Husbands injury - advice

[LanaL]

Hi
ive posted this here as it is about a relationship as it concerns my husband and this thread seems quite active . This is more for advice with the NHS

My husband had an accident with significant injuries ( there’s a complaint and possible negligence but that’s a long story ) so I’m trying to shorten it here .

He had a broken hip , broken shoulder and all ribs broken on one side . He was discharged, we believe unsafely , after surgery to repair his hip and shoulder ( advised to hop in and out of a large step to our home , told it was safe he could go out etc . No assessment , no one assessed our home or saw the step but we told them repeatedly and our concerns . Bear in mind using a crutch - both sides of his upper body are broken ) . The day after he came home he fell on the step and further damaged his hip and shoulder , damaging the pins put in and both breaks are actively deteriorating. The fall was 2 weeks ago. Before the fall he was healing well .

we went to a hospital appointment a few days after the second discharge to be told that his shoulder needs surgery asap ( still not had a date , we were told 1-2 weeks it’s been 2 weeks . ) With surgery he will have 80% function in his arm , leaving it will lead to complete loss of function as it’s deteriorating day by day. The original hospital told us he may need surgery - a nurse mentioned it in passing as he was being discharged- the new hospital knew nothing until we mentioned it then said it was an emergency. Had we not told them it would have been left.

Anyway , back to the main point. The new hospital told us at the appointment that his hip cannot be repaired by surgery , it’s actively deteriorating. This was all new information and unexpected . We had been led to believe his care was being transferred as the new hospital had a better surgical reconstruction team. The scan that day showed more damage than the scan a week before that he had just after his fall . They said they have two options . 1- a hip replacement if it continues to deteriorate- he would recover from a hip replacement within a few weeks , slowed down by his other injuries, but he would pretty much completely recover , be able to go back to his job ( a physical job but high paid and it’s his career he’s worked hard to move up and it’s all he has ever done - he’s 36 ) . No long term effects that would affect him day to day .
Option 2 - leave it to heal , if it stops deteriorating. But with this , he would need a replacement in 10 - 15 years anyway , but in the meantime he will have one leg significantly shorter than the other and have a permanent limp , need special built up shoes and have walking sticks permanently too. He won’t be able to do his job and his mobility will be affected in all areas of his life . This isn’t a “maybe” this is it , this is 100% what is going to happen without the replacement, the damage is already there and only replacing the hip will fix it.

My husband is 36, very active , we have children he plays football with them, he takes them swimming , he loves his job , he is the main income earner . This will kill him . His whole life affected , he will slip in to depression I know he will . This may not sound like a big thing either but he’s a very image conscious person - the amount of difference in the length of his legs means he can’t have discrete buildup inside his normal shoes it will be a specialist medical boot / shoe . The replacement would take all of this away and mean he can live a normal life , it would affect his ability for maybe extreme sports ( that’s fine ! ) but day to day he wouldn’t be affected and he would be able to do his job . As a side note the financial aspect will really affect us , as it stands I am not at work right now due to his care ( I have a post grad level career , newly qualified, but I work agency so no work = no pay ) and he was very newly self employed ( 6 weeks prior to accident ) so no income coming in - we have applied for universal credit but the income loss is about 70% . We have no savings . He asked the doctor if he could opt for the replacement- in an emotionally charged moment he said “ if I have to live like that I’ll end up killing myself “ - the response to all this was “ that’s not justification for a replacement” . The doctors reasoning was that there is no going back after a replacement and at his age they want to do what they can to save his hip - even though he had just said that they can’t , but he spoke as if him having permanent disabilities was the best option as “ most people cope ok “ but he has also just said that he categorically will not be able to do his job and that the sticks , limp , length difference is guaranteed and permanent- nothing they can do .

What can we do ? Can we push for the replacement ? Surely at 36 years old the replacement is the best option ?! He will have to have one in 10-15 years anyway but by then the prime of his life has passed . They also said that at some point the pins may start to protrude out of his hip and then if that got ‘too bad ‘ he might need a replacement. He worked hard to get where he is , I recently qualified in my field and agency work was temporary - I was going to go into a permanent salaried role once my son started college this year . My son is autistic and we don’t know what the future holds - I studied for my career so at this point , with my husband also recently making good progression , that we could begin to put things in place for his future … to save for a house so that we have some security for him and something to leave him so he doesn’t end up in the care of social services when he’s an adult if he’s not able to live independently and our time comes . This is impossible if he can’t continue to work . In 10-15 years my husbands prime part of his life is passed .

I don’t understand why they would leave him like that when there is an option. It’s not like we’re just saying we want it with no valid reason or to just make it a bit easier to recover - the entire course of our lives will change without it but most importantly my husband will have to live with permanent disabilities without it and I really worry how that will affect him and how he will cope .

Push hard and relentlessly for a hip replacement.

I felt sick reading this, I’m so sorry you are going through this. As above, keep pushing. I would suggest is there anyone else - close friend, family member - who could be your advocate in meetings with consultants as sometimes it is tough to keep up being relentless when you are so close to DH and affected by the emotion of the situation.

