FREQUENTLY ASKED QUESTIONS

Category I When Can I……?

Question 1: When can I drive?

Research shows that you reaction times (from the accelerator to the brake) are not normal until you are ambulating without any assistive devices (i.e. a cane, crutch, or walker) for a month. Therefore, based on that research, I typically let patients with lower extremity injuries drive once they are able to ambulate without any kind of assistive devices for one month. Upper extremity injuries vary based on the injury but in general not for at least the first 6 weeks.

Questions 2: When can I weight bear?

In general, it will vary for the lower extremity injury but most fractures take roughly 3 months to heal. Oftentimes we can partial weight bear people somewhere around 6 to 8 weeks after their injury, but full weight bearing, particularly if it is an articular fracture, requires 12 weeks prior to being able to fully weight bear.

Question 3: When can I stop wearing my elastic stockings?

People with lower extremity injuries, I prefer to use elastic stockings to try to decrease the amount of swelling people generate during the day. Anytime you have a lower extremity injury there has been a disruption of the venous outflow system and can create a significant amount of swelling. Most people will wind up with some permanent swelling from the injury. The best way to try to address this swelling and return the patient back as close to normal ultimately is with the elastic stockings. I ask patients with lower extremity injuries to wear them for the first 6 months.

Question 4: When can I start Physical Therapy?

Formal physical therapy usually does not start for lower extremity injuries until the patient can fully weight bear. Most of the exercises that a patient needs to do can be accomplished with the patient working on their own as opposed to requiring going to physical therapy.

Patients with upper extremity injuries, depending on the injury, may start physical therapy after their first office visit from surgery, i.e. roughly 2 weeks after their surgery or may start it later, depending on the injury and how they are doing with their range of motion when they return for their first office visit.

Question 5: When can I go to Work/School?

I like for patients to return back to their normal daily routines as soon as possible. Obviously there are many jobs that require being fully weight bearing or to be able to fully use upper extremities. Therefore the patient is not able to return back to those jobs immediately. However, often times the employers will offer modified work duties and I think it is better for a patient to return back to a modified work duty and try to get back into their daily routines than to stay at home for several months during the healing process. I feel very strongly that the sooner the patient gets back into their daily routines the better off they do. In particular I feel very strongly the sooner the patient returns back to school, the better it is overall. They miss less schoolwork, and they miss less of the socialization process that happens at school. Not only am I opposed to patients staying home from school after an injury, but feel it is wrong when schools will refuse to allow patients into school during the time that they are on crutches.

Question 6: When can I shower?

I like to make sure that we have a good, stable, well-healed wound that is sealed prior to allowing patients to bathe. Therefore I encourage patients to wait until their first post-op visit. Once we can see the wound, remove their sutures prior to allowing them to shower or bathes. In general I prefer patients to shower as opposed to taking a bath, as I feel that a shower in general encompasses better hygiene.

Question 7: When can I leave the nursing home?

We are not responsible for when a patient is discharged from the nursing home. That decision to discharge a patient is made by the physician that is following the patient at the nursing home; he is the one who has admitting and hence discharging privileges. The decision as to when a patient is ready to be discharged is based on many factors that are centered around the patients safety; their ability to function independently and the extent of the supports the that the family can provide for the patient when they return back to their home. Therefore, as you can see, this will be different for every patient.


Category II (Will I……..?)

Question 1: Will I set off metal detectors?

Most patients with fractures that have been fixed with plates, screws, or nails will not set off metal detectors. It does depend on the particular metal detector, and it seems the ones at the County courthouse seem more sensitive than the ones at the airport. Patients who have had a hemiarthroplasty i.e. a hip replacement or partial hip replacement often times do set off metal detectors. If this is a concern of yours or if you are required to do a great deal of traveling, we can provide you with a card stating that you have an extremity with hardware in place to hopefully assist you in getting through metal detectors.

Question 2: Will I need to have my hardware removed?

In general, probably 80 to 90% of the hardware that we use to fix fractures will not be required to be removed. We do usually recommend removing all hardware in patients who are 18 years or less as they are still growing and often times can grow bone right up over the top of the hardware, making it impossible to be able to remove the hardware later on.

Some screws that we use around the ankle and foot region also require being removed. However that is injury dependent and we can review that, if it is a concern of yours, when you return to the office. Typically hardware removal is accomplished in the 4 to 6 month time frame or sometime after the hardware has been in for a full year.

Question 3: Will I get arthritis from this injury?

Obviously this depends on the particular injury. Injuries that involve the joint surface make this joint more likely to get arthritis later in life. However there are many factors that will play into this. Fracture that do not involve the joint surface and we are able to regain a good alignment, often times return the patient to nearly zero chance of increased risk for arthritis. Again, that is only in situations that we are able to retain anatomic or perfect alignment.


Category III Physical Therapy

Question 1: When can I start Physical Therapy?

Formal physical therapy usually does not start for lower extremity injuries until the patient can fully weight bear. Most of the exercises that a patient needs to do can be accomplished with the patient working on their own as opposed to requiring going to physical therapy.

Patients with upper extremity injuries, depending on the injury, may start physical therapy after their first office visit from surgery, i.e. roughly 2 weeks after their surgery or may start it later, depending on the injury and how they are doing with their range of motion when they return for their first office visit.

Question 2: Where do I need to go for Physical Therapy?

Physical Therapy can be addressed anywhere. We write out specific orders and we are available for physical therapists to call us at any time to address their questions. I feel very strongly that it is more important that you attend physical therapy someplace that is convenient so that you can attend more physical therapy appointments than it is to go to a specific physical therapist, as the exercises and activities that we are asking the therapists to help you with most physical therapists should be able to provide. I find that when a patient travels a distance to try to work with a particular physical therapist, the only thing that is accomplished is that they end up missing more physical therapy appointments because of the travel time. Therefore I feel very strongly that the closer the place is to your house, the better the overall outcome will end up.

Question 3: When can I start strengthening?

Strengthening is something we can always address at any time during the recovery process. I feel very strongly that we need to regain range of motion first and foremost. There is a brief window that will allow us to regain our motion. Beyond that time, it is very difficult to regain motion. Until we have regained for the most part all of the motion that we need to, I like to hold off on strengthening. The most important factor though is when the bone is at least healed enough – it may not be fully healed, but healed enough to allow for strengthening. Usually we can provide enough stability with the plates and screws or a rod or a nail to be able to allow working on range of motion exercises right from the very beginning. However rarely can we provide enough stability to be able to work on strengthening from the very beginning. However some cases may be different, but in general, most fractures will require at least 6 weeks and can require up to 12 weeks before beginning strengthening.

Tim Weber 2012