Broken Tib/Fib : seeking knowledge

[azrider]

Yep. As title implies, I somehow managed to break tib/fib, non compound, and shattered my ankle. All it took was .05 seconds of inattention on a non technical (almost f'ing walking trail) singletrack and this is end result. Had surgery the same night it happened and coincidentally the two Orthos who performed surgery AND the medical device rep who sells the plates, screws, rod they put in my leg all ride for my team/club. Small world.

Anyway.

Questions are these. Anyone have any advice on bone stimulators? Found some online for $200 range and want to know if they're worth it.

Also. Doc said I'd have Intermedullary Rod in my leg for rest of my life. Anyone have the same?

Finally...I know everyone is different and doc already said he's seeing signs of bone growth (i'm 4 weeks post op), but how soon can i realistically start trying to walk with a cane? I'm partial weight bearing but these crutches are driving me f'ing mad.

Thanks all

[RonW87]

Broke my femur in mid-November. Non-displaced fracture. They inserted an Intermedullary Rod and two screws. I could weight-bear (a little) the day after surgery. I was on the trainer four weeks later and on the bike at Xmas. Still have occasional dull pain in my thigh, but no biggie.

[bigreen505]

Yep. As title implies, I somehow managed to break tib/fib, non compound, and shattered my ankle. All it took was .05 seconds of inattention on a non technical (almost f'ing walking trail) singletrack and this is end result.

Ouch! That sucks.

Questions are these. Anyone have any advice on bone stimulators? Found some online for $200 range and want to know if they're worth it.


From what I was told, the research is somewhat inconclusive. If you are seeing signs of bone growth that is a good thing. If you are willing to take a $200 gamble, sure go for it, it won't hurt anything. The bones will probably heal just fine without it, the stimulator may speed things up though.


Also. Doc said I'd have Intermedullary Rod in my leg for rest of my life. Anyone have the same?


I wouldn't take that as gospel, but if it isn't causing any problems there is no reason to take it out. Bones not healing properly or pain/other issues could be a reason to take it out. A friend of mine had a rod put it, had it replaced with a stiffer rod, then removed completely because it hurt and was causing problems. She didn't heal completely until it was removed.

I'm assuming the doctor will remove the bottom screws after six - eight weeks? I started feeling immediately better when the bottom screw came out.


Finally...I know everyone is different and doc already said he's seeing signs of bone growth (i'm 4 weeks post op), but how soon can i realistically start trying to walk with a cane? I'm partial weight bearing but these crutches are driving me f'ing mad.

Thanks all

Probably after the bottom screws come out. You need to ask the doctor what partial means -- 50%, 90%? I only did two crutches for a week or two, and one crutch for a while after that. You would be surprised how much easier it is. To me, with absolutely no medical training, I would be most concerned about your ankle. Your leg is bolted together, you can't really do anything bad to it. When you can put weight on it without it hurting, you can put weight on it.

My recovery is documented here (http://billgreen.tumblr.com/) in reverse chronological order, so if you want to read it start on the last page.

Since this is a cycling blog and should have some bike content, you might consider getting some pedals with easy entry and release. I have Dura Ace pedals, and it was a long time before I could get my leg out without pain. Look and Speedplay can be adjusted for easier release. I would not blindly assume that your legs are the same length as they were before the injury. I was not healing as fast as the doctors wanted, so they pulled the bottom screw to let the bones crunch into each other so not as much bone would need to fill in. The bad news was I lost about a centimeter or a bit more from my leg. The good news is that removed my leg length discrepancy and I don't need cleat shims any longer.

Understand that regardless of what your doctors said, this is a major injury, it does take a long time to recover, and when you start riding again you will have a lot of scar tissue to crunch out. Also, there may be some level of damage to minor tendons and supporting muscles that will take time to rebuild and restrengthen. Find a good PT who works with athletes. I'm about a year and a half post injury and am just starting to be able to hop on one foot -- not completely, but almost.

