1. 123456789
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    123456789 Contributing Member Contributor

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    broken leg

    Discussion in 'Research' started by 123456789, Dec 22, 2014.

    Hey I'd like some pointers to several questions, maybe from @GingerCoffee ee, or anyone else who may be more familiar than I


    1. In what specific cases can a broken leg, even if treated, lead to the possibility of that person not being able to walk (or walk normally) again? Is it just misalignment of certain bones or what?

    2. How might a doctor realistically relay this news to the patient. You always hear 'doctors said I'd never walk again," but what does this really mean? Would they say something, like, "there's an 80% chance, your bones will align properly," or what?

    3. In a case where the odds look bad, considering a miraculous recovery and good physical therapy, how quickly could the patient heal and be able to walk normally?


    Thanks in advance for any help.!
     
  2. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    If this is the modern world, even with one's leg amputated people walk again with protheses. The best you could realistically do is smash a joint. Joints can fuse after a bad, poorly repaired fracture and no longer have any flexion.

    Another possible scenario is have the break happen because of a tumor or bone infection that is found when the leg is X-rayed for the fracture. I saw surgery on a young man once, they thought he had bone cancer. When they got into his femur it turned out to be a large abscess. They had to clean the abscess out leaving a seriously weakened femur behind and he was looking at months of IV antibiotics. Currently a drug resistant infection might make a good prognosis doubtful. An amputation might be needed for an infection that isn't treatable.
     
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  3. NickAI
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    NickAI New Member

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    Another possibility is simply nerve damage. The doctors do not know the extent of it, only time will tell.
     
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  4. theoriginalmonsterman
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    theoriginalmonsterman Pickle Contest Administrator Contributor

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    My brother once broke his femur, so he had a pretty bad injury. The doctors managed to fix his leg though using a metal nail to help support his leg. His femur was fixed within a few months which was a pretty amazing miracle. Of course he only broke his bone, so that may have something to do with his insanely fast recovery. What is the condition of the broken leg? If it's only a broken bone it should be fairly easy to fix, but something like a muscle can't be fixed. If the muscle is damaged badly that may lead to the disability to walk. Hopefully this isn't the case for this particular injury.
     
  5. 123456789
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    123456789 Contributing Member Contributor

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    Thanks a lot everyone! I'm probably going to go with shattered knee cap.
     
  6. DeadMoon
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    DeadMoon Contributing Member Contributor

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    I have problems all of the time with my knee, I have had two surgeries on it after a bad accident, Doc told me to get out of a labor job and into a desk job to prolong the use of the knee, mostly likely I will need a knee replacement in 20 or so years. It took a lot of work and a few return trips to physical therapy to be where I am today. cold weather still effects it causing pain and weakness. oddly and sadly so does to much beer...
     
  7. Sifunkle
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    Sifunkle Dis Member

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    I see you've made some decisions since I typed this, but I'll leave it here for reference :) :

    The cause of the fracture is important: I'll assume 'traumatic', but as @GingerCoffee pointed out, if it's 'pathological' (cancer, infection, nutritional disorder, other underlying disease) the underlying disease must be addressed as well as the fracture itself.

    If traumatic, the type of trauma (‘high impulse vs low’, e.g. gunshot wound vs falling on it in the street, respectively) generally governs the degree of damage: shattering of bone (comminution), damage to surrounding soft tissues, etc. It’s generally true that the more complex the damage, the worse the prognosis.

    How the fracture is treated might govern the prognosis somewhat (is your character at a fantastic hospital or out in the boonies?).

    - Whether the patient is old or young (healing slows with age)
    - What bone is fractured
    - What part of the bone is fractured (is the patient still growing? If a growth plate is damaged, this could lead to abnormal growth and altered gait.)
    - What type of fracture: if it’s ‘straight across’ the shaft of the bone, it’s easier to appose; if it’s angled or spiralling, even if you piece the ends together they might have a tendency to slide apart again if not fixed correctly. This will be governed by...
    - The forces acting around the fracture site (think physics and vectors: compression, tension, shear force, etc) – these affect different parts of the fracture site differently
    - Whether there’s a ‘splint bone’ present (e.g. if the ulna is fractured, the radius can still hold the forearm together somewhat and take the load off the ulna; if the femur is fractured, there’s no other bone to hold the thigh together)
    - How much damage there is to the surrounding soft tissues (which may include damage caused by surgery to fix the bone...): both because soft tissues add stability to the fracture site and because some of the blood supply to the bone (which is important for healing) comes from the surrounding muscle
    - Whether the fracture is open (skin penetrated), thus exposed to contamination, infection, etc

    The prognosis depends (amongst other things) on anything that affects how well the bone can be pieced back together and held in its original shape to facilitate healing. If the pieces can be fit tightly back together, ‘direct bone healing’ might be possible (the bone itself just grows over the gap): this will generally be slower but more stable, and more desirable overall. If there’s a gap between the pieces, ‘secondary bone healing’ will come into play (more likely): this involves the gap filling with blood which will clot and slowly mineralise back into bone. This leaves a much messier new piece of bone, which will take much longer for the body to remodel back into an appropriate shape.

    You should bear in mind that even after the bone initially heals, it won’t be as good as it was and will take months-years to remodel appropriately (an important part of this is for the bone tissue to become dense along the lines of force that the bone is naturally exposed to: this is why it’s important to start physiotherapy after it initially heals – to expose the bone to those forces in order to stimulate that remodelling).

    A large part of the prognosis will depend on the method chosen for fixation, how skilfully that method is applied, how well the patient adheres to aftercare and any complications that arise (e.g. perhaps a plate or screw becomes infected: this will slow down healing and the implant will need to be removed at some point as it’s pretty much impossible to entirely clear contamination from implants in situ).

