Spiral tib/fib

[LightRanger]

Because your bones bend, and the hardwear does not. You'll hear mixed recommendations from orthos on this ("I usually don't recommend guys get them out unless they're racing motocross or something. Or it starts to bother them.") Paraphrasing, but those were almost his exact words.

My intramedullary nail bothered me more over time as the bone remodeled/calloused. When I got it pulled, the iridescent coating on it was rubbed off at the fracture site. I think, and I believe my last ortho (I saw four over the course of four years) agreed, that the bone began to rub on the metal as it remodeled and calloused. It hurt more 3 years later than it did the winter after it happened.

I also believe that it can be a bit harder to get them out as time goes on due to the bone growing around screws and holes in the bone and such. The removal surgery has a short recovery period. Basically as long as it takes the wounds to heal. Crutches for maybe 2-3 days. You'd probably be skiing again in a month. Only thing preventing you from it is the wounds themselves.

YMMV.

Other recommendation is to do toe taps and keep the tendons in your lower leg as active as possible--even when you're non-weightbearing. Not sure how fast you were going, but mine break was really high-energy. I developed a rare "Checkrein Deformity," which none of the orthos was able to diagnose/treat until I figured it out myself by reading Wheeless Textbook of Orthopedics. When I showed it to my last MD in Fall 2012, he agreed with me and I finally had the indicated surgery for it--three years and nine months after the injury. My case was particularly shitty, but it doesn't hurt to be careful and try to work your tendons as much as possible.

What kind of fixation did they use?

Edit: I should also add that the other, and probably most obvious/important, reason to get it removed is that if you rebreak it, it can be quite bad and a huge pain for the ortho to deal with. That's obviously not a sure thing, and hopefully doesn't happen, but it's certainly a possibility when you're into things like alpine/BC skiing, mountain biking, climbing, etc.

[jrredho]

LightRanger, thanks so much for following up with this explanation. I'm glad to read that there's been a happy ending for you, despite the long path reaching it.

I don't know the formal name for the hardware I had installed. I've only just in the past day or two gotten mellowed enough on the percocets to make any sense of things I heard, or may have said or written.

But I think I heard the doc referred to it as a tibial nail. He installed from the top of my tibia, through my patellar tendon, along with 5 screws, 2 at the top, three at the bottom.

As for how fast I was going, it was pretty fast. I was doing long sweeper turns through that mank; laying on some pretty good angulation. I caught the rock flush at my inside boot top.

Extrapolating on what I'm reading here in GC, I've been pretty lucky: No compartment syndrome, e.g., but I am continuing to have pretty bad pain---especially when I move my leg from elevated to hobbling about on crutches. And I've been trying my best to move my ankle, however limited my range of motion is in it, and to flex/extend my knee.

The swelling has gone down quite a bit in the past day or two, although I've got a pretty significant, and painful, bump in the area where I think the break itself actually was.

Thanks again for the info, it's really dang helpful, and all the best to you going forward.

cheers,
john

[LightRanger]

No worries man. It's hard finding decent answers. I remember being there.

My fixation was the same, with an extra couple screws in my medial malleolus because that was cracked too.

No compartment syndrome is fantastic. My last ortho remarked that I might have had mild compartment syndrome that wasn't treated, which may have contributed to the deformity. My leg was so swollen I couldn't dorsiflex the ankle for 2-3 months after the injury. I had to go to class for my last year of grad school too, so I couldn't elevate it all the time.

Best of luck to you too man. Post updates in here.

Also, keep yourself as regulated as possible with collace or whatever to combat the effects of the narcotics.

[couloirman]

I'm post op day 3 after tibial IM rod placement for spiral tib fib fracture. My calf is so painful. When I stand up for longer than 30 seconds it feels like my calf is so swollen it might explode. Also my calf is really tender and painful when I squeeze it and just laying down with my leg elevated even. I don't have the other symptoms of compartment syndrome that I am aware of and my toes are still well perfused, warm and can move normally. Is this amount of what feels like calf muscle belly pain normal? Did anyone else feel like this? I know the disclaimer, go see my doc if I'm really worried, I just wanted to know if everyone's deep calf muscle hurt this much after the surgery

[jrredho]

Hey couloirman,

I