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Thank you for your time, and I do indeed intend to accept your answer. However, I wanted to clarify a few issues so that we can be less general.
My father had a stroke the month prior to his fall, but it was mild. He had carotid artery surgery, recovered well, and was able to walk on a walker with supervision. (This was due to a partial left hip replacement the year prior). His speech was affected a bit, but that was the most serious repercussion.
A month after the carotid artery surgery, he was in the ER for a skin rash. He was left unattended sitting on the edge of the gurney with no safety rails or equipment. He became itchy and fell off the gurney, which resulted in his right hip fracture and left shoulder fracture. He was discharged without diagnosing these injuries. 11 days later he was brought in because he hadn't been able to walk since this fall and was in increasing pain. He had total right hip replacement surgery and his left arm was put in a sling. The orthopedic surgeon showed that the implant was in place-nothing was wrong surgically.
My dad went to inpatient rehab following the hip surgery, but was unable to do much walking because he is left handed and his left arm was in a sling and his right hip had been replaced. He was in rehab for 8 weeks the first time and the most he could walk was 25 feet with supervision and assistance. Since then, he has not been able to walk at all.
His right leg is permanently contracted up; he cannot extend it. His doctor calls it neuropathic pain and avascular necrosis. He is on methadone twice a day for the pain.
1) what is avascular necrosis and how does that relate to these facts? Is it caused by the 11 day delay in surgical intervention?
2) Could this 11 day delay be the cause of his inability to walk now? I've heard that a delay in time to reduction can impair chances of successful recovery.
3) How does a contracture and neuropathy develop after surgery?
4) in this case, is it foreseeable that a total right hip replacement could result in this sad outcome?
Please help me get a handle on these issues. Thank you.
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Thank you so much for your thorough answer. I will accept and leave positive feed back. I do have one last question:
I guess what I am trying to get at, and you seem to have addressed this, is whether my dad's outcome is a foreseeable result of the fracture AND the surgery?
I know this is not a common outcome, but does it happen more frequently than I think it does? In other words, this is not a random, freak result.
It appears the THR went well-surgically, but the fact that his left shoulder was fractured at the same time (he's left handed) his right hip was fractured appeared to impair his rehabilitation since he could not weight bear on either side with any confidence. Also, would his right side weakness from his stroke contribute to poor rehab?
thanks so much for your time.