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.
What is Orthopaedic Surgery?
The treatment of broken bones may require surgeons with training in muscles, joints and bones. Surgeons who specifically work on muscles, joints and bones are Orthopaedic Surgeons. This is different from general surgeons. General surgeons typically operate on organs such as the stomach, kidneys or bowel. Orthopaedic surgeons may specialize in specific areas including: spine, tumors, hand, upper extremity, pediatrics (kids), foot and ankle, hip and knee total joint replacements, and sports.
What is an orthopaedic trauma surgeon?
This surgeon has training muscle and bone problems resulting from trauma. Trauma happens in many ways including: motor-vehicle and motor-cycle collisions, falls, weapon injuries, as well as industrial accidents. Trauma orthopaedic surgeons a tend to have more training for treating injuries to the pelvis and hip joint than other orthopaedic specialties.
What is a General Surgery Trauma Surgeon?
Don't confuse a general surgery trauma surgeon with an orthopaedic trauma surgeon. General surgeons typically operate on organs such as the stomach, kidneys or bowel You may be treated by both types of surgeons if you had major trauma.
What is the difference between a fracture and a broken bone?
There is no difference between a fracture and a break.
What is a level 1 trauma center?
These are special hospitals that specialize in treating patients with injuries resulting from a traumatic event. They have teams of surgeons trained in multiple specialties including; general surgery, orthopaedics, vascular, plastics, facial, and neuro surgeons. Trauma centers are reviewed by state agencies or surgical societies to ensure that they have the resources to treat the needs of their trauma patients.
What is the healing time for a broken bone?
Healing time depends on many factors. These include the blood supply to the bone, the amount of muscle and tissue that is near the bone, how badly it was broken, how old you are, and how healthy you are. In general, most fractures require 8-12 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: the foot, the wrist and the tibia (shin bone).
What is the healing time for ligaments?
A ligament attaches a bone to another bone. Ligaments can take several months to heal. This is due to the relatively poor blood supply to the ligament. Therefore, their healing time is longer than fractures. Every ligament is also different. Some ligaments don't heal completely.
What does the Term "Soft Tissue" refer to?
Soft Tissue usually refers to skin, muscle, tendons and ligament. These are the things that surround or connect to the bones.
How long before I can drive?
This is a complex question given the tough issue of when is it "safe" to operate a car. This is general information only and is only a very rough guideline. Please talk to your treating doctors.
Reaction time, decision making, the ability to move the steering wheel and push the peddles are some big factors that determine the ability to safely drive. You cannot be taking any narcotics or other reaction time altering medications. Some medications cause sleepiness and impaired decision making and cannot be combined with driving. You must be able to bear weight on the leg to use a foot pedal. Casts, splints or braces can get in the way of 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 safer to not drive. If you get in an accident, and your injury 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 arm or legs may limit the ability to do exercises or use equipment safely. It is important to remain as active as possible when recovering from your injury, while obeying the restrictions your doctor has talked to you about. This may mean doing different exercises then you are used to.
It is also important to realize than 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 smart to start with low impact activities before returning to higher impact ones. An example of this is using an elliptical before running on a treadmill.
How long before I can return to work?
This depends on the type of work you do and your specific injuries. Jobs where you have to be on your feet, have to be 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 and injures to determine your limitations, when you can return to work and in what capacity.
How long before I should start physical therapy?
Typically, your incisions and wounds need to be healed before motion and activity is started. The injury, splints and casts can cause joint stiffness. Sometimes therapy is needed to restore motion before your bones are fully healed. Therapy is sometimes used to help teach you how to move around and/ or do your activities of daily living. They will teach how to use crutches and walkers. Always consult your doctors before engaging in any work or exercise activities.
How long will I be in a cast/boot?
A lot of broken bones fractures are put back in the right place by the orthopaedic surgeon and then held in place with hardware. A cast, splint or a brace maybe used to protect the wound or to let the soft tissue "rest " and are used to different periods of time depending on your specific injury.
Some fractures can be treated with a cast only and need to stay on until the bone is healed enough to no longer need a cast.
Should I take my cast or boot off myself?
These should not be removed by you unless instructed by your doctor. Generally, a cast or splint should not to be removed by anyone besides 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 your skin may damage you skin and lead to an infection or other issues with your wound. If your splint or cast is bothering you, you should call your surgeon as soon as possible. Sometimes, removable boots or splints can be removed for physical therapy, motion activities, sleeping or bathing. You should ask your surgeon if this is okay.
How long will it take until my nerve heals?
It depends on how severely your nerve was injured. Nerves that are completely cut, severely pinched or bruised may never fully recover. It can take up to a month before the nerve starts to heal. From there nerves heal very slowly around an inch a month. Nerve healing may feel like "pins-and needles" or when your extremity "falls asleep". This can be painful as some of the first fibers of the nerve to heal are the pain fibers. As your nerve heals it may take a long time to heal enough to make your muscles work. It typically takes recovers by 12-18 months after the injury to know how much, of if, a nerve will recover. Ask your surgeon if you would benefit from physical or hand therapy while your nerve heals.
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 treating surgeon directly about this.
Can I, May I...
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, especially permanent ones. Consider visiting your local DMV and/or their website before asking for a temporary permit.
Can I get more pain pills?
Narcotic overdoses and deaths are a major problem in the U.S. In response to these issues, 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. The point is that if your doctor denies a refill request it may be due to new state laws limiting how much you can have. These laws are not flexible or based upon injury severity or your number of broken bones. A lot of surgeons now use multiple drugs and methods to help treat your pain including drugs such as Tylenol and Motrin. Please ask your surgeon and/or your primary care doctor directly about what can be used to make your pain bearable.