This is what I want to do , I just don’t know how ? Do i ask for a second opinion , is that something you are able to do ? I understand if it’s private you can but I just don’t know how to do this with the NHS I have never had to deal with anything like this , ever . I’m so clueless 😩

I have his family but obviously they are all as emotionally invested as me . I do have a friend who is an OT and has been giving me advice regarding his unsafe discharge but I wouldn’t want to bring her into the situation in that way as it’s her career .

I think I really need to pull my socks up and start being firmer x

I’m so sorry to read this, what an awful situation for you all.

When I was a small child my parents faced a similar situation, though not through an accident, it was a cancerous growth embedded into one of my Mums limbs. The prognosis was grim, no use of the limb, unable to work, do day to day things like put washing out or change bedding, not play sports (she was very active), swim, drive etc and she had two children both under 10.

Obviously, they were devastated and I am not 100% sure if they pushed for the second opinion (I am sure they must have) or if the doctor asked for help within the specialist field but they were referred to another hospital who came up with a completely different route they could take meaning she can do 90% of what I have listed above with the exception of sports incase of injuring the limb again. It’s not worth the risk.

I would absolutely advocate for the hip replacement and a second or even third opinion. Make sure you do your research and have questions prepared at each appointment. To echo another poster I would take someone with you who is able to remove the emotion from the appointments.

Hoping for a positive outcome 🙏🏻

Can family beg steal borrow to go private?

Not ideal but if it means he can earn again quicker and quality of life.

Of they refuse the hip replacement contact pals they are very good as resolving

Thank you for sharing that . It gives me hope . Im sorry to hear what your mother went through and I am glad she got that second opinion and was able to have a better prognosis x

Unfortunately not. They would if they could , everyone would . It’s something we have thought about but it’s a large deposit then high monthly payments that we simply can’t afford .

The sad thing is he was newly self employed , no insurance or anything sorted yet it was only a few weeks . With his previous job he had private health cover !

I’m so sorry your husband, you and your children are going through this awful time. Firstly absolutely push for a hip replacement. If they won’t ask for a second opinion you are entitled to one. Also speak to PALS every hospital has a PALS team they are there to help you if communication is difficult or breaks down with the drs and hospital staff. Look up the hospital your husband is under and search their website the PALS team details will be on there. I used them for my late Dad they was amazing and really helped when no one else would listen.

your husband would definitely have a better quality of life with the hip replacement do not allow the drs to force you into their plans just because they think it’s best, It obviously isn’t for your husband. Good luck 🤞

Bloody hell.

I wonder if they are thinking about the replacement of the hip replacement. They last 15 years ish, or used to, so at his age he’ll need a few of them and each redo is potentially more complicated.

Quality of life matters and what is clear is that your husband does not feel listened to. Ask for a second opinion?

Yes this is my thinking . It’s financial I’m sure - they know they will have to do another anyway ( we were told in the very early days of his accident that if he had a replacement he would still need another in around 15 years as it wouldn’t last as long as it would with an elderly patient due to how active people are at his age ) . So I imagine they are thinking that doing one now and having to do another in 10-15 years either way just adds the cost of another replacement. But I don’t think they truly understand the implications for him . A lot of doctors have said it’s unusual to have to deal with this type of injury in a man of his age so I feel like they are thinking of the impact of leaving it on how it affects elderly people as they said most people are ok with the mobility issues of the shorter leg etc and my husband did say yes I’m sure they are if they are elderly and not very active and he agreed x

He may well need another replacement in 15 years, but that's time for new developments and better technology to be developed. Also, quality of life is so important - who knows what else might happen in those 15 years, and they are years when your children are young and living at home, and need their Dad in the best shape he can be. You can definitely get a second opinion. Might be an idea to wait a bit for all the other injuries to heal before going ahead with the hip replacement - his body has a lot to cope with right now, but no reason why you can't get the wheels turning now.

Do you know where the break is? Osteonecrosis can be quite common in hip fractures (blood supply is reduced and the bone dies) depending where the break is And this could be the cause of the deterioration.

I would push for a second opinion. When i broke my hip I had a dynamic hip screw and told to get walking asap as my hip was now fully weight bearing so i wonder if perhaps the decision to pin or replace was 50/50 at the time.

Have you considered going abroad? Apparently people are doing it to avoid the waits in the UK, but it can also be cheaper.
https://www.theguardian.com/society/2023/jan/21/not-medical-tourism-desperation-britons-resort-treatment-abroad
https://www.bbc.com/news/uk-wales-62993311

If it reassures you a bit, it's not true any more that hip replacements only last 15 years. The new ones being used these days will likely last much longer than that. I just had it done and was told 30 years at least, possibly more. (I'm late 40s)

I can recommend the tertiary Orthopeadic Hospital my DD is still under. They are world leaders in complex bone repairs, replacements and similar and could be a good choice for a second opnion if you can get to them. DD has been under their care for 11 years, she will need a hip replacement sooner rather than later and has had additional surgery and active pain management but the care she has had from the consultant surgeons has been absolutely fantastic as they get to know of the newer incoming replacement options better suited for under 40s before it reaches local hospitals.

