Another Femur Fracture

Our lives once again changed in an instant. Friday, March 13th started wonderfully with warm weather and great report cards for Travis and Barrett. Late that afternoon (around 5:20p) T, Barrett, and neighbor kids were playing outside when our dog ran into T that resulted in T's left femur fracturing immediately below the lowest screw on the metal plate. We knew pretty quick that T's femur was fractured again, we quickly gathered a few things and headed to the ER.

Travis requested Nolan hold his leg on the way to the Primary's again this time and we tried to avoid all the bumps on the road. Nolan stayed in the car with Travis while I went to the front desk at the ER to get help bringing T into the ER. (Barrett had an in-town hockey tournament game that night and Scott stayed with B until B's coach picked him up.) Landon was great getting T into the ER and very soon T was in a room. The doctor arrived quickly and he ordered an IV and pain meds after his assessment. You could see the lower femur was broken looking at T's leg, the doctors wanted to make sure that T's leg wasn't normally firm where the break was. We were asked that question several times.

T cried when it happened (that scream you know when something is wrong), yet he didn't cry on the way to the ER or waiting for the pain medicine. I'm not sure where his mind goes during the time of intense pain, he is the strongest person I will ever know. When asked in the ER room to rate his pain from 0 to 10, he replied "13"...with no tears.

He headed to x-ray shortly after receiving fentanyl for pain. We saw the images when they loaded into the computer...

Fracture - top view

Fracture - side/frog view

The hardest part of obtaining the images is when they move him to get the side view / frog leg position. That was only 1 of 2 times he cried after the initial fracture. We headed back to the room and a little while later our friend Jean joined us for the evening.

Here's where things start to blur for me on timing...We told the resident that before any surgery was done, we wanted either Dr. Lor Randall (orthopedic surgeon) or Dr. Kevin Jones (performed prior surgery) to be called for a consultation. I don't think he realized the complexity of Travis' situation. We learned the orthopedic doctor at Primary's that night also has privileges at Shriners, I think she was the same person that was there when he fractured last July. (She gave the guys at Shriners a heads up the next morning when he fractured the first time).

Dr. Jones had a biopsy that night and they were able to speak with him. ***Big sigh of relief***

Scott dropped Nolan off at the hockey rink close by for Nolan to ref hockey games. Since Travis ate a snack around 4:30 and there was no need for immediate surgery, midnight would be the earliest time the anesthesiologist would be ok with surgery. We were still waiting for the doctors to determine when the surgery would be and Travis wanted to eat. We're glad he was feeling really good and wanting to eat then. We also contacted some of Travis' doctors to see if we could line things up where samples could be collected during surgery for research purposes.

Sometime around 9:00p they moved Travis to the RTU (rapid treatment unit) near the ER and on the way there Travis learned that he could eat. He thoroughly enjoyed the 3 or 4 packages of Oreos, 3 cartons of chocolate milk, some mac and cheese, yogurt, and more. He knew what was ahead.

Around 12:30a, Dr. Jones arrived to see Travis and discuss plans for surgery. He stated he hadn't seen the x-ray images yet, but was thinking of removing some of the narrow part of the femur during surgery. He needed to make sure his schedule allowed, but he hoped to be able to do the surgery at 1p on Saturday. Travis finally fell asleep at 1:30a and started crying out in pain around 3a. They administered more pain meds and he fell back asleep for a few hours before needing more medicine. He wanted me to sleep next to him and that also helped.

We had Travis sleep in on Saturday morning since we knew his surgery was at 1p (or later depending if there were other traumas or other surgeries ran long). He remained in good spirits during that time.

Prepped and ready for the OR

Around 1p Travis headed up to the OR prep area and we met with the surgical team. We spoke with Dr. Viskochil and he said things were ready for the samples for research. :) Hopefully something good will come from the research. We spoke with Dr. Jones and his plan (subject to change once he opened up Travis) was to take out the plate, remove the narrow portion of the femur, and insert a rod in the center of the femur. Hugs and kisses and Travis was heading to the OR. The initial thought was surgery would be 2-3 hours, maybe as short as 1.5 hours if all went well.

1:20p - Travis headed to the OR
3:20p - Call from OR nurse...no surprises, the old hardware is out and they were starting to put the rod in. Probably another 1.5 hours.
5:00p - Call from OR nurse...they had to put in a few more screws and then they'll close. Probably 30 more minutes. The screws were harder to put in
6:00p - Call from OR...still in surgery and T needs a blood transfusion due to blood loss. Travis is OK.
6:20p - Dr. Jones came to talk with us, surgery was a success.
7:22p - We went back to recovery to see T
8:00p - Travis arrived in his room

In recovery, I love how all 3 stuffed animals received bandages.

Surgery info...Dr. Jones removed the old hardware, removed ~5 cm of the narrow part of the femur, and inserted a rod down the center of the femur. They were able to get 4 vials of samples for research and did a biopsy of the plexiform down by Travis knee (checking to see if the tumor is still happy). Travis lost ~600ml of blood during surgery (approx 1/3 of his blood volume), not unexpected given all the tumor mass.

Images of the rod in the left femur

More views of the rod in the left femur

Travis had a good night Saturday night and we both slept as good as possible in a hospital. Travis stayed comfortable during the night. He had a frustrating morning Sunday, it's really hard seeing him like that. He wanted a sprinkled donut at breakfast and the one that arrived had too many sprinkles according to Travis. You know he doesn't feel good then.

The overly sprinkled donut

Sleeping after a rough Sunday morning

He rocked out PT (no surprise) and quickly adjusted to walking again while needing the walker for support. He was worn out after PT and quickly fell asleep, we both did. We had the NASCAR race on during the nap and he woke up feeling refreshed. He enjoyed watching the end of the race and even wanted to play on his iPad. :)

Travis playing iPad after watching NASCAR

Dr. Jones stopped by on Sunday late afternoon/evening and was pleased at how Travis looked at the time, especially considering it was less than 24 hours since Travis was in surgery. :)  He said that the rod is a better overall for T as it provides more stability. (We always have the bone healing question/issue not matter what was done.) We looked at Travis' leg length difference and it has been years since we have seen Travis' legs about 1" different in length. He said that the recovery will be similar to last time, maybe even a little quicker due to the rod. Travis can do things, but stop if it starts to hurt. As far as school goes...again, see how he feels.

T's new leg length discrepancy...bye, bye 3+ inch difference

We received a nice surprise on Sunday, the hardware (cleaned) from Travis' first break. I thought those would be included in the research stuff, but they probably got enough samples during surgery.

T's hardware

Travis did great again last night, we both slept beautifully. Certain positions cause great pain for T (we'll talk with the doctor about that), but most of the time he's ok. He enjoyed watching "Dolphin Tale 2" today and I think that helped some in his emotional healing.

Thank you for all the thoughts, prayers, offers, and support during this time.