Hardware Removal Post-Operative Care

The following are after surgery instructions. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office:  (970) 879-4612 or (877)-404-4612.
CRUTCHES:
Usually we will not be using crutches for simple hardware removal of the lower extremities.  If it was more extensive we will advise you to use them and the amount of weight bearing allowed.  You may obtain crutches with a returnable deposit from Lyons Drug, City Market or Safeway, or borrow from a friend.
DRESSINGS:
You have a dressing over your wound. Although it is very unlikely, you may notice some bloody spotting coming through the dressing. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until we remove the dressing.  For most simple hardware removals we allow you to remove the dressing down to the steristrips or wound on the 3-4th day after surgery.  For example with absorbable suture, if surgery was on Thursday, you may remove the dressing on Sunday or Monday.  If the wound is dry, you may shower, minimizing the amount of soaking, and leave the wound dry.  If there is drainage, apply a lite sterile dressing and notify our office to arrange a wound check.
SUTURES Absorbable for small wounds:
The sutures utilized in closing any wounds will be an absorbable type, and will not need to be removed unless you are told otherwise.  The steristrips can be left on until they fall off or removed after 2 weeks.
SUTURES Nonabsorbable for larger wounds:
The sutures utilized in closing the wounds are nylon suture or stainless steel staples. We will remove these around 7-10 days after surgery.
ICE:
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days.  You can keep ice packs on the dressing for 30 minutes every 1-2 hours during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once you have removed the original dressing I would recommend ice applications to the region for only 20 minutes at a time up to every 2-3 hours as needed for pain and swelling.
PHYSICAL THERAPY:
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital.  If not then we may prescribe the exercises in our office or with the therapist at a later date when healing will allow.   All of the different therapy firms in our area are excellent with rehabilitation, so you are free to select your therapist.   Here are some simple exercises to keep the leg strong if the hardware removed was in the lower extremity.

Isometric Quadriceps Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down.
Straight Leg Raising: While lying on your back, hold your knee straight with the opposite knee bent and tighten your thigh. Then lift your leg a few inches off the floor and hold for several seconds.
Range of motion: Unless instructed otherwise, we encourage you to increase motion of your knee as soon as possible, within your comfort range. Bend and straighten your knee while sitting, or lying down. Increase motion as tolerated.
OFFICE FOLLOW-UP:
Please call our office within a few days following casting to schedule your first follow-up visit.  The exact timing of follow-up should be outlined after surgery.
MEDICATIONS:
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with, or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 600-800 mg three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure.  If you have kidney problems you should avoid these medications.
Plain tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg.  If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran).  Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.

COMPLICATIONS:
Most hardware removal surgery is safe and performed as outpatient, so complications are fortunately quite rare. The worse early problem is excessive swelling or wound drainage.  If you are having increasing pain unrelieved by the pain medications, pressure, the feeling the dressing is too tight, or numbness and tingling, the dressing may be too tight.  If this is unrelieved by elevation you may loosen the dressing.  If there is no relief you should seek immediate consultation either in the emergency room or our office.

The incidence of an infection is low after these procedures but can happen. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the wound, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner.  If we did not start this let us know.  If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized.  A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. Contact our office for any concems at 970-879-4612 or 877-404-4612.
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