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Screw Removal for Lisfranc/Multiple Fractures

Discussion in 'Ask your questions here' started by Andrea, Jan 21, 2011.

  1. Andrea

    Andrea Guest


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    First, I will preface with I am not seeking medical advice, but rather a general idea of what to expect in a postoperative situation to be described below. I am a former nurse, disabled on the job in an unrelated incident.

    In Sept 2010, I sustained a Lisfranc injury to my right foot which included 7 fractures (1st, 2nd, and 3rd metatarsals were displaced, Lisfranc avulsion fx from 1st metatarsal as well as 3 cuneiform fx's). In early October, I underwent ORIF (3 screws through 1st, 2nd, and 3rd metatarsals and K-wire for 4th and 5th) and remained NWB for 2 months progression to partial weightbearing in the past 6 weeks. K-wire was removed from 4th/5th metatarsal in Nov in the office. My saving grace, according to my surgeon, is I have a really high arch, thus pushing back fusion indefinitely.

    It is the ortho's assertion that we have reached a point where the screws are impeding progress and he wants to schedule removal for a month from now.

    I had a ridiculously complex recovery period for the ORIF due to pre-existing DJD/DDD, compartment syndrome, and inadequate pain control. I am less concerned with pain control this time as my pain mgmt doc has started me on morphine tid with Norco for breakthrough for my djd/ddd.

    I am not asking for medical advice, per say, but rather just a general idea based on your experience. Getting a general idea would be wonderful so I may sort of prepare myself and my household. I am a mother with 3 young boys and husband who has a 12-hour workday. Would be good to plan for help should I need it. I saw my surgeon yesterday and quite honestly did not even think to ask these basic questions: Does this require immobilization in a cast postop? Do patient's typically resume weight-bearing soon after?

    Thank you in advance for your insight.
     
  2. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***************************************************
    I cannot speak to how easy or difficult the approach to the hardware might be in your individual case, but typical uncomplicated screw removals should generally not create much in the way of post-operative disability or pain, although pain is always an very subjective and individual matter. I cannot understand the need for morphine, especially along with hydrocodone, even if you have chronic degenerative disc and joint disease. I do not know what your doctor's protocol might be, but I hardly think that a cast will be necessary. Check with your surgeon about weight-bearing. I am puzzled that someone with nursing training did not think to ask her surgeon such basic questions.
     
  3. andrea

    andrea Guest

    Well, considering I had a very active 4-year-old boy with me at the time, had driven 50 miles one way, waited for over an hour and I am clearly dealing with significant pain issues aside from the foot injury outside of you depth of knowledge, it is quite easy to understand how a question could be forgotten. Though I do always appreciate a doctor questioning another's protocol, despite it being quite unethical, as well as questioning the need for my med regimen. I suppose were you my neurosurgeon, my orthopedic surgeon, or my pain managment doctor you would fully understand the need for said regimen.

    I do appreciate your time to answer my question. Enjoy your weekend.
     
  4. FootDoc

    FootDoc New Member

    My, my . . What a passive aggressive response, tinged with condescension. Going to talk to one's doctor about impending surgery and failing to ask if there will be a cast applied and if weight-bearing will be permitted is a dramatic failure on YOUR part. Don't blame your child or your discomfort for that failure and then not even have the good sense to call the doctor back when you had the chance. In addition, sounds to me that, especially as someone with nursing training, you are overly sensitive to the suggestion that you might be taking too strong a narcotic regimen. I wonder why that might be??

    By the way, there is NOTHING unethical about a doctor questioning another doctor's regimen. Conversely, it is often the basis of good medicine.
     
    Last edited: Jan 22, 2011
  5. Unregistered

    Unregistered Guest

    Wow, you are a real jerk. She just wanted some advice and you insulted her. Your an arrogant human being and I really hope you are not actually a physician. If you are I feel terrible for your patients. No physician should insult someone worried about their health with an understandable and reasonable question.
     
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