Post-Surgery Issues with Artificial Bone: Managing Swelling and Discomfort

Postoperative issues related to artificial bone surgery?

My grandmother had a fracture above her knee about a month and a half ago and underwent surgery to replace the bone with an artificial one.
The doctor applied a cast (from the fracture site to the sole of her foot) because he was concerned that movement would prevent proper healing.
However, the sole of her foot became excessively dry, causing discomfort, so she cut the cast herself.
Currently, her foot is swollen and has developed a blister.
What should be done at this point, and why did this happen? Thank you for your response.

sabrina, 20~29 year old female. Ask Date: 2010/02/06

Dr. Shi Qiming reply Orthopedics

The fracture above the knee is likely a distal femoral fracture, which is generally considered an unstable fracture.
Postoperatively, it should be stabilized with a cast for a short period (approximately four to six weeks).
If there is pressure from the cast on the sole of the foot leading to a hematoma during the acute phase, ice therapy should be applied.
However, if it has been more than two weeks, heat therapy can be used.
It is important to rest both legs and elevate them to assist with blood circulation.
After the fracture has healed, rehabilitation training for walking should be initiated, and please follow up with the original treatment facility.

Reply Date: 2010/02/06

More Info

Post-surgery issues, particularly after an artificial bone replacement, can be quite common, especially in elderly patients. Your grandmother's situation, where she experienced discomfort due to a cast and subsequently developed swelling and a blister, raises several important points regarding post-operative care and management.

Firstly, it is essential to understand that after a surgical procedure like an artificial bone replacement, the body goes through a healing process that can involve swelling, discomfort, and sometimes complications such as blisters. The swelling you mentioned is likely a result of several factors, including immobility due to the cast, the body's inflammatory response to surgery, and possibly fluid accumulation in the lower extremities.

The cast, while necessary for immobilization and protection of the surgical site, can also lead to complications if it is too tight or if it causes skin irritation. In your grandmother's case, the dryness and discomfort from the cast may have prompted her to cut it, which is not advisable without medical supervision. Cutting the cast can lead to further complications, including exposure of the surgical site to potential infections, as well as inadequate support for the healing bone.

Here are some steps to manage her current situation:
1. Consult a Healthcare Professional: The first and most important step is to contact her healthcare provider or surgeon. They can assess the situation and determine if the cast needs to be replaced or adjusted. They will also check for signs of infection or other complications.

2. Managing Swelling: To help reduce swelling, elevating the leg above heart level can be beneficial. This position encourages fluid drainage away from the injured area. Additionally, applying ice packs (wrapped in a cloth to avoid direct contact with the skin) for 15-20 minutes at a time can help reduce swelling and numb the area to alleviate discomfort.

3. Blister Care: If the blister is intact, it is generally best to leave it alone, as it serves as a natural barrier against infection. However, if it is painful or at risk of bursting, a healthcare professional should evaluate it. If it has burst, keeping the area clean and covered with a sterile bandage is crucial to prevent infection.

4. Skin Care: For the dry skin under the cast, once it is removed, gentle moisturizing can help. However, it is important to avoid applying any creams or lotions while the cast is still on, as this can lead to skin irritation or infection.

5. Physical Therapy: Once cleared by her doctor, engaging in physical therapy can help improve mobility and strength in the affected leg. This is crucial for recovery and can help prevent complications associated with prolonged immobility.

6. Monitoring for Complications: Keep an eye out for any signs of infection, such as increased redness, warmth, or discharge from the surgical site, as well as fever. If any of these symptoms occur, seek medical attention immediately.

In summary, while swelling and discomfort are common after surgery, it is crucial to manage these symptoms carefully and under the guidance of a healthcare professional. Your grandmother's comfort and recovery depend on proper care and monitoring during this healing phase. Always prioritize communication with her healthcare team to ensure the best outcomes.

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