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Frequently asked questions about orthopaedic trauma injuries (broken bones) (FAQs)

This site is designed to provide answers to questions about broken bones. You should discuss all of your questions with your treating doctors. This site is not meant to explain everything in great detail. This is another reason to ask questions directly to your treating doctors or surgeons.

Being treated for a serious injury is life changing and can be confusing. Keeping a notebook with details about your doctors and your surgeries may be helpful. You can record medications, instructions and test results. Generally, all of your medical records can be obtained after you are discharged from the hospital. This includes x-rays and other images (MRIs, CT scans, etc.). Getting copies usually requires signing a release form. It may help to get these forms signed and copies of records and x-rays before being discharged—especially if you live far from the hospital.

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Healing

   How long does it take a broken bone to heal?

Healing time depends on many factors, such as the blood supply to the bone, the amount of muscle and tissue near the bone, how badly it was broken, a patient’s age, and general health. Sometimes things you might not think matter will affect the bone healing, like smoking or diabetes. Most fractures require 8 to 12 weeks to heal to the point where they can be walked on. Some areas of bone heal more slowly. This is usually due to poor blood supply to these areas. Slower healing areas include: some bones in your wrist and foot, and the tibia (shin bone).

   How long do ligaments take to heal?

A ligament attaches a bone to another bone. Ligaments can take several months to heal; they heal more slowly than broken bones. This is due to the relatively poor blood supply to the ligament. Every ligament is different, and some may never heal completely.

   How long do nerves take to heal?

It is difficult to tell when a nerve injury will recover. Some nerves heal and others do not—it depends on the nerve and how severely it was injured. The spinal cord does not typically heal. Nerves that are completely cut, or severely pinched or bruised, may never fully recover. It can take up to a month before the nerve starts to heal, and many nerves require months or years to heal fully. Nerves heal very slowly—around an inch each month. Nerve healing may feel like "pins-and needles" or when your arm or leg "falls asleep." This can be painful as some of the first fibers of the nerve to heal are the pain fibers. But the tingling sensation can be seen as a good thing. It means something is trying to heal.

As your nerve heals, it may take a long time to heal enough to make your muscles work. It typically takes 12-18 months after an injury to know how much—or even if—a nerve will recover. Ask your surgeon if you would benefit from physical or hand therapy while your nerve heals. Sometimes the surgeon will order nerve conduction studies to see if the nerve is healing. Some nerves do not show healing with these tests, so it may or may not be part of your evaluation to get these tests.

If you have experienced head trauma, it can take time for brain function to return. This requires time and therapy from therapists experienced in treating head injured patients. Many neuro-rehabilitation centers (stroke and spinal cord injury centers are examples) specialize in these areas and offer outpatient therapy programs.

   Is my wound infected?

The best place to get your wound evaluated is in your orthopaedic surgeon's office. If they are not available, you can go to your local emergency room or primary care doctor for evaluation. They may be able to contact your doctor or another surgeon who can assist you. Always notify your treating surgeons of wound or surgical site concerns. Antibiotics may help fight the infection. Sometimes, after the antibiotics are stopped, the infection comes back. Whenever you can, keep track of the names of antibiotics you’ve taken, for how long, and if possible, your culture results.

   Is my fracture healing?

The best place to get evaluated is in your orthopaedic surgeon's office. If this process does not provide sufficient guidance, you can go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon who can assist you. Some fractures heal more slowly than others. It does not mean that your care was wrong or inappropriate. Sometimes it is hard to assess healing with x-rays, so the surgeon will need to conduct a clinical examination as well. You can ask your surgeon how your fracture is healing. If it is healing slowly, ask if there is anything you can do to help the healing process. Some things that may help include adjusting your diet or your vitamin levels, or addressing other medical issues you may have. Sometimes there is a need for another surgery to place a bone graft at the fracture site. This is common in high energy injuries and fracture of your long bones. It is also seen in some medical conditions and smokers.

   How long will I be in a cast or a boot?

Broken bones are often repaired by an orthopaedic surgeon and held in place with hardware such as screws and metal plates. In that case, a cast, splint, or brace maybe used to protect the wound, or to let the soft tissue "rest" for several weeks. Some fractures are only treated with a cast, which needs to stay on until the bone is healed enough so that the cast is no longer needed. The length of time you’re in a cast or a boot is injury- and patient-specific, and the best estimate will come from your doctor.

   Should I take my cast or boot off myself?

