Elbow Surgery for HO

It's been one year and 3 months since Daniel's burn accident. It's been a long journey, but we've reached the point where an operation on his elbows is possible. We chose his right elbow for the first operation. Why? That's his dominant hand and it doesn't bend at all. The left elbow bends only a little, but it's bent at about 90 degrees and that's enough of a bend that he can feed his face, scratch his head and get a lot of other things (with difficulty and a bit of creativity) done. His right elbow is locked at about 45 degrees - so not as useful at this time except to put on socks.

We met with several orthopedic specialists and we think his orthopedic surgeon Dr. C. is great! We are fortunate to have her performing his surgery. She was very patient and thoughtful throughout the process of meeting, planning and performing the surgery. She had various other support people that we also met with and the team worked really well together. (Plastic surgeon, anesthesiologist, nurses, techs). She's also about to have a baby so there was a backup colleague observing and standing by in the OR - just in case!

Short recap: You may recall that the burn caused a somewhat rare response in his body that caused bone to grow outside of both his elbows. It happens in some burn patients. It's called heterotopic ossification or HO. I've written about it in prior posts so I won't go into more detail, but suffice to say - it sucks for all kinds of reasons!!

Daniel was super happy this morning. We had to get a bit crafty with preventing him from eating anything the entire morning and lunchtime. We tanked him up with food the night before, gave him an extra meal before bedtime and then kept him distracted in the morning. When we left for the hospital he was smiling and happy and skipping. When we arrived his festive mood continued. No one could be happier. Who does this before a major surgery?

He brought smiles to all the other waiting people in the surgery waiting area. We got him in his gown and he snuggled into his surgical bed with a warm blanket and waited while they prepped him with wires, monitors, and IV. It was only after a lot of boring discussion, signature releases, and poking/prodding that he got a bit quieter and settled down.

We received positive updates from the OR nurse after 2 hours, and after 3+ hours the operation was complete. We met with Dr. C. who had pictures to show his now extensive range of motion. Before he had zero, now he has from 20 - 135 degrees of motion in his elbow! That's about the best outcome possible we could have hoped for. Once he heals the range might lessen some, but for now we are excited with this result. If his recovery goes well he will be able to actually use his elbow again almost like a normal person!

Here is a picture where he is just recovering in the post-op area. Normally they don't allow family back in this area, but Dan gets special treatment - he's VIP.

So we are home now after a long day at St. Joseph's. Daniel has a huge dressing around his elbow. The tissue will drain and we were told to expect a lot of blood. With a procedure like this where you chip and hammer away actual bone there's a lot of bleeding since that's where blood is made - in yer bones ya' know? So a couple of days with this dressing, then there are drainage tubes that Dr. C. will remove. In less than two weeks she will remove his stitches and then we hope the healing will be far along. 

Starting tomorrow we will have him moving his elbow as much as we can. A little at first, then more as his pain and discomfort drops. We have a CPM machine to help bend his elbow slowly, but we also plan to assign as many activities as we can once he is more himself. For tonight he can sleep and rest up. 

It's super important to get his elbow moving as much as we can get away with. It might be painful at first, but Daniel is quite an awesome fellow. If there's one thing we've learned through all his surgeries and the painful recovery as a burn survivor it is how tough he is! There's also a drug (indomethacin) we will give for several weeks that is reported to help keep the HO from returning. The real therapy and movement begins tomorrow!