EDIT: Looking at your x-rays, yours look better now than mine did at 9 months out. Seems like a pretty clean break.

[steelbikerider]

Talk to your ortho - he would know best. Being in your club, he would understand your desire to get back on the road ASAP.

[azrider]

Understand that regardless of what your doctors said, this is a major injury, it does take a long time to recover, and when you start riding again you will have a lot of scar tissue to crunch out. Also, there may be some level of damage to minor tendons and supporting muscles that will take time to rebuild and restrengthen. Find a good PT who works with athletes. I'm about a year and a half post injury and am just starting to be able to hop on one foot -- not completely, but almost.

EDIT: Looking at your x-rays, yours look better now than mine did at 9 months out. Seems like a pretty clean break.

Tons of good stuff. Thank you very much. Last my Ortho and I spoke he's pretty convinced all hardware will be staying put. He brought up fact that if i did want it removed (must wait at least 24 monts before it's even on table) that there would be 4-5 weeks recovery for getting it removed so not sure what i'll do.


Talk to your ortho - he would know best. Being in your club, he would understand your desire to get back on the road ASAP.

Of course he would know best but just seeking input from others and honestly above all else i've realized that sometimes it's better just sharing this God awful expereince with others and talking about it...............which to me........is a very new concept.

[JasonF]

Among multiple other fractures (T7 vertebrae, both arms, multiple facial fractures, most fingers, etc...) I had an open (i.e., compound) tib-fib fracture that was actually broken in 7 places. I got the worst of a run-in with an illegally-overweight and out of control cement truck while riding.

The image was taken 2 years post-op when I reached "maximum medical improvement" and that final fracture (mid-tibia) never healed. By this point, the screws securing the rod inside the tibia had been removed since they had become dynamised.

To your questions:
1. My insurance paid for a bone growth stimulator and I'd be shocked if yours didn't either since the alternative could be PT for many years. The stimulator was used on one very bad fracture near the ankle that if it didn't heal, would have meant much pain forever. The stimulator did its job.

2. I've had the rod/plate/screws, etc, etc...since 2002. There is pain, and it's really bad in higher humidity. It basically feels like my leg is going to explode from the inside-out. I have some edema in my shin and my wife is kind enough to help massage the leg when it's bad. I'm 44 now and finding I'm less tolerant of the weather so we're planning a move to a drier climate (probably Santa Barbara area from NJ) within the next few years.

3. I had a "re-do" of the rod and I was forced by my surgeon to begin walking out of the recovery room. Realistically, I wasn't ambulatory for about 4-5 months.

Good luck, that looks like a nasty fracture but it sounds like you're well on your way to recovery. As others have said, this is a very serious injury and you'll need to take your docs advice, give it time and adjust accordingly. Believe it or not, I found the site mybrokenleg.com to be helpful.

Jason

[tiretrax]

Call the club doc - don't ask us. I wish you a speedy and full recovery.

[MattTuck]

I feel for you my friend :( atleast you're in AZ, so you're not missing the prime cycling season.

Speedy recovery.


For what it's worth, I'd focus on eating a super healthy diet, good balance of macronutrients and micronutrients. Lots of veggies with vitamins, organic if you can, etc.

That would probably have more impact than a bone stimulator.

[FlashUNC]

I'll stop complaining about my non-weight bearing elbow fracture after seeing that. Can't even imagine what a leg fracture like that is like.

FWIW, doc has told me the two plates around my humerus and the one covering the end of my ulna will be in there for the duration, along with the bakers' dozen of screws holding it all in place. And I'll second the other poster who mentioned it, high humidity days it is particularly creaky and achy.

[azrider]

To your questions:
1. My insurance paid for a bone growth stimulator and I'd be shocked if yours didn't either since the alternative could be PT for many years. The stimulator was used on one very bad fracture near the ankle that if it didn't heal, would have meant much pain forever. The stimulator did its job.

