an achievement. Not so easy if you are toe touching only and have to balance on wet tiles. The shower bench helps out tremendously even though it looks a bit different than this scene…

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…it’s more a matter of “fifty shades of purple”, looking at my op side foot. During the day I rest and ankle pump away or crutch around for keeping the circulation going but in the shower that foot looks creepy.

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People keep asking my why I even went skiing after two hip surgeries and want to know if I will go skiing again.

I went skiing already 10 months after hip surgery and had a great time. The endurance was still not there but I skied!

And yes, I have full intentions of going again. Why not? I live for winter,  love to zip through the powdery snow and feel the cold, fresh air on my cheeks. This is freedom and happiness to me.

I took this picture last year in Colorado. How can this not look perfect?

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Of course it is “safer” not to, but I am not the slave of my hip. I will do whatever it takes to get strong and healthy again and then, I am back on the slopes.

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To finish up, I want to quote an orthopedic surgeon, talking about recovering from hip fractures and why recovery can be challenging.

“It takes a vast amount of energy for a young person to break normal, healthy bone – some estimate as much as 1,700 pounds per square inch or more – compared with the significantly lesser amount of energy required to fracture osteoporotic bones.

The direction that the energy takes as it enters and exits the bone, as well the position of the limb when the trauma occurs, results in the fracture pattern and the type and severity of the fraction.

Despite the fracture patterns sometimes appearing the same in healthy, strong bone versus osteoporotic bone, it’s a very different injury because the energy and trauma needed to break healthy bone is much greater.

The increased energy also imparts significant injury to soft tissues that surround the bone and result in tissue tearing and bleeding.

When I care for a patient with a fractured hip, young or old, I always explain that the recovery is often more difficult than it is for someone who undergoes elective hip or knee surgery or replacement. This is due to the greater damage to the soft tissue and bone in a trauma patient compared with the elective hip or knee patient.

While the hip fracture patient is an energency, the elective patient can be optimized both mentally and physically prior to surgery.

Also, the patient with a broken hip often has a more difficult rehabilitation after surgery. The broken bones and injured tissues must heal and frequently the fracture pattern dictates that the patient delay full weight bearing on the injured lower extremity.”

Just some food for thought from a surgeons perspective.

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