These should not be removed by you unless instructed by your doctor. In general, a cast or splint should not to be removed by anyone other than your surgeon. It is important to not cut them off yourself, as you may hurt yourself or make your injury worse. Also, do not stick things down your cast or splint. Trying to scratch an itch may damage your skin and lead to an infection or other issues with your wound. If your splint or cast is bothering you, call your surgeon as soon as possible. Sometimes, boots or splints can be removed for physical therapy, motion activities, sleeping, or bathing. You should ask your surgeon if this is okay.

   What do I do if my cast gets wet?

Even a wet cast can be effective in supporting an injury. Do not try to remove it on your own or with help. The best place to get a new cast is in your orthopaedic surgeon's office. They will know best what is needed and why. Sometimes x-rays are needed to make sure nothing has changed. Do not use a blow dryer to try and dry it out yourself. This can cause burns to the skin. Always call your orthopaedic surgeon's office with concerns about a cast, or wound. If this does not provide sufficient guidance, you can go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon who can assist you.

   What should I do if my wound or incision starts draining?

The best place to get evaluated is in your surgeon's office. If you can't reach them, you can go to your primary care doctor’s office or a local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon who can assist you.

   What if my pain suddenly gets worse?

The best place to get evaluated is in your orthopaedic surgeon's office. If this process does not provide sufficient guidance, you can go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon who can assist you.

   Why is my leg/ankle so swollen?

Almost every surgical patient has two injuries. The first is from the event that caused the injury. The second is from the surgery to correct the first injury. Swelling is a natural part of the injury and healing process, and it develops much faster than it goes away. Swelling around the feet and ankles often takes months to go away, since gravity pulls fluid downhill to the legs. Sometimes it never completely goes away. Even a simple fracture is not just an injury to the bone; the soft tissue around the bone is also injured. The healing of fluid channels in your injured limb involves waiting for soft tissue repair and the return of pathways through which that fluid normally returns to the heart. If you have swelling in both of your legs, it could be from other medical issues. If you have any concerns, contact your primary care doctor.

   Why is my leg/ankle discolored?

Every injury causes bleeding. As your body breaks down the blood at the site of the injury, it turns various colors. Essentially, it's a bruise that may take months to fully resolve. Gravity may cause these color changes to track down the arm and the leg all the way to the toes or fingertips, even if the injury was at the shoulder or the hip.

   Why is my leg/ankle tingling after surgery?

Odd sensations after an injury or surgery are common, due to inflammation or swelling at the injury or surgery site. Some surgical incisions or even the injury itself can cut or stun the nerves to the skin. This can cause some numbness around the incision, and these changes can sometimes be permanent. If you feel like you had normal sensation after surgery, but things are changing for the worse, you should contact your surgeon as soon as possible. It could mean that there is too much swelling or that the bandage is too tight. If you cannot reach your surgeon, you may need to go to an emergency room to have this evaluated. It is best to ask your treating surgeon about what to expect long term.

   What can I do to make this heal faster?

Injuries heal at a certain rate. Your surgeon should be able to give you a general timeline for healing from your injury. Don't expect a faster return to certain activities because you think you're a fast healer. There are no miracle medications or herbs to promote healing. There are several things that definitely greatly slow healing, one of which is smoking. The best thing you can do is follow your surgeon's instructions.

   What can I do to get to sleep at night?

It can be tough to sleep after an injury due to pain (especially at night when there are no other distractions) or because you cannot stop thinking about your injury. Some helpful tips to improve your sleep include:

  • Set a routine for getting into bed and waking up, and stick to it through the week.
  • If you cannot sleep, get up and out of bed after about 20 minutes and do not go back until you think you can fall asleep. Do not nap during the day.
  • Ice or heat can reduce your pain. Ice helps in the immediate time after surgery.
  • Limit stimulants, like caffeine and alcohol.
  • At bedtime, avoid stimulating light sources like TV, computer screens, or your phone.

Sleep medications are not always the answer. They make it hard to wake up and can have unwanted side effects. These should be discussed with your primary care physician. Some medical conditions like sleep apnea can affect your sleep as well. Narcotics are not the answer to sleep disturbance and can cause issues with sleep. You should discuss your sleep concerns with your surgeon as well as your primary care physician.

   What if I walked too soon?

Never do anything before permission is given from your treating doctors. Don't let the lack of pain encourage you to do something you were advised not to do. If you think you may have done something too soon, the best place to get evaluated is in your treating surgeon's office. Your surgeon knows your injury. Some injuries take long periods of time to heal before they can be stressed with activities like walking. Try to follow the instructions of your surgeon.

   When should I start physical therapy?

Typically, your incisions and wounds need to heal before activity is started. Injuries, splints, and casts can all cause stiffness. Sometimes therapy is needed to show you how to use crutches or other devices and to restore motion before your bones are fully healed. Therapy is sometimes used to help teach you how to move around and/or do everyday activities. Discuss this with your doctor. Always consult your doctors before engaging in any work or exercise activities.