Good luck, that looks like a nasty fracture but it sounds like you're well on your way to recovery. As others have said, this is a very serious injury and you'll need to take your docs advice, give it time and adjust accordingly. Believe it or not, I found the site mybrokenleg.com to be helpful.
Jason

Thanks for the info sir. As matter fact I did go to Mybrokenleg and it scared the living crap out of me. People had stories of being bed ridden for months and on crutches for months (instead of weeks) so i quickly stopped reading.

I feel for you my friend :( atleast you're in AZ, so you're not missing the prime cycling season.

Speedy recovery.


For what it's worth, I'd focus on eating a super healthy diet, good balance of macronutrients and micronutrients. Lots of veggies with vitamins, organic if you can, etc.

That would probably have more impact than a bone stimulator.

Thanks for kind words. Very true words in regards to diet and that keeps getting mentioned by doc and head nurse. They shared same sentiments....and you're right on in regards to weather...who the hell wants to ride when it's 120 anyway.

I'll stop complaining about my non-weight bearing elbow fracture after seeing that. Can't even imagine what a leg fracture like that is like.

trust me....it's hell. Sucks big time.

[soulspinner]

Dude keep that rubba down

[aosty]

Also. Doc said I'd have Intermedullary Rod in my leg for rest of my life. Anyone have the same?


I had a very similar crash and injury and rod.

The bottom screws were removed after a year It was recommended, and I opted, to have the the rod removed after a few years. Given my age (relatively young mid-30's, at the time), a foreign object in my body carries higher risk of harboring latent infection (over many decades) and being active = risk for leg injury = very bad with rod in there.

If there's a complication/infection, especially later in life, it can potentially become a serious factor/problem.

YMMV

[azrider]

I had a very similar crash and injury and rod.

The bottom screws were removed after a year It was recommended, and I opted, to have the the rod removed after a few years. Given my age (relatively young mid-30's, at the time), a foreign object in my body carries higher risk of harboring latent infection (over many decades) and being active = risk for leg injury = very bad with rod in there.

If there's a complication/infection, especially later in life, it can potentially become a serious factor/problem.

YMMV

How long were you out for when you had the bottom screws removed?

Curious: how long were you non weight bearing?

[12snap]

I had a severe tibial plateau fracture about 15 years ago. My ortho had been practicing for 25 years at that point and said it was the worst he had ever seen. Basically the top 2-3 inches of bone were shattered like a jigsaw puzzle. I had a 3.5 inch plate and 14 screws and some bone grafts holding it together for awhile. I was non weight bearing for 6 months after the surgery.

I no longer have any hardware in my leg. My ortho had also told me the hardware was most likely permanent. But he also told me that if they were bothering me to come back and we could talk about it. I had them removed as soon as possible. They weren't unbearable but I knew it would get worse as I aged. Yes, there was downtime from getting them removed but I'm so glad I had it done. I'm not a doctor but in my opinion the plate and small screws should be able to come out at some point with no issues. The rod may be a different story.

I also used a bone stimulator. Yes, it worked. However, it worked too well. Long after I stopped using it, the bone continued to grow. I now have a "lumpy" knee; i.e.: extra bone mass. It sticks out on the inside of my knee and the tendons and ligaments rub against it and cause pain and soreness. As long as I'm diligent with going to the gym and/or riding to keep muscle mass in my thigh, it's ok. If I slack, it let's me know. If I had to do it over again I would choose to not use a bone stimulator. That extra bone mass is by far the worst lingering side effect of my accident.

Technology has changed quite a bit since I used the bone stimulator back in 1998. Maybe stimulation levels were allowed to be higher back then and that lead to the extra bone growth. They've probably learned to limit how often to use it and for how long as well. I still wouldn't use one again.

Just my experience.

[aosty]

How long were you out for when you had the bottom screws removed?

Curious: how long were you non weight bearing?

I was non-weight bearing for about 3 months. Recovery from the lower screws was pretty brief... maybe a week or so?

