Hip Fracture for Art: The Fall in Paradise

(Last updated on: April 3, 2019)

Marooned in Honolulu for Eight Weeks…

hip fracture - fall warning icon

A hip fracture was this year’s uninvited surprise during my winter vacation.

Yes, ArtChester.net tries to deliver something new that’s useful or interesting, and also based in science. Today’s blog is not so much science as the personal story of my misadventure. My tale will offer advice for avoiding my slip-and-fall if you can, and for coping with it if you must.

This blog has three parts:

  • Hip Fracture for Art: The Fall in Paradise (this blog)
  • Hip Fracture 2: An Inside View of Skilled Nursing
  • And Hip Fracture 3: Recovery Worries, Insurance and Life Planning

A Hip Fracture in the Winter – with No Ice!

You may know that in the winter, Nola and I often spend six weeks at our condo in Maui. The most important reason we visit is that while we are not there, forty or so guests rent it for visits of three days to a month or more. Our guests are really thoughtful and careful but still, the condo needs annual maintenance. During our annual visit our contractor touches up paint, tile and furniture; and we replace furnishings, cookware and appliances that have worn or failed.

So that’s the why we visit. But the when has to do with winter in Michigan, which we are happy to briefly escape. Ironically, one reason to escape an icy winter is the hazard of a fall. However, I managed to have my fall on Maui, in downtown Lahaina, without the excuse of ice, snow or even drizzle!

hip fracture location in Lahaina

Nola and I checked in at Gerard’s, a favorite French restaurant, for a Saturday dinner. I was walking to the car to put our parking pass on the dashboard. Suddenly my left sneaker slipped on the sidewalk and I landed hard on my left hip, as suggested by the icon leading this blog. I was not bleeding or even bruised, yet I could not get off the ground without help. My left hip was immobile.

An Embarrassing – and Avoidable! – Hip Fracture

How could I manage to mis-step on a sidewalk that was not wet and not terribly uneven? Except when I was learning to ski in the 1970s, I have never before fallen. My balance is not perfect, but it’s generally pretty good.

I was wearing a dearly beloved pair of my Chung Shi sneakers that are comfortable and give me great foot support. However, I had not realized that my high-traction soles had worn down to the point of being – slippery! It was no wonder that they misbehaved when presented with a bit of imbalance.

I was really embarrassed to discover that the fault was 100% my own. Naturally, when I get home I plan to re-sole or discard any slick shoes in my wardrobe. Locking the barn after the horse…

In the Arms of Aloha

In the arms of Aloha

Hawaii is a friendly place and a dozen passersby instantly gathered round to help me. They lifted me into a chair, notified Nola, and helped me into our rental car, as a passenger of course. Nola drove to an urgent care center, Doctors On Call (DOC), and my experience with Hawaiian healthcare began.

DOC had an x-ray machine but the technician was gone for the day. So I purchased a walker from them and hobbled up the five steps to our condo. We returned the following morning for the x-ray, which revealed not much: that my femur was out of position and blocking the view. The doctor opined that my femur might be dislocated. So DOC called an ambulance and we zoomed across Maui with siren and red lights, to Maui Memorial Hospital.

The hospital Emergency Room took its own x-rays and gave me the news. No, my femur was not dislocated. But yes, it was out of position. In fact, it was jammed into the pelvis, having broken through the hip socket or acetabulum. I had a comminuted (splintered) hip fracture.

An acetabulum fracture was much more than a broken bone, which the Maui hospital might have been able to repair. Instead, it was a hip fracture calling for reconstruction of part of the pelvis. The necessary skills and equipment resided only on the island of Oahu.

The hospital summoned an air ambulance, a small plane with barely enough room for me on a gurney, two nurses, and the pilot. I arrived at The Queen’s Medical Center in Honolulu and Dr Lorrin Lee scheduled me for surgery at 7:00 am the following morning, 36 hours after my mishap.

Health Care, In Paradise? Who Needs It?

People think of Hawaii as Paradise, and they are mostly right. The weather, lush tropical vegetation and friendly people are pretty much heaven on earth. But since it’s not really Heaven, people need health care.

The annual US News survey counts 38 hospitals in the state of Hawaii, with at least one on each major island. However, only three of the 38 are considered worthy to be “ranked,” and all of those are in Honolulu. Thus, if you are anywhere else in the state of Hawaii, any significant medical problem means you will take an air ambulance to Oahu. Several friends on Maui have found this to be true – they invariably have to fly to Honolulu for procedures and therapies.

The Queen's Medical Center menu

The Queen’s Medical Center, where the Maui hospital sent me, is clearly the best of the 38. Queen’s is “High Performing” in a dozen specialties and procedures, including hip and knee replacement. The food is good too! I feel confident that I received the best care available in the state of Hawaii.

My previous surgeries were either elective or urgent-but-not-an-absolute-emergency. In contrast, this instance was an emergency requiring immediate surgery. I had no opportunity to thoughtfully consider which hospital I should patronize. Therefore I count myself lucky to wind up at Hawaii’s top hospital.