How can I get paperwork completed, such as FMLA or other?
The short answer is your surgeon's office can help you with this. Do your best to make it easier for your doctor and his/her 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 have the paperwork mailed, emailed, or faxed to wherever it needs to go. Due to the overwhelming demands of paperwork, some doctor's offices charge a fee for paperwork. So, be ready to pay for this time-consuming service.
Can I/ Should I Follow-up with someone closer to my house?
Of course, you can especially if your injured while away from home but realize no one understands your injuries as well as your treating doctors. If you will be following 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 try searching on the orthopaedic trauma association's website for another surgeon. Find a Surgeon
Can I just go to an ER for follow-up?
In general no. Emergency rooms are there to take care of emergencies not to provide follow up care. Your wounds and fractures are best evaluated in the office of your treating surgeon. The emergency department is not meant to be a follow-up clinic. Make every attempt to get back to see your treating doctors. They know your injury and wound better than anyone else.
Can I have a muscle relaxer pill?
The short answer is no. Some patients hope muscle relaxers will help with pain, sleep, or muscle spasms. They do not help with any of those. Every medication has potentially side effects, especially when combined with other medications such as narcotics. Nearly every issue after trauma and/or surgery subsides with time. For example, as you get moving and return to walking your low back pain from sitting in a wheelchair will get better.
What if I get dizzy or short of breath?
After a period of inactivity such as being in a hospital bed, and not moving around as much these feelings can be common. Or, they can be signs of something such as blood clots in your lungs. The best place for evaluation is your local emergency department. You don't necessarily have to travel back to the trauma 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 offices, but they will likely give the same recommendation. Do not delay getting care to call your surgeons office.
What do I do if my cast gets wet?
Even a wet cast can be effective in supporting an injury. Don't try to remove it on your own. The best place to get a new one is in your orthopaedic surgeon's office. He or she will know best what is needed and why. Sometimes x-rays are needed to make nothing has changed. Don't ever put anything inside your cast to scratch an itchy area. This can injure the skin and lead to an infection. Do not use a blow drier 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, splint incision site, or wound area. When this does not provide sufficient guidance then you can always go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon covering for them.
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 then you can always go to your primary care doctors officer or a local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon covering for him or her.
What if my pain suddenly gets worse?
The best place to get evaluated is in your orthopaedic surgeon's office. When this process does not provide sufficient guidance then you can always go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon covering for him or her.
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, then 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 things like walking. Try to follow the instructions of your surgeon.
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 always go to your local emergency room or primary care doctor for evaluation. They may be able to contact your doctor or another surgeon covering for them. Getting antibiotics from another doctor may improve the infection signs briefly. Sometimes, once the antibiotics are stopped the infection comes back. Always notify your treating surgeons of wound or surgical site concerns. Also keep track of the name of antibiotics taken and culture results if possible.
Is my fracture healing?
The best place to get evaluated is in your orthopaedic surgeon's office. When this process does not provide sufficient guidance then you can always go to your local emergency room for evaluation. The emergency room may be able to contact your doctor or another surgeon covering for Them. Some fractures heal more slowly than others. It does not mean that your care was wrong or inappropriate. Ask your surgeon how your fracture is healing. If it is healing slow then ask if there is anything you can do to help the healing. Some things that may help include asking about your diet, your vitamin levels and possibly about other medical issues you may have.
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 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. If you have swelling in both of your legs that could be from medical issues. A visit to your primary care doctor should be made.
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 all kinds of colors- essentially, it's a bruise. It may take months to fully resolve. Gravity will cause these color changes to track down the arm and the leg even if the injury was at the shoulder or the hip.
Why is my leg /ankle tingling after surgery?
Funny sensations after an injury or surgery are common. Much is due to the inflammation or swelling happening at the injury or surgery site. Some surgical incisions cut 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 now it is going away, you should contact your surgeon as soon as possible. This 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 into an emergency department to have this evaluated. It is best to ask your treating surgeon about what to expect long term.
Will my walking ever be the same?
Please ask your surgeon since they know your injuries and treatments. Sometimes walking will not be the same, and/or it may take up to a year to know. A hard part of the recovery process is not knowing what to expect. Your logbook is a great place to write down questions for your next doctor's visit.
Will my nerve ever work again?
Some nerves heal but require months or years to fully heal. The spinal cord does not typically heal. Some brain function can return after head trauma. 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.
What can I do to...
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. 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 approach to try and sleep include:
- Setting 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. But- do not nap during the day. Hopefully as some point you will be tired enough to fall asleep once you get into bed
- Limit stimulants like caffeine and alcohol.
- Limit stimulating light sources like TV, computer screens or your phone around bed time.
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. You should discuss your sleep concerns with your surgeon as well as your primary care physician.
Dentist office visits
Do I need to take antibiotics?
There are many opinions on this topic. In general, 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. To read more go to the American Academy of Orthopaedic Surgeon's website or the American Dental Associations website.
Flying related questions
Will I set off the metal detector?
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 easier. Lots of people have knee and hip replacements and still travel without issue. Hardware from your trauma is not very different then a total knee or a hip replacement.
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. Not all of these materials trigger metal detectors. Some implants depending upon their location and length of time implanted will never trigger a metal detector.
Do I need to do something about blood clots when flying?
You should discuss flying and the chance of blood clots with your surgeon. Sometimes they may recommend a medication to try and prevent these for long flights. Things you can do on the flight include moving your ankles and knees during the flight. You can walk down the aisle occasionally when safe to do so. It is important to not just sit there the entire time of the flight. Especially if it is a longer flight.