I have learned many things about our business of orthopedics since the start of my ordeal.  Let me regress and toot our horn for a minute, medcom is a twenty-four hour, seven day a week hospital and patient provider.  We are part of the orthopedic surgeons’ rehabilitation team.  Our goal is to respond to request for services, be it new equipment needs, or service to an ongoing patient.  So maybe this approach to medicine had tainted what I expect from my surgeons.  Here is an anecdote you all may enjoy.  As we now know, one of the screws broke away from the new plate and the plate has migrated, bent, whatever, away from my lateral condyle.  My femur and leg was experiencing excruciating pain.  And I mean – excruciating.  I called the surgeons office on a Thursday in the later morning.  Thursday.  Remember that day.  I called and finally reached a live person and I said that I was experiencing extreme pain in my medial condyle area and distal femur area.  The woman I was speaking with seemed confused as to the severity of my discomfort so I made an analogy.  I asked her if she had seen the original movie, Psycho.  She said of course.  I said remember the shower scene?  She said of course.  I said picture him drawing the knife up to his shoulder and plunging it into her body.  Now picture that same shoulder height raised knife plunging into your knee.  That is how my knee feels when the acute pain happens.  And it had happened at least seven times already that day, and I had drawn on my leg in indelible marker exactly where the pains had occurred.  She said, “Oh my! We must see about getting you in right away.  (Remember, this was Thursday.) How about next Thursday?”   As this was not my first confusing experience with his support staff, telephone voice mails with questions that went unreturned, general attitude, well, needless to say, I started exploring other options.  When I did take my case to another surgeon, the previous surgeon’s office never once called to see how I was, what had happened to me, could they help, etcetera.  Maybe I am out to lunch, but is this the way medicine is supposed to be?  Medcom responds to the slightest concern a patient has. No matter how seemingly insignificant.  We are in the rehabilitation cycle, not the surgical phase where care, and questions, are, or should be, far more critical.  I always knew orthopedics from the other side of the counter, I am sure many that I know are as nice and generous with their time with patients as they have been with me, obviously some are not.  I actually had someone say to me, they are surgeon’s Steve; they do not want to talk with you afterwards as they make no money talking with you.  Go pay another surgeon if you want to ask questions.

The above paragraph happened prior to May 14.  The following is a result of the films taken on May 14th.

It has been awhile since I added an update as I thought I was progressing along.  I had a few questions and concerns about the large anchor screw in the condyles that protrudes past the medial condyle that was really hurting me and I wanted a second opinion about removing it.  So I saw the preeminent bone and fracture specialist in Denver today.  He actually is one of the most respected fracture specialist in the field.  He shot a number of films and discovered that one of the five screws in my condyle has broken away from the implant and it appears that the implant has bent away from the condyle.  He also was able to move my femur by holding my knee and bending it back and forth, thus the lack of union.  You could see the fracture site bending back and forth.  I am scheduled for a CAT scan tomorrow, Wednesday.  I have officially progressed to a non-union status.  He has curtailed my weight bearing and general activity.  We are now discussing options, including removing the distal portion of my femur and the condyles and putting in a prosthesis.  I did not even know they made such an implant.  A total knee, partial femur and a full rod.  I will try to get today’s x-ray posted soon.  The CAT scan is Wednesday, they have to be read, I will have a CD-ROM burned at the hospital for those that can read such.  We should know something next week. 

It appears that I am once again starting over.  Obviously, more to come . . .

Click to enlarge.

Notice the plate at the bottom as pulled away from the condyle, and one of the anchor screws has become unattached from the plate.  This plate is 16" long and pretty wide, a substantial plate.

Some brightness in a debris laden field of morass.

I hung the film in my office window.  The previous films were shot digitally.  This film was shoot conventionally.  When I hung it in the window to take a digital picture of it, I did not realize that you could see the bush through the x-ray, so here is my artistic attempt:   At least there is some humor.

Click to enlarge.

Should I enter it in an Andy Warhol look-a-like contest?  Pretty artsy if I do say so myself.

I asked this same physician about the really painful area I had around my coccyx.  He looked up and said, “We are here to discuss your femur only!”  And blew me off.  I was surprised.  Sallie was very surprised.  Well, it had been suggested that if I had questions, I should not bother this doctor, but pay to see another doctor who would answer my questions - so I did.  He said that he was not a spine expert, but kindly referred me to an orthopedic that was.  The really acute pain I have been experiencing since the accident was a broken tailbone from the accident.  You know part of the exam for a broken tailbone?  Never mind.  I was injected with a steroid and I have my doughnut I carry around.  I try to sit at any one thing for more than twenty minutes, I am supposed to get up and crutch around for awhile.  Just what the psychologist said so that works out. Fun and games.