And You Should Retire – Where?

I have written before about logically choosing the best place to live as a senior, and finding the best facility at that location. But I am not always logical, and I find the idea of retirement to west Maui very appealing.

Fortunately, Nola is more sensible than I am. She points out that we have no relatives and few friends on Maui, and the hospital is much too far away. And as a result of my hip fracture, we have learned that even when you get to the Maui hospital, there’s a lot that they simply cannot do. Honolulu provides the only serious healthcare available in the state of Hawaii.

Art, Marooned by Emergency Surgery…

Art's hip fracture after repair by Lorrin Lee MD

Art’s hip fracture after repair by Lorrin Lee MD (click to enlarge)

During four hours of surgery, Dr Lee gathered the pieces of my pelvis and used them to repair my hip fracture. He installed a stainless steel plate and six screws to hold the broken sections in place. The hospital kept me for four more days and then discharged me to a skilled nursing facility for rehab.

The rehab therapy will take a long time. I should not put full weight on my left leg for 8 to 12 weeks after the surgery. That is how long it will take for the hip fracture repair to knit and for the soft tissues to recover. I’m receiving occupational and physical therapy to strengthen my muscles, but I can only make partial progress until my left hip can tolerate 100% of my body weight. At that time, I’ll have to re-learn to walk, which will take a bit more time.

Most of this is occurring where I am now, in Honolulu. Traveling to Michigan entails two long flights with a change on the West Coast, over 12 hours of travel. A long trip in cramped quarters offers many opportunities for a misstep, a lurch or even a fall. Any of those could put too much weight on my healing hip socket. If my pelvis broke while healing it would constitute a medical emergency, one occurring far from medical care.

So I am doomed to stay in Honolulu, receiving therapy and under supervision of my doctors. (Tough life, but someone has to do it…)

This Friday I will complete 7 weeks of therapy and will be safe to travel. When Nola and I fly to Michigan on Sunday I will have been in Honolulu for 8 weeks. Once I’m back home, my orthopedist will probably prescribe continued outpatient therapy. Total recovery is likely to take 6 to 12 months.

Hip Replacement versus Hip Repair

You might wonder, and I did ask: Why repair the hip socket instead of simply replacing the hip? Dr Lee explained that a hip replacement indeed heals more rapidly than a hip reconstruction. However, a hip replacement can be installed only with a stable foundation of pelvis and femur. My broken acetabulum disqualified me from a simpler surgery.

The fall caused an unknown amount of damage to my hip cartilage. In addition, the accident slightly re-shaped the end of my femur so that it no longer matches the curvature of my hip socket. For these reasons, Dr Lee advises that it’s likely that I’ll need a hip replacement in the future, perhaps even within a year. However, by then my pelvis should be solidly healed and able to support a joint replacement.

Have Your Hip Fracture Close to Home

I don’t need to tell you that a long unexpected extension in my visit to Hawaii really disrupts life for me and for Nola. We canceled tickets to 7 performances in Chicago and New York that we were planning to see with friends. We also canceled a cruise scheduled for August, because the shore excursions involve more uneven walking than I can commit to at this time.

The hip fracture is also hell on family life. Nola’s daughter and granddaughter came to Maui to keep her company, and Nola visited me in Honolulu. However, in mid-March she had to return to Michigan. Therefore, we have to cope with a long-distance marriage until I can recover sufficiently to re-join her there.

Think how much simpler things would have been if I had suffered a hip fracture in Michigan! No air travel. No long-distance calls from family, fraught with concern. Local surgery, local therapy and perhaps early release to our own home, despite its stairs and non-ADA layout. And of course, the comfort of family and familiar activities to relieve the boredom of therapy and healing.

Thus, my lessons to date are:

  • Don’t own shoes with slick soles! And:
  • Be extra-cautious when you travel. A health issue that would be manageable at home becomes an immense logistical, cost and medical problem when it occurs far from home.

As I heal I will have lots of time to ponder this adventure. I hope to gain insights that you will find useful or interesting, which I will share. In the meanwhile, keep your good balance! For more about my hip fracture recovery, see the next blog installment, Hip Fracture 2: An Inside View of Skilled Nursing.

Drawing Credit: Adapted from a patient safety reminder at The Queen’s Medical Center, Honolulu, HI

Image Credits:
– Gerard’s Restaurant image courtesy of Google Maps
– Girls in green dress dancing adapted from pixabay on pexels.com
Pelvis x-ray taken by the Clarence T C Ching Villas at St Francis, Honolulu, HI
– Other images by Art Chester


Comments

Hip Fracture for Art: The Fall in Paradise — 19 Comments

    • Thank you, Monica! I hope to be back in competitive trim – well, normal good health for me at least – as soon as I can. Stay healthy, yourself!
      Art

  1. Dear Art,

    Sorry to learn of your accident. Several thoughts:

    1. Ask the surgeon if it’s advisable to get a bone density test to see if you may be more susceptible to other complex bone injuries.

