Friday, April 20, 2012

#5 Joes Leg Break - Pictures

20th April

So today we were up at the Hospital for 2pm today for the scheduled visit where the wounds would be dressed and the bones would be xrayed to see how they were going and a general review of Joe's progress towards recovery. There was some hope on Michelles part that the big heavy plaster of paris cast might be removed and a lighter resin cast put on. At the minute the massive full length PP cast is so heavy Joe can't move around with it independently, so it's a hinderance to him and it means that one of us (Michelle) has to be off work looking after Joe. Additionally, not until Joe can walk around with ease and confidence will they let Joe go back to school and even then they're saying that initially he'd probably be better off just going in for the morning. My own thought were that there was no way they'd be taking this cast off at these early stages unless he was under general aneasthetic because the bones wouldn't have even started to knit together again.

The image here below is of the leg and the damage to the leg on the day of the accident before the operation. The consulant surgeon was saying today that the damage that was sustained was far worse than a sports accident because of the energy through the bone inflicted by a car was extremely severe and therefore far more damaging, but despite this the damage overall wasn't as bad as first suspected. The damage it seems caused to the surrounding tissue is instrumental in the repair process and again because of the nature of the accident that has to repair, so that the length of time will be longer than your usual tib/fib break.
This is the leg on the day of the crash before the operation.

This is another view of the leg on the first day before the operation

This is the leg today showing the re-allignment of the bones and the titanium pins that extend along the length of the lower leg. These pins are thin as you can see.

The nature of the pins means that the damaged leg cannot sustain any weight so this is one of the reasons while the recovery process will be longer. Joe's next appointment was initially set for two weeks time and there was the suggestion that perhaps at that stage the heavy PP cast could be replaced with one of the light weight resin casts. If that was the case it would have mean that Joe could have got around a bit with some independence and start to get around on his crutches on his own. At the minute one of us has to lift and move his leg when he gets up and moves around, he simply cannot lift the leg with the PP on his own. Through further discussion and the surgeons comittments, it then transpired that he wouldn't be able to see Joe until 3 weeks time. That's bad on one front as it means the PP cast is on for another 3 weeks, but on the other hand it's another week for it to knit together. He was saying that if the plaster is replaced after two weeks that would be done with no aneasthetic and it would cause some 'Discomfort' (Read pain), so another week surely must mean less pain and the bones knitted together better?

On first look most of you including both Michelle and I will see that in the images 'Post Op' the alignment of the bones isn't that exact which was of some concern, but apparently this is par for the course and is in part due to the damage of the surrounding tissue, but as it repairs and the calcium grows back and the tissue repairs the allignment will improve.

Now to some of the more gruesome features of the accident "The Hole".

"The Hole", This is where the leg bent so much prior to snapping that the skin split across the leg.
The image above is "The hole" where the skin split. Joes foot is to the left of the image and his knee is to the right. You can see in the image above and below the hole, where they've been able to close the hole up with stitching, at the road-side this was a massive open gash across his leg - splitting across 1/3rd of the width of the legs circumference with a deep V-shaped aspect. Think of a breast of chicken and slicing across it with sharp knife and opening it up - that's what it was like! This hole is deep 12mm - 15mm and looks at the moment like it wont heal without leaving a massive hole in his leag and at the moment I just cannot imagine skin ever growing across it, but the surgeon is pretty sure that the hole will fill naturally and that there'll be an indent and no need for plastic surgery or skin grafts. But out of all the stuff going on this is the bit that looks the most worrying.
This view shows the hole (Plugged with absorbent material) and the exit wound where the bone came through the leg (Left).

The image above shows both wounds prior to being cleaned up and having the stitches removed. The exit wound (Left) looks in very good condition and cleaned up nicely and is the least of my worries.

All of these processes where the wounds are dressed mean that the panel that normally covers the leg is removed and a lot of padding and absorbent fabrics are removed. In between each visit these obviously are clogged up with blood tissue and the removal is painful with Joe screaming "It hurts, make them stop please? Please - make them stop the pain - it hurts", with him saying that the pain gets up to 10 out of 10, but there's not a lot we can do, it has to be cleaned and part of the process is that they loosen it up using saline (Salt water) which again stings. So today the wound was opened for an extended amount of time as the surgeon picked all of the stitching out of the wounds and did a thorough cleaning, so the process was pretty traumatic and upsetting.

The good news though is that once it's done and the new padding is in place it resumes very quickly to a no pain scenario. Overall he's doing well, but the out of plaster scenario seems to be projected for a period longer than 8 weeks. In himself he's in good spirits, smiling laughing and being our Joe. He's a brave little lad!

He identified blame today during his pian... The scooter!