Post-Fracture Care: Addressing Complications and Recovery Strategies

Post-operative care for fractures?

My mother (69 years old) was injured in a car accident two and a half months ago, with the most severe injury being an open fracture of the lower leg that was shattered into three pieces, with about 90% of the skin and tissue torn away.
The first local hospital immediately suggested amputation, but she was transferred to a medical center where they successfully reattached the limb, inserted a steel rod, and performed a skin graft.
However, there is still a remaining wound (approximately 6-8 cm) that has not healed after more than two and a half months; we are only cleaning the wound and applying artificial skin.

1.
Does the artificial skin contain medication? Why is it unnecessary to apply additional medication?
2.
The wound has not healed for such a long time (although the doctor says it is gradually healing and the wound is red), but we are really concerned.
Could there be other underlying issues? (It shouldn't be osteomyelitis, right?) My mother previously had mild diabetes (around 130), but she has not had any issues with it lately due to poor eating and sleeping habits.
Should we consider another skin graft?
3.
There is no sensation in the front quarter of the injured limb's knee, which seems to indicate nerve damage.
Does this mean there is permanent injury? As a result, she has been unable to straighten or stand, and her ankle and toes can only move slightly up and down.
Besides her age, which contributes to slower recovery, what supportive treatments can we pursue? Thank you in advance for your response; we are very grateful!

emma, 40~49 year old female. Ask Date: 2011/07/04

Dr. Li Wenlin reply Orthopedics

Congratulations on your mother's leg being saved.
However, it is important to understand that successfully treating a severe open fracture will take a considerable amount of time and will require the expertise of many specialists, as well as multiple surgeries.
You may have many questions, but remember this: it is essential to wholeheartedly trust and believe in the attending physician.
Any concerns can be addressed directly with them.
If they feel that flap surgery is outside their area of expertise, you can ask them to refer you to a trusted plastic surgeon.
Do not doubt the attending physician; what they say is based on facts.
Wound healing takes time, so please be patient and cooperate closely with your physician.
Wishing your mother a speedy recovery! Li Wenlin

Reply Date: 2011/07/04

More Info

I'm sorry to hear about your mother's situation following her severe car accident. It sounds like she has been through a lot, and I understand your concerns regarding her recovery. Let's address your questions one by one.

1. Artificial Skin and Medication: Artificial skin, or skin substitutes, are often used in wound care to promote healing. These products can vary in composition, but many do not contain medication. Instead, they create a moist environment that is conducive to healing and may help protect the wound from infection. The reason your mother's doctor may have advised against applying additional medication is that the artificial skin itself can help manage the wound's environment, reducing the need for topical treatments. However, it’s essential to follow up with her healthcare provider to ensure that the wound is healing appropriately and to discuss any concerns you may have about the care plan.

2. Concerns About Wound Healing: It is understandable to worry about the healing process, especially given the complexity of your mother's injuries. A wound that remains open for an extended period can be concerning, but as her doctor mentioned, if the wound is gradually healing and is red (indicating blood flow), that is a positive sign. However, if there are concerns about potential complications like osteomyelitis (bone infection), it’s crucial to monitor for signs such as increased pain, swelling, fever, or discharge from the wound. Given her history of mild diabetes, it is essential to manage her blood sugar levels, as uncontrolled diabetes can impede wound healing. If the wound does not show signs of improvement or if you have ongoing concerns, it may be worth discussing the possibility of another skin graft with her healthcare provider.

3. Nerve Damage and Recovery: The lack of sensation in the area around the knee could indicate nerve damage, which can occur with severe injuries. Nerve injuries can sometimes lead to permanent changes in sensation or function, but this is not always the case. Recovery can vary significantly based on the extent of the injury, the nerves involved, and the individual’s overall health. Physical therapy can be beneficial in such cases, focusing on improving mobility, strength, and function. Even if there is some degree of nerve damage, rehabilitation can help maximize recovery and adapt to any limitations.

4. Supportive Treatments: In addition to physical therapy, there are several supportive treatments that may aid in recovery. These include:
- Nutritional Support: Ensuring your mother has a balanced diet rich in proteins, vitamins (especially Vitamin C and Vitamin A), and minerals (like zinc) can support wound healing. If she has difficulty eating, consider consulting a nutritionist for tailored advice.

- Pain Management: Managing pain effectively can improve her ability to participate in rehabilitation. Discuss with her doctor about appropriate pain management strategies.

- Regular Monitoring: Frequent follow-ups with her healthcare team are essential to monitor the healing process and adjust treatment as necessary.

5. Emotional Support: Lastly, don’t underestimate the importance of emotional support during recovery. The psychological impact of severe injuries can be significant, and ensuring your mother has access to mental health resources can be beneficial.

In conclusion, while your mother’s recovery may take time, there are various strategies and treatments available to support her healing process. Regular communication with her healthcare team is crucial to address any concerns and adjust her care plan as needed. I wish your mother a smooth and speedy recovery.

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