Hip Fracture Update: 10 Weeks

Nov 092011

I recently had my 10-week postoperative check for my left hip fracture. As you can see from the image below, the fracture shows considerable healing and improvement from the earlier 6-week image (click on image to see full size):

The image on the left is the most recent 10-week image; the image on the right is the earlier 6-week image. The arrows point to the fracture line.

For reference, here is the matching CT scan of the hip just prior to surgery (click on image to see full size):

In particular, the fracture shows good bony union on the 10-week image. There is no breakdown of the fracture repair site, and no bending or deformity of the three titanium screws which would indicate abnormal stress at the repair site.

Nor is there any sign of the complication known as “avascular necrosis” or AVN, which is when the bone of the femoral head starts to die off due to inadequate blood supply (a known risk from certain types of hip fractures). If I had developed AVN, then this would have meant that the attempted repair failed and I’d likely need a second surgery for artificial hip replacement.

My orthopedic surgeon (Dr. Steve Morgan) has now given me the green light to get rid of the crutches and start walking with cane. I’m continuing my physical therapy and am now much more mobile. He’ll continue to monitor my progress over the next few months, but for now everything is looking good.

Diana deserves tremendous credit for putting up with my relative immobility these past 10 weeks, including doing all the unpleasant household chores that I used to do (like cleaning up the kitty litter).

And we’d like to extend our thanks to all our friends who have offered their support and encouragement during this challenging time!

Earlier posts on this topic:

My Hip Injury“, August 31, 2011
Hip Injury Aftermath“, September 6, 2011
Open Letter to Apple: My iPad and My Hip Fracture“, September 7, 2011

Alas, Four More Weeks

Oct 112011

Yesterday, Paul had his six-week check-up with his orthopedist. The good news is that nothing has gone wrong so far — although he’s not out of the woods yet. Unfortunately, the femoral head fracture is still plainly evident in the x-ray, and the doctor wants him to stay off that leg for another four weeks. Basically, as with the last six weeks, he can only put a wee bit of weight on that leg for balance.

That came as a major disappointment to us, as we’d hoped and expected that he’d be able to switch to a cane and start bearing some weight. However, we were surely just expecting too much. So we’re bummed… but we’ll manage.

The good news is that the doctor has lifted Paul’s restrictions on his range of motion with that leg. So that will make some daily tasks easier, including showering, getting in and out of the car, and even putting on his own left sock. Overall, Paul is much better able to drive himself to and from work than before, so that’s good.

I’ll be so freaking happy when Paul is back to his old self. It’s been a hard slog for both of us.

Open Letter to Apple: My iPad and My Hip Fracture

Sep 072011

Dear Apple:

I’ve been a happy iPad2 owner since March 2011, but I never fully appreciated its value until I recently broke my hip in a bad fall and required subsequent hospitalization.

I am a physician, so I had already been using my iPad for my work, reading PDFs of medical articles, communicating with my colleagues via e-mail, etc. But when I broke my hip in an accident a few days ago, the iPad became my lifeline to the outside world:

Because I had my iPad with me at the time of the accident, I was able to immediately notify my friends and family of what had happened once I arrived in the ER.

In the ER, the iPad also helped keep my spirits up as I checked e-mail, followed my friends on Twitter and Facebook, and followed the regular world news. When my orthopedic surgeon presented my treatment options to me, he also e-mailed me some relevant medical literature in the form of PDF files which I could digest at my own pace on the iPad. And of course, I was also able to perform Google searches on my various surgery options, the complication rates, postoperative care requirements, etc.

Because of the specific nature of my fracture, I had to choose between two treatment options, each with its own pros and cons. I found it enormously helpful to be able to gather the relevant medical information literally “at my fingertips”. Because of the iPad, I was able to more quickly make an informed treatment decision that I was comfortable with.

I did briefly leave my iPad with my wife during the surgery itself, but she gave it back to me immediately after the surgery. Other than that, it did not leave my side while in the hospital.

While in the hospital after my surgery, I used the iPad to read eBooks, check my e-mail, surf the internet, and keep up my regular blogging. It was a real morale booster to be able to continue as much of my regular online routine as possible, despite my impaired physical condition.

My wife also had her own iPad with her while I was hospitalized, which allowed her to update our friends and family in real time on my condition, as well as keep her occupied while I was asleep or in surgery.

And now that I’m at home recovering, my iPad is still at my side!

For someone such as myself with limited physical mobility, the iPad2 with its light weight and long battery life was perfect. A laptop computer simply would not have worked while in the hospital. The iPad was literally an emotional, medical, and physical lifeline for me during a difficult time in my life.

I know Apple has been in the news lately because of Steve Jobs’ decision to step down as CEO. I just wanted to take this opportunity to publicly thank Mr. Jobs and Apple for creating such a wonderful, life-enhancing product.