I really don't know how relevant this is but I heard a clip of some celeb talking about his hip replacement and he said that he chose a ceramic hip replacement and that they last a lot longer than the ones traditionally used. I really don't know if that helps at all when you are struggling to get them to agree to anything but it might be something to look into.

I hope you and your husband manage to get what you need, it sounds like a really awful situation for all involved.

I have seen it on the scan , quite hard to describe but yes they did tell us that the blood flow could be restricted and could cause it to deteriorate. But scans after the op and before discharge showed no sign of that and they have said that the bent pins have compressed the fracture and that’s making it collapse .

It was very close at the time of surgery - they said they wouldn’t really know for sure if it would be repair or replace until in theatre ( although I would have thought that would mean that they wouldn’t have done a replacement there and then as surely they would need a prosthetic hip ready and wouldn’t just have one there in case ) . It was also very close after the fall - the doctor originally said he didn’t think they could save the hip and were on the fence about what to do . They then came back and told us that they were having a board meeting with 20 doctors to discuss the case and how to move forward and then a decision was still not made which is why they contacted the other hospital for advice ( they had apparently gave advice for his first surgery ) then the new hospital asked for his care to be transferred over to them and they wanted to see him x

Definitely contact PALS (Patient Advice and Liaison Service) for the hospital (contact info will be on the hospital homepage of website). Tell them everything that you have mentioned here and tell them you are not happy and want a second opinion/the hip replacement. They usually respond within 48hrs. I hope this helps.

Thank you everyone .

I feel like it just gets worse .

It was last Tuesday that we were at the hospital and got the news and also where they said his shoulder needs operating on ASAP . They said if it’s left he will lose function of his arm completely, already he’s lost 20% even with surgery. They told us surgery would be during last week or during this week but stressed the importance of needing to do it asap. It’s now Thursday and we have heard nothing , so it’s clearly not going to be this week .

He is in more pain with it and now unable to move it barely , whereas before he could a bit . So I’m worried it’s deteriorated more. I have been trying to call the hospital to find out and being passed from pillar to post , unable to be told anything as we don’t know the name of the surgeon operating . We have nothing with his name on , we met him once that day . We did find a name on the consultant directory that we think may be him so tried to call his secretary with no answer, emailed - no reply. Emailed booking dept at the hospital - no reply. Managed to actually speak to someone as the hospital today , gave all the details and stressed the importance we were told and the fact it’s clearly getting worse and was told an email had been sent to everyone in the Trauma and Orthopaedic dept and I should hear back from them today but there was nothing on the system to indicate that there was any surgery booked for him . Lo and behold , no one has called and now I can’t get through to anyone .

Im worried this is going to end up meaning that he loses use of his arm on top of everything going on with his hip and I just don’t know what to do. I have never felt so helpless and so let down . It’s like screaming at a brick wall .

I am a patient and understanding person and I would usually understand that with surgeries other cases come in and take priority but the consultant stressed the need for this surgery and the implications of not having it soon enough ! I’m worried the lack of communication between the two hospitals has led to it being overlooked .

Could you go to A&E at the hospital and say he cant move his arm and is in agony with it? I think thats what I would do.

What have PALs said?

In all honesty if there is a rapid determination in movement plus pain head straight back to A&E to be on the safest side. They can offer decent pain meds and an assessment by the trauma orthopeadic on duty. My DD was sent home with a known life changing injury. Ended up in hospital for two weeks. Surgeons were very unsure if surgery had worked so they advised us to go straight back to A&E. TBH they set up bi-daily. Fracture clinic appointments so an ortho-surgeon could keep a very close eye on her.

It really is horrible to watch someone you love struggle and be in pain from bone injuries that will not heal. To have to face lots of extra time sensitive surgery that can get cancelled becuase someone has ended in resus and taken out the orthopeadic surgeons planned ops. Add a limited chance of being able to eventually recover to do everything a person used to be able to do then yes your concerns are legitimate. I doubt I would have stayed sane without the support of a charity as I learned the crash course in caring for a person whose life had changed in the blink of an eye. I have looked through my Ortho Fb contacts and this charity is one that might be worth contacting for support for an adult with potentially life changing injuries from trauma. They also offer support for the persons family including financial advice on accessing benefits et al. They may also be able to help you fight his corner with your local NHS Trust. Be kind and gentle with yourself. No one sane would choose to have to deal with this and it comes with a very steep learning curve so be kind and gentle with yourself and remember it’s okay to take a few short rest breaks from having to fight be that a coffee takeout shared together in the hospital to a take away over a film at home.
https://www.dayonetrauma.org/

Stay at A&E.
Call PALS. And keep following up.
I would urgently email your MP as well.
This is really really bad - time to advocate, big time.