The CAT scan was not good news.

Remember, I went in to see him for a second opinion about the screw that was protruding past the condyle on the medial side.  I never in my wildest thoughts was expecting the news I received.  Not only had one of the screws broken away from the plate, the plate had migrated laterally away from the condyle and I had non-unions, or the bone was not healing. 

The CAT scan revealed two non-unions and a 4 cm, or 40 mm's, deficit in my leg length.  I am scheduled for a July 17th complete re-do.  A starting over.  I will be completely unzipped, filleted, all 15 inches of my incision.  All the hardware will be removed and at that time, an analysis of my exposed femur and condyles will determine the direction taken.  Either an intramedullary rod, essentially shish kabobing me back together, or a femoral implant and total knee replacement.  Not what you think of when your grandfather has a total knee replacement where new surfaces are installed in the knee, but a TOTAL KNEE REPLACEMENT and femur replacement.  I would prefer the former, but as the surgeon is world renowned, I have put myself in his hands.  Literally.

I am fairly depressed these days.  I am in a hurry up and wait stage.

Here is an Adobe PDF of what is probably going into my leg.

This is a three and a half megabyte file,. so depending on your connection speed, it may a few minutes.

Wright Orthopedics GUARDIAN Limb Salvage System.pdf

There is some interesting information in this PDF.  It is specifically for a distal femoral replacement.

I am going to have surgery Wednesday, July seventeenth.  I will be out of touch for at least a few weeks.  Or ... ?

July 20, 2002, Nea's Birthday

OK, a lot has happened.  I went in for my final appointment prior to surgery and we shot two follow-up films, an AP and a Lateral.  Those films showed a 50% increase in bone growth.  We decided to post-pone the limb salvage system and try one stop-gap measure first.  It is also a Wright product from their Bio-Orthopedics division called AlloMatrix. 

  Wright AlloMatrix Information & Surgical Technique

If this attempt at saving what is left of my leg does not work, then we go back to the limb salvage system.  If it does work, then we go for a modified Total Knee Replacement, TKR. 

The big question is why all of the sudden, in the period from the last horrific films and July 15, 2002, did bone start growing?  All we could ascertain is that whatever I had been doing for the last two months, keep it up.  When I went to see Dr. W, I went to see him for a second opinion if we could remove the one very painful screw through the condyles that was protruding past the medial condyle to the point you can feel it through my skin.  When he looked at the films he shot, he said that we had far larger issues than the screw and, after reviewing the CAT scan (that always reminds of the old joke about the Vet) and  presenting my case at Limb Preservation Society, that I needed a full leg implant.  With that cheery news, I quite, PT, reduced swimming, exercising, and at doctors orders reduced weight bearing to no more than 40 pounds and in general become very depressed.  And of course increased my Martini and Margarita intake.  Whichever of these various components worked, I have grown bone.  What actually makes the most sense is the dramatically reduced level of activity, for whatever reason, stimulated bone growth.  That and the foot pump with the obligatory Martini.

The procedure was done under a fluoroscope and I have attached two thumbnails that were snapped during the procedure.  Look at the January x-ray for implant orientation and then it should make sense.  It was done under a general anesthesia and for the first time in my sordid medical history, I did not recover well from the anesthesia.

 
Views taken during AlloMatrix procedure.
Click on them to enlarge view.

              Swollen enough for you?  Nice blister.

The August 22, 2002 Visit

New films were taken on August 22, 2002 to see how the AlloMatrix treatment had progressed.

  
These are thumbnails, please click on them to enlarge the photo.  While not very pretty, I do have new bone growth.  The white you see is new bone growth.  What we do not see, is what you see on my tibia and that is the hard outer shell, like an M&M, and that is called cortical bone.  That is the white thin shell that you see on the tibia, the right x-ray, left side.
 This is what is NOT growing - yet.  On my leg.

Films from my September 26, 2002 Follow-Up Visit

My one-year anniversary of the accident, October 27, 2002 - and still handicapped.

Treading Water, so to speak.

Not advancing, but not regressing either.

January 9, 2003

There has been some new bone growth.  I have attached the two films from that visit.  Just click on them to enlarge them.