The follow-up that became the pre-op appointment

This piece needs to go backwards

Monday came and just like any Monday I was dreading the day. Nonetheless this was the hand I was dealt. We arrived at the clinic. Waited our turn. Soon we were in our room to wait some more. My poor stomach was in knots. My best recollection of the visit is that Jesse was an unhappy as us with what we were seeing on the CT scan.  In fact he looked mad. As he suspected the top part of my hip (femoral head and neck) was anteriorly rotated so the bone fragments indeed were not aligned. There was over 1.5cm of difference in them, and their best guess was maybe I had 20% bone to bone contact. Without more bone touching healing would be delayed tremendously and might not ever occur.  In that case, I might not ever walk again.

In order for me to make the most well informed decision J sent Dr. S in to talk to me. I was truly on the fence about what to do until Dr. S came in. I’ve known of Dr. S for a really long time, I’ve seen him put some bad trauma patients back together, and he is well respected. He was nursing his own bike-induced injury at the time, so I know he totally understood my circumstances and desire to get better. As he talked he was pretty definitive in his opinion that if I didn’t have the revision surgery that my hip would likely never heal correctly and I had a high risk of rebreaking it plus the hardware could fail causing further issues. All the while I had and still have a risk of avascular necrosis, a condition where the head of your femur dies because of lack of blood flow (You wind up needing a total hip replacement). The trauma I had already sustained and the first surgery already increased the risk of AVN. Now I deepen my risk, but my other choice is keep the first hardware and risk a big mess. This is again where I’m thankful for Mindy and Carrie. Had my follow up been put off longer I would have started healing more which would have meant rebreaking what was healed. After talking to Dr S. I decided that I wanted to best chance to get better so I’d be scheduled for surgery two days later on D-Day, June 6th. I’d just have to worry about work, money, finances etc. later on.

The surgical plan was going to be to try to go in and back off the over rotation and see if that fixed it. If unable to do that, all of the hardware would be removed and replaced. One trick to it was the Smith-Nephew rep would have to come because Carilion doesn’t use their equipment so to have the right tools, reps must come. This is par for the course. I am High Maintenance.

I’m sharing some images below and hopefully by comparing shapes etc. from right to left you can see the issue. I added the red arrows to the CT image. The best way to look and this and try to understand is hold your right fist up like you’re holding the steering wheel then rotate your hand back like using the throttle on a motorcycle. Imagine the neck of my my femur needing to rotate that direction. Get it?

Next post will discuss why I am now a high risk surgical patient... told you high maintenance.

Can you see the difference?

I love 3D CT, but I don't love my own images!

I wish they had spun it around the long axis of the femoral neck.