In your advertisements, Apple has touted the iPad as “magical” and “revolutionary”. To that, I would add the term “life-saver”.

– Paul Hsieh, MD

[Crossposted from GeekPress.]

Hip Injury Aftermath

Sep 062011

After my earlier left hip fracture, I underwent successful surgery to repair the broken femur head. The surgeon was able to get a good repair, and here’s a post-op image:

For comparison, here’s a matching pre-operative CT image:

For the record, those were definitely the three most expensive titanium screws I have ever purchased! But of course, I wasn’t just paying for the screws but for the highly customized, personalized, urgent delivery method as well.

I’m now home for a few days of Medical Leave before I return to work. Fortunately, I should still be able function pretty well at my job at a computer work-station, although I won’t be able to perform invasive procedures (or anything that involves prolonged standing) for a little while.

I do have a few observations in this immediate post-operative period:

1) American medical care is really really good. My care at all steps from the ambulance to the ER to the pre-op to surgery to the surgical aftercare was superb. Again, I want to give my kudos to the Level 1 Trauma Center where I was treated.

2) It’s very easy to think that this superb medical care “just happens” and grows magically on trees. But knowing how bad care can be in other countries with socialized medical systems, I appreciate the current semi-free American system even more than ever. And I want to continue to fight to keep it as free as possible.

3) Some of the various personnel at the hospital knew I was a physician on staff there, but many did not. For those who didn’t, I deliberately didn’t mention the fact that I was a doctor just to see how they treated a “regular” patient. They were consistently competent, courteous, and professional — and that makes me feel much prouder about where I work.

4) It’s amazing how much one’s life changes when one has restricted mobility on a single hip. Even simple ADLs (activities of daily living) such as sitting in chair, taking a shower, going to the bathroom, etc., become much more challenging. Fortunately, part of my patient education included some extremely helpful training sessions with the Physical Therapy and Occupational Therapy teams to prepare me for functioning at home.

5) The first shower at home after surgery feels really, really nice!

6) Some of the postop physical therapy exercises are a real b*tch!

7) Having an iPad was a huge boon throughout the entire process, staring in the ER, then at home prior to surgery, then in the hospital immediately postop, and now at home. Being able to reply to e-mails, keep up on the news, interact with friends via Twitter/Facebook, look up medical literature, read my Kindle books, etc., was an enormous morale boost. A laptop would not have been as convenient or portable for someone like me with limited physical mobility.

Finally, Diana has been a tremendous help during this challenge. She’s been unfailingly cheerful despite now having to do twice as much work around the house as before. Certainly, if you value her work on NoodleFood or the Rationally Selfish webcasts, please feel free to be extra-generous with the tip jars!

My Hip Injury

Aug 302011

As many of you know, I sustained a fluke hip fracture yesterday. Basically, I was crossing the street to my office when I tripped on something in the intersection. I’m not sure if it was a rock or a crack in the asphalt or what. I landed hard on my left hip and had a classic, “I’ve fallen and can’t get up”. My left hip was twisted in an unnatural position and I couldn’t put any weight on my left leg.

To get out of the road, I had to crawl out of the intersection to the traffic island. A passer-by alerted 911, and the paramedics took me to Swedish Medical Center, which is top-tier level 1 trauma hospital that my radiology practice helps staff.

The emergency team there was superb, including all the docs, nurses, EKG techs, radiology techs, etc.

My initial x-ray showed a dislocated left hip:

The “ball” of the femur is out of place, no longer sitting within the “cup” or acetabulum socket.

Here I am looking at my x-ray on the ER physician’s laptop:

The ER team then arranged for a “closed reduction” (relocation) of the hip. For this, they had to heavily but briefly sedate me, both so I wouldn’t experience the pain and to help relax my muscle spasm. I don’t remember much of this portion, but I do recall the IV sedation was very rapid acting. Then a lot of blurriness, then a resumption to groggy-consicousness with the ER doc telling me the hip was now back in place.

So that first step was went okay!

(Note from Diana: I was in the room for the reduction, and it wasn’t easy! Paul required three doses of the sedative to keep him under. His ER doc wasn’t able to do the reduction himself, despite a valiant effort, so he called another very muscular ER doc who was able to do it in short order. The whole procedure was a bit hard to watch, but I was glad to be there.)

The next step was a CT scan to see how much damage there was to the ball and/or socket. Unfortunately, I do have fractures of both portions, as you can see below:

Presumably, the force of the dislocation also caused the fractures.

Yesterday evening, while still in the hospital, the orthopedic surgeon reviewed the images, discussed various options, and recommended surgery. He decided that I was sufficiently stable to be able to go home on crutches, and surgery is planned for tomorrow.

One of my partner radiologists — who is also an orthopedic trauma radiologist like myself — has already filed my images in his list of “interested cases”. Basically, you never want to be someone else’s “interesting case”!

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