Recovery from rod removal was estimated to be 2-3 weeks but there were some difficulties in the procedure. The top of the rod has a threaded fitting and is removed using a slide hammer... it took longer than expected to locate and the tool didn't thread on easily (stripped or wrong thread? :eek:). I think it took close to 1.5-2 months to recuperate. Despite the complication, I am glad it's outta there.

Biking-wise, I would say recovery was 90-100%... pretty amazing.

[12snap]

Tons of good stuff. Thank you very much. Last my Ortho and I spoke he's pretty convinced all hardware will be staying put. He brought up fact that if i did want it removed (must wait at least 24 monts before it's even on table) that there would be 4-5 weeks recovery for getting it removed so not sure what i'll do.


Don't be afraid to get a 2nd opinion from a different Dr. I had my hardware removed in stages. The first screws were removed about a year after the initial surgery. Almost all of the rest were removed about a year after that. He left one screw in because it was supposedly in an awkward spot and would require 4 hours of surgery to take out that one screw. It never bothered me so I didn't think anything about it. A few years later, I had the same knee scoped by a different surgeon to clean up a meniscus tear. The new surgeon was able to remove the screw in 5 minutes.

Downtime was 4-5 weeks but you can bear weight you just need to be careful. I went skiing in the Swiss Alps 3 weeks after my 2nd removal. I skied one day and it was on tame, groomed runs only. I did not have Dr. approval for that but the trip had been planned and I couldn't not go skiing. Besides some muscle weakness, I had no issues but I was skiing conservatively as well.

[12snap]

Some doctors are more conservative with recovery times especially with injuries they may not see a whole lot. I'm fortunate that I live in a CO ski town where they see a lot of knee trauma. They also know that people here live active lifestyles and want to get back to that as soon as possible. My doctors were willing to be slightly more aggressive with therapies and treatments to get me back to living my life as soon as possible.

In some ways, you can think of Doctors like custom frame builders. You might talk to one guy that says, "This is the way it needs to be because I've been doing this for years and I know what's right". But another guy will say, "I've got an idea for something that I think you'll really like. We can try it if you want or we can stay on the straight and narrow path".

[azrider]

If I had to do it over again I would choose to not use a bone stimulator. That extra bone mass is by far the worst lingering side effect of my accident.

I was non weight bearing for 6 months after the surgery.

NWB for 6 MONTHS !?!?! :eek: Dude I am at 5.5 weeks and i'm counting the hours it's so unbearable. How the hell did you do that.

THanks for advice on the bone stimulator. Someone else had mentioned to me the 'overgrowth' and the complications they've had with it. I'm doubting i'll do it, especially since my ortho said i'm "ahead of schedule" in regards to growth.

[bigreen505]

I also used a bone stimulator. Yes, it worked. However, it worked too well. Long after I stopped using it, the bone continued to grow. I now have a "lumpy" knee; i.e.: extra bone mass. It sticks out on the inside of my knee and the tendons and ligaments rub against it and cause pain and soreness.

I can't say that is/is not correct, but I did not have a bone stim but still have the big mass where the bone healed. The OP does too to a lesser extent (look at the x-rays in the first post).

I'm guessing that AZrider doesn't ski based on the username, but if you do, that is its own brutal learning/healing curve. Skiing was its own special kind of pain and still is.

[azrider]

I'm guessing that AZrider doesn't ski based on the username, but if you do, that is its own brutal learning/healing curve. Skiing was its own special kind of pain and still is.

"Have" skied yes, but not regularly. With how much the plates (see pic) are digging into the side of my air cast/boot I doubt i'll be lacing up ski boots anytime in near future.

[12snap]

NWB for 6 MONTHS !?!?! :eek: Dude I am at 5.5 weeks and i'm counting the hours it's so unbearable. How the hell did you do that.


Because I knew it was going to be such a long time I think I learned to accept it. I did a lot of PT and my therapist was really good about keeping me motivated. I started going to the gym more. I could sit at the machines and do upper body exercises. I rode the stationary bike a lot. Swimming became a big part of my routine as well. Which was really good for maintaining my cardio plus the kicking helped with leg strength and endurance.