    The general methods available for fracture treatment are:
    - External coaptation (splints, casts, slings, etc) – the least invasive, but usually the least stable and only appropriate for pretty simple fractures (unless you have no other options...)
    - External skeletal fixation (looks like scaffolding around the limb, with screws going through the skin and into the bones to hold them in place)
    - Internal fixation (surgical repair) – plates, pins, screws, etc

    They have different pros and cons, and which is best depends on the details of the fracture. Part of the skill of the doctor is selecting appropriately. There are lots of variations on the basic methods, and complementary strategies too (e.g. bone grafts). If things go awry, there are ‘salvage strategies’ possible, such as amputation or arthrodesis (fusing a joint together, with complications as per what @GingerCoffee mentioned).

    The actual language a doctor might use to talk to the patient will vary a lot, so I can’t really comment. In terms of prognosticating, I suspect most would come up with some kind of grade or score based on many of the qualities of the fracture that I mentioned above. I’d expect they’d also want to regularly monitor the healing process, which might involve repeat x-rays. This might be a point where they’d be likely to identify complications (infection, misalignment, non-union, etc) that might lower the prospects.

    It’s a bit hard to guess at the time for recovery where ‘odds look bad’, because it would depend on what factors were actually in play. I suppose for a simple fracture, you’d look at maybe 4 months or so for the bone to heal via indirect healing (but then it still won’t be as good as new for probably several years as the bone remodels). If complications arise, it would usually add time to that (in some cases, akin to starting over again). Worst case (well, other than death I suppose), they’d give up on the bone healing properly and opt for salvage.

    Hopefully this overview, combined with what others have mentioned, allows you to ‘hone in’ further. If you iron out some more specifics, I can try to help with further details. All the best!

    (And just to clarify @theoriginalmonsterman ’s comment a little: muscles can be patched up, but they generally won’t return to their previous function as they heal by scarring rather than restoration of actual muscle tissue. With severe damage, perhaps the doctor would chalk one up as a loss.)
     
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  8. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Rather anti-climatic. How is that supposed to have an uncertain prognosis?

    No worries, you don't need to explain. :p
     
  9. 123456789
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    123456789 Contributing Member Contributor

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    From my own reading, it seems like smashed knee cap could be uncertain in terms of walking outcome, couldn't it? If not then that's a poor option
    I still need to read that behemoth post above yours, though, so I could always change my mind.
     
  10. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Go with nerve damage. I just don't see how a doctor would tell a patient with a fractured kneecap that he/she might not walk again. A knee joint is replaceable.
     
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  11. Shadowfax
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    Shadowfax Contributing Member Contributor

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    I don't think anyone's mentioned this, but age would make any break more problematic from, say, post 50 years, especially in a post-menopausal woman.

    As far as how the doctor tells the patient, I think that it would depend upon the doctor. However, he'll probably be very calm and unemotional and won't commit himself to certainty either way (NOT "you'll never walk again" or "we'll have you back on your feet in no time"). The best you're likely to get is (in my father's case) "Without the operation there's a 50% chance of surviving the year. With the operation, there's a 20% chance of dying on the table" or (in my wife's case) "We've done x of these and got 100% success". Again, the delivery will depend upon the location of the treatment...local GP out in the sticks will be chattier, top specialist in hospital will be more remote.
     
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  12. Sifunkle
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    Sifunkle Dis Member

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    Sorry :oops: Trying to 'teach a man to fish', but probably overkill.

    If you want a fracture, something that fits your bill might be a gunshot wound or a fall from height that causes lots of fragmenting of the bone, requiring surgery to try and piece the puzzle back together. You could have the patient come in for repeat x-ray in a month or so and they find a worrying complication (e.g. repair has come apart a bit), but over the next few months it heals anyway, leaving a bony swelling around the fracture site that gradually smooths back up over the next couple years (with ongoing physio).

    I agree that nerve damage is perhaps easier to write, as there's generally less a doctor can do and it's more of a 'suck it and see' deal. Surgical or neurological specialists may have some tricks up their sleeve, so grain of salt.

    Nerves are quite elastic, so if they're severed the ends often snap apart. If they find each other, they'll usually repair to some extent, but slowly (and whether all the individual neurons match up as they should is anyone's guess, so things might not feel or move the same as before). If the severed ends don't find each other, there could be a complete loss of sensory or motor function or both (depending on which nerve) in the relevant body part.

    I severed a nerve running up my finger once. Only lost sensory function, but that still impaired my fine motor control because I couldn't feel what I was doing. It was a stressful few months (I worried I'd never play bass as well again), but the feeling gradually returned (with a fair bit of 'pins-and-needles'). I can only dread what it would feel like to wipe out a more important nerve. Healing seemed to finish after about half a year. Ten years on and my finger is much as it used to be, but for a tiny spot right at the tip where I can't feel anything.

    And I've written too much again :oops: Sorry, I'm just trying to be helpful.
     
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  13. !ndigo
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    !ndigo Member

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    My dad broke his kneecap when he was maybe 55 or so. His whole knee swelled up like a balloon and turned an amazing shade of purple. He never went to a Dr or PT or anything, just left it alone and stayed off it as much as possible. It took a few months to heal and about two years for his limp to go away but there was no lasting damage, certainly not something where you'd never walk again.

    If you want to cripple your person, I might go for a more severe injury, either really severely shattering the kneecap or something where it fused or paralyzed the knee. Also, anything bad enough to fully shatter a kneecap is probably going to hurt the surrounding joint/bones.

    Don't forget that if this is set in modern times, they can do full knee joint replacements. http://orthoinfo.aaos.org/topic.cfm?topic=a00221
     

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