    2. I was in pain after my knee replacement surgery several years ago. For days, postsurgery, I was in severe pain. I was prescribed a derivative of an opioid to lessen the pain. It really didn’t relieve my pain, other than to make me woozy. I asked the doctor if we can stop the opioid, and, instead, try an anti-inflammatory, such as Celebrex, ibuprofen, etc. He agreed, and, from that point onwards, I was COMPLETELY painfree! I was very concerned about the outcome had I not proposed to try a less invasive anti-inflammatory initially, before opioids. I dread to think if I hadn’t suggested the anti-inflammatory, they may have simply increased the dosage of the opioid. Moral: Feel free to question/challenge them (give them a oral, qualifying exam). If their ego precedes them, demand a second opinion (hopefully not affiliated with the first), whose ego is barely visible in the distance.

    3. One of the so-called physical therapy protocols is to place electrodes on either side of the surgery, and, apply a repetitive pulsed waveform, that causes the skin to twitch. I always questioned the effect of this “treatment,” which was never compelling (it may be highly effective, so, deal with a grain of Pepper on this one).

    5. When I had the knee replacement, they would flex my leg to measure the range of motion… which, apparently, is one of their metrics that can be the quantatified. Every subsequent session, he would push the limits of this procedure, until I demanded that he stop, owing to the severe pain it created… I can’t say if this procedure is a good one. However, I suspect that the PT is more driven to “improve” this parameter as a measure of their personal success of this treatment…at my expense of severe pain. I insisted that he limit the range of motion test when I tell him that it’s enough. Again, he may be correct, but, I felt that I empirically struck a happy medium.

    6. In my case, the last thing on my mind was to be too aggressive and cavalier with my “progress” to gain his approval, however they choose to document it.

    7. And, let’s face it, as we age, our reflexes diminish somewhat, our sense of balance needs more to be desired, etc. This is to be considered in light of our ego, whose strong influence may not be in one’s best interest overall, especially when it comes to attempt physical motion of any kind, in a futile attempt to reclaim our fountain of youth. I try to focus a little more on each step I take to minimize the chance of slipping, hitting a small crack on the sidewalk, etc. “Avoid mental texting while in motion,” which is my new mantra, as I celebrate this New Year of the Ox on Crutches.

    • Hi David, and thanks for your sympathy and your advice.

      I’ve been getting bone density measurements for perhaps 20 years, during which time my orthopedist has coaxed my bones above 30-year-old-male standards. Perhaps that’s why my femur didn’t break as would be expected from a hip fall. However, since the pelvis wasn’t as strong as the femur, I simply acquired a rarer and more awkward type of injury.

      I have had very little pain, and that has made it easy to refuse opioids. The medical folks have offered Tylenol which I have taken once in a while when sore after therapy. So far, my physical therapy experience has been somewhat different from yours. I have seen no electrical plates, and my therapists have stopped whatever they were doing at the first instance of pain. Apparently they use a different system to measure progress. They have a difficult balancing act between helping the patient and qualifying for insurance reimbursement. Their company is proud of their algorithms because they are very close-mouthed about them!

      In any case, your mantra to focus on the task at hand – getting from here to there – is well taken. The OT portion of my 7 weeks of therapy had a strong focus on balance, and I think that my awareness of balance is much better now than weeks ago. Hopefully it will allow me to focus my attention productively!

      Best wishes, and stay healthy!

      Art

  2. Dear Art,
    I am truly sorry for the physical suffering you had and the following 8 weeks being stuck in Honolulu.
    On the other hand I am glad you got the best medical care in the paradise.
    Hopefully you will be happier in your home after Sunday.
    I will take your advice and check the soles of my shoes.
    Best wishes to you and Nola.

  3. Art: I calculate that I have over 15,000 bike miles, and another 33 million steps on my total replacement. With my orthopod’s approval, I was cycling 10 days after surgery. Heavy exercise is a critical.
    George

    • Wow, George, that’s some stress test you’re putting on your joint! Glad you got such a good replacement. I will certainly invest in exercise, but walking is more my cup of tea than cycling.

  4. This is incredible story. Follow your PT and you’ll be back in no time. 10 years ago I had my hip resurfaced after I ended up in bone on bone stage from OA. It is still working! I got many, many miles on it.

    • Wow, resurfaced already! Thanks for your wonderful success story Elena. I know from your posts that you indeed have many miles on your repair. May you have many many more!

  5. Art, what an amazing story. As we continue to age (hopefully) these events become more likely. It sounds like have had the best possible result. My hip replacement, 10 years ago, has been perfect, allowing me to continue cycling. That strong exercise is most important as you know. Thanks for highlighting the necessity for caution. Sara and I send our love,
    George

    • I’m glad to hear of your hip success, George. You’re getting great mileage out of the bionic one! Much love to you both…

  6. Art,
    Missing you and Nola this spring at Mon Reve. Your condition sounds miserable but less frightening than your last health issue.
    Get well soon.
    Dot

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