Return to activity

   What if I get dizzy or short of breath?

After a period of inactivity—such as recuperating in a hospital bed—these feelings can be common. However, they may also be a sign of something more significant, such as blood clots in your lungs. The best place for evaluation is your local emergency room. You don't necessarily have to travel back to the center where you were treated. Emergency departments see these kinds of things frequently and can do a thorough job of making sure things are okay. You should also try to contact your treating doctor's office, but they will likely give the same recommendation. Do not delay getting care while waiting to contact your surgeon’s office.

   Will my walking ever be the same?

One of the hardest parts of the recovery process is not knowing what to expect. Your surgeon is the best person to ask, since they understand your injuries and treatments. Sometimes walking will not be the same; sometimes it takes up to a year to find out. It’s a good idea to write down questions for your next doctor's visit.

   How long before I can return to work?

This depends on the type of work you do and your specific injuries. Jobs in which you have to be on your feet, able to lift, or perform repetitive activities usually require complete bone healing and getting your full strength and range of motion back. You may be able to return to a desk type job or work from home sooner. Please talk to your treating surgeon about your specific job to determine your limitations, when you can return to work, and in what capacity.

   How long before I can drive?

The question of when is it "safe" to operate a car is a complicated issue and varies with the patient. Below is some general information that can serve as a very rough guideline. Please remember that it is always best to discuss this issue with your doctor.

Reaction time, decision making, the ability to move the steering wheel and push the peddles are a few of the factors that determine the ability to safely drive. You must not be taking any narcotics (opioids) or other medications that may alter your reaction time. Some medications cause sleepiness and impaired decision making, and cannot be combined with driving. You must be able to bear weight on your leg to use a foot pedal. Casts, splints, or braces can prevent safe driving by limiting movement. In most states it is illegal to drive if you have a cast on your foot or ankle. Pain with moving the arm or leg may also limit your ability to respond. If you cannot respond quickly enough due any of these factors, it is not safe to drive. It may take months to recover adequately. Some studies show that even if you feel normal, your reaction time might be affected enough to prevent you from driving safely. If you get into an accident and your injury is believed to have limited your movement, reaction time, or decision making, the authorities may say you couldn't respond to the road appropriately and it's your fault.

   How long before I can run/work-out?

The ability to fully bear weight on one or both legs without pain influences your ability to resume physical activities. Splints or casts on your arms or legs may limit the ability to exercise or use equipment safely. While it is important to remain as active as possible when recovering, it is also important to obey any restrictions your doctor has talked to you about. This may mean doing different exercises than you are used to.

It is also important to realize that when you restart activities after your injury, your muscles, tendons, and ligaments are weaker. You will not be able to lift as much or do activities for as long as before. It is important to slowly work back up the strength and endurance that you had before your injury. Further, it may be wise to start with low impact activities first; for example by using an elliptical machine or a stationary bicycle to build up strength before running on a treadmill.

   How long until I can have sex?

This is a very common question and you should not be embarrassed talking to your doctors about sex. The answer is dependent on your specific injuries and restrictions as well as your overall health. Ask your surgeon directly about this.

General questions

   What is orthopaedic surgery?

The treatment of broken bones, injuries to tendons, muscles ligaments, or joints may require surgery. Surgeons who specifically work on muscles, tendons, ligaments, joints, and bones are orthopaedic surgeons. Orthopaedic surgeons may specialize in specific areas including: spine, tumors, hand, upper extremity, pediatrics (kids), foot and ankle, hip and knee total joint replacements, or sports medicine.

Orthopaedic surgeons are different from general surgeons. General surgeons typically operate on internal organs such as the stomach, kidneys, or bowel. There are other surgeons you may see after a trauma that are not orthopaedic surgeons, such as neurosurgeons or urologists.

   What is an orthopaedic trauma surgeon?

An orthopaedic trauma surgeon has training in muscle and bone injuries that result from trauma. Traumatic injuries can happen in many ways, including motor vehicle and motorcycle collisions, falls, weapon injuries, industrial accidents, etc. Orthopaedic trauma surgeons tend to have more training for treating injuries to the pelvis and hip joint than other orthopaedic specialties.

Don't confuse a general surgery trauma surgeon with an orthopaedic trauma surgeon. General surgeons typically operate on internal organs such as the stomach, kidneys, or bowel. If you had a major trauma, you may be seen and treated by both types of surgeons.

   What is the difference between a fracture and a broken bone?

There is no difference between a fracture and a break. There are different types and severities of broken bones, and your surgeon can explain why this is important when determining treatment. Some breaks are viewed with x-rays, and others are better explored with a CT or an MRI scan.

