Red Flags: Warning Signs That Need Immediate Attention

Use Your Discharge Instructions First

Your treating team's written emergency instructions take priority because normal postoperative findings and escalation thresholds vary by operation. This page cannot diagnose a complication. If symptoms are severe, rapidly worsening, or you cannot reach the treating team, use local emergency services rather than waiting for a scheduled visit.

Seek Emergency Care Now

• New shortness of breath, chest pain, coughing blood, fainting, severe lightheadedness, or a fast or irregular heartbeat. These can be signs of pulmonary embolism or another emergency. ^[1]
• Severe or rapidly increasing pain that is out of proportion, especially with a tense or swollen limb or pain when the toes or ankle are passively moved. Numbness or paralysis can be late signs of acute compartment syndrome. ^[2]
• A foot or toes that become cold, pale, blue, markedly discolored, or newly difficult to move, or an instructed pulse check that becomes absent.
• New major motor loss such as foot drop, inability to move the ankle or toes, or rapidly progressive weakness.
• Uncontrolled bleeding, rapidly expanding swelling, loss of consciousness, confusion, or any symptom your discharge plan identifies as an emergency.

Contact the Surgical Team the Same Day

• New one-sided leg swelling, pain or tenderness, warmth, redness, or discoloration. DVT can also occur without obvious symptoms, so a new concerning pattern needs clinical assessment rather than self-diagnosis. ^[1]
• Fever at or above the threshold in your discharge instructions; spreading redness; increasing warmth, swelling, or pain; pus or foul-smelling drainage; wound separation; or feeling systemically unwell. ^[3][4]
• New or worsening numbness, tingling, burning, electric-shock pain, sensory loss, or weakness, even if some discomfort was expected.
• A new pain pattern, a sudden increase after prior improvement, pain not controlled by the prescribed plan, or pain associated with a fall or unintended loading.
• The nail or frame does not behave as instructed; an external component loosens or breaks; a pin moves; distraction measurements diverge; or there is clicking, grinding, deformity, or loss of alignment.
• A meaningful or progressive loss of knee, hip, or ankle motion, loss of heel contact, or inability to achieve the therapy targets set by the team.

When Distraction Does Not Match the Plan

A controller error or unexpected measurement can reflect positioning, user technique, premature consolidation, implant malfunction, or another issue. Record the message and what happened, stop repeating attempts beyond the device instructions, and contact the team for guidance and imaging. Do not compensate by adding unscheduled sessions.

Prepare for Care Away From the Surgical Center

• Carry the operation note, implant card, medication list, allergy list, anticoagulation plan, recent images, and surgeon contact details.
• Know the nearest emergency department able to obtain radiographs and evaluate postoperative orthopedic and vascular symptoms.
• Agree in advance which symptoms require local emergency care, same-day surgeon contact, or return to the operating center.
• Have an after-hours route that does not depend on social media or a single coordinator.