Question

J.R., age 17, has a compound fracture of the femur and is undergoing surgical repair. The day after surgery J.R.’s toes are numb and cold.

1. Explain the possible cause of the cold, numb toes.

2. Explain why appropriate excercise is important during healing of the fracture.

3. List four factor that would promote healing of this fracture.

4. Explain why the leg should be elevated during recovery.

5. Explain why, following the removal of the cast , J.R. can expect to feel some weakness and stiffness in the leg.

Answer 1

1. Incision Numbness. The area immediately around an incision is often numb after surgery and may continue to be numb for several months after surgery. This is caused by the nerves that run through the surgical site being damaged, and the sensation often returns in the months following surgery.

   Causes of Numbness

   Numbness can be present for multiple reasons. Anesthesia causes numbness intentionally and can cause numbness that lasts for hours or days.

   Being still on the surgical table for an extended period of time can cause numbness, the longer the procedure the higher the risk for this type of problem. If you have ever had your leg “fall asleep” after sitting too long, you are familiar with this issue. The difference is that if your leg falls asleep during surgery, you aren’t awake to reposition yourself. To help prevent this, most operating rooms have padded tables where the surgery is performed.

   An injury that cuts a nerve can also lead to numbness in the area where that nerve works. For example, a severe cut on the lower leg could potentially cut through nerves, and the area below the cut nerve could have areas of numbness.

   It is possible for a nerve to be cut during surgery, and this may be unavoidable during the procedure. Surgeons who work on the face are particularly aware of the potential for nerve damage, as even a slight amount of nerve damage could result in an inability to smile, feel areas of the face, and can even cause issues with speech.

   Numbness might develop soon after surgery due to swelling impinging on nerves. This is a concern especially if you are placed in a hard cast or have a restrictive bandage.

   Numbness Due to Anesthesia

   The reason that anesthesia is used is so you don’t experience the pain of surgery. There are many types of anesthesia, but all have one purpose: to prevent the brain from feeling the surgical procedure. Most surgeries would be too painful to even consider without the benefit of anesthesia.

   After surgery, anesthesia can result in temporary numbness, especially if a nerve block was performed. In fact, for some procedures this numbness lasting for hours or a day after surgery is a blessing: you don’t feel pain where you are numb.

   Incision Numbness

   The area immediately around an incision is often numb after surgery and may continue to be numb for several months after surgery. This is caused by the nerves that run through the surgical site being damaged, and the sensation often returns in the months following surgery.

   Surgical Nerve Damage

   If permanent nerve damage is a potential complication of your procedure, your surgeon should discuss this with you before surgery. This will be one of the things you will need to consider when deciding whether you are willing to have surgery and if the risks of the procedure outweigh the rewards.

   Numbness Worse After Surgery

   If you had numbness before your surgery, it may be worse after surgery, especially if that was the reason for your surgery. Then, if surgery was successful, you may begin to feel more sensation as inflammation and swell from your procedure improve.

   For example, if you had a “pinched nerve” in your back and had numbness in your foot, you may experience an increase in numbness in that area, but it improves as your surgical recovery goes on.

2. The body needs exercise of some sort in order to increase blood flow and thus promote faster healing. Make sure to do exercises that are safe and not going to further harm your broken bones. ... Complete immobilization of the bone is necessary for healing to happen. Exercise can help broken bones heal faster, a new study finds. ... According to new Danish research, the substance ATP maintains the cells of the skeleton and appears even to promote healing in broken bones. "We have known for a long time that exercise helps prevent osteoporosis.

3. factors for healing.

• Watch Your Calcium. The focus should be on all nutrients. It's true that calcium is needed to heal bones, but taking excessive doses of calcium will not help you heal faster. Ensure you are consuming the recommended dose of calcium, and if not, try to consume more natural calcium--or consider a supplement.
• Stop smoking. patients who smoke, have a much longer average time to healing, and a much higher risk of developing a nonunion (non-healing of the bone). Smoking alters the blood flow to the bone, and it is that blood flow that delivers the necessary nutrients and cells to allow the bone to heal. The number one thing you can do to ensure your recovery from a fracture is not smoke. If you know someone who has a fracture and smokes, find ways to help them quit.
• The body needs exercise of some sort in order to increase blood flow and thus promote faster healing. Make sure to do exercises that are safe and not going to further harm your broken bones.
• Eat a Balanced Diet. Healing of bone requires more nutrients that the body needs to simply maintain bone health. Patients with injuries should eat a balanced diet, and ensure adequate nutritional intake of all food groups. What we put into our body determines how well the body can function and recover from injury. If you break a bone, make sure you are eating a balanced diet so that your bone has the necessary nutrition to make a full recovery.
• Adhere to Your Treatment Plan. Your doctor will recommend a treatment, and you should adhere to this. Your doctor may recommend treatments including cast, surgery, crutches, or others. Altering the treatment ahead of schedule may delay your recovery. By removing a cast or walking on a broken bone before your doctor allows, you may be delaying your healing time.
• Augmenting Fracture Healing. Most often, external devices are not too helpful in accelerating fracture healing. Electrical stimulation, ultrasound treatment, and magnet have not been shown to accelerate the healing of most fractures. However, in difficult situations, these may be helpful to aid in the healing of broken bones.
• Ask Your Doctor. There are some fractures that may have treatment alternatives. For example, "Jones" fractures of the foot are a controversial treatment area. Studies have shown these fractures usually heal with immobilization in a cast and crutches. However, many doctors will offer surgery for these fractures because patients tend to heal much faster. Surgery creates potential risks, so these options must be weighed carefully. However, there may be options which alter the time it takes for a bone to heal.

4. Leg elevation, coupled with compression socks, can keep blood flowing to help prevent DVT. Keeping the legs up also helps provide essential nutrients and oxygen to the body's cells. ... On the other hand, elevation can help blood flow more easily and efficiently, equating to quicker healing.Elevating your legs can help to reduce swelling. Compression garments may be helpful for prevention of such swelling, and pneumatic compression (Normatec boots) may also be helpful for reducing it once it is present. ... If you do elevate yourlegs, sit up or get up and walk around for a few minutes about every 15 minutes.

5. When the cast is removed, it is not unusual to experience some pain, swelling and stiffness of the joint for a few days and notice atrophy of the leg muscles (calf and quadriceps) for a few weeks. There will also be dry scaly skin around the leg. Do not rub it; it will gradually fall off. Wash in warm soapy water and apply body lotion daily. Crutches can be used for partial support but you can begin walking on your leg as soon as it is comfortable enough or as per the advice of your doctor. You may be limping on the injured foot for a few weeks after removal of the cast. It can be sore when you walk long distances. The muscles of your leg are weaker, especially the calf muscle. Therefore, as you walk, you may have the tendency of turning your foot outwards and lifting it with the hip. As your calf muscle gets stronger your foot will be turning in more towards the midline and will help decrease your limp. Try to walk with the foot as straight as possible as this will help improve the strength of your calf muscles. Rehabilitation: An important part of the treatment after cast removal is early rehabilitation. It will encourage recovery and help prevent re-injury and/or chronic problems. Physiotherapy is the best way to improve the strength and flexibility of your leg, retrain your balance and help you return to activity within a few weeks. An exercise program is provided for you to begin the initial phase of rehabilitation. For assistance with these exercises and for further evaluation and treatment, you can consult a physiotherapy service within your area.