   What is "soft tissue?"

Soft tissue usually refers to skin, muscle, tendons, and ligaments. These are the things that surround or connect to the bones. One of a bone’s important purposes is to hold the soft tissue in the right place for the tissue to work to move your body. Sometimes the bones have to be fixed to allow your soft tissue to work correctly.

   What is a Level 1 trauma center?

Level 1 trauma centers are hospitals that specialize in treating patients with injuries resulting from a traumatic event, and have been "verified" to be able to provide that care. They have teams of surgeons trained in multiple specialties including; general surgery, orthopaedics, vascular, plastics, facial, and neuro surgeons. Trauma centers are "verified" by state agencies or surgical societies to ensure that they have the resources needed to treat trauma patients.

Other concerns

   Can I get handicapped parking?

A temporary handicap permit may be applicable if you have limited walking or carrying capacity. Every state has different requirements for granting permits, and permanent permits may have different requirements from temporary ones. You may wish to check with your local department of motor vehicles and/or their website to understand what is required before asking for a temporary permit. Sometimes your license will be suspended because of your disability and need for a handicapped permit.

   Can I get more pain pills?

Narcotic (opioid) overdoses and deaths are a major problem. Many states now have very restrictive narcotic prescription policies. For example, some states limit prescriptions to a 3-day supply, and doctors cannot call in refills over the telephone. your doctor denies a refill request, it may be due to state laws. Such laws are not flexible or based upon specific injuries. Many surgeons now use multiple drugs and methods to help treat your pain, including drugs such as acetaminophen (e.g. Tylenol) and ibuprofen (e.g. Motrin or Advil). Please ask your surgeon and/or your primary care doctor directly about what can be used to make your pain bearable.

   Can I have a muscle relaxer pill?

Some patients hope muscle relaxers will help with pain, sleep, or muscle spasms, but they do not help with any of those. Every medication has potential side effects, especially when combined with other medications such as narcotics (opioids), so your doctor may not recommend them. Nearly every issue after trauma and/or surgery subsides with time. As you get moving you will start to feel better.

   How can I get paperwork completed, such as FMLA or other?

Your surgeon's office can help you with this. Do your best to make it easier for your doctor and office staff to complete your paperwork. One option is to photocopy everything and fill out as much as you can on one copy and give both the partially completed and blank copy to the office staff. Don't expect the paperwork the same day as your appointment. Offer to come back, or ask to have the paperwork mailed, emailed, or faxed to wherever it needs to go. Due to the overwhelming demands of filling out paperwork for their many patients, some doctor's offices charge a fee for this helpful service.

   Can I/should I follow-up with someone closer to my house?

Of course, especially if you were injured while away from home. Just realize that no one understands your injuries as well as your treating team. If you do follow up with another doctor, request all your records and images in advance. If your orthopaedic surgeon cannot recommend another orthopaedic trauma surgeon in your home city and state, the Orthopaedic Trauma Association’s Find a Surgeon resource may help you out.

   Can I just go to an ER for follow-up?

In general, no. Emergency rooms have limited resources and should be reserved for emergencies; not to provide follow-up care. Your wounds and fractures are best evaluated in the office of your treating surgeon. Make every attempt to get back to see your treating doctors. They understand your injury and wound better than anyone else.

   Do I need to take antibiotics if I have dental work done?

There are many opinions on this topic. If you have metal hardware from fracture repair, then probably no. Antibiotics are recommended for a dental visit if you have an artificial joint replacement. For more information on this visit the American Academy of Orthopaedic Surgeons or the American Dental Association websites.

   Will I set off the metal detector at the airport?

You may or you may not, depending on the sensitivity of the detector. You can tell security you have metal in you before going through the detectors. They may ask to see your scars or do a more extensive search regardless of what you tell them. There is nothing your surgeon can give you to go through security more easily. Lots of people have knee and hip replacements and still travel without issue. Hardware from trauma is not very different from a total knee or a hip replacement.

   When flying, do I need a "card" describing my implant?

At one time, implant identification cards were given to patients with joint replacements. In the past 15 years, this has not been the case. Implants are either stainless steel, titanium, or other alloys. Many of these materials don’t activate metal detectors. Depending upon their location, length of time implanted, and the sensitivity of the scanner, some implants never trigger a metal detector.

   When flying, should I be concerned about blood clots?

You should discuss flying and the chance of blood clots with your surgeon. They may recommend a medication to prevent blot clots during long flights. During the flight, it’s a good idea to move your ankles and knees, and (when safe to do so) walk down the aisle occasionally. It is important to not just in one position the entire time; especially if it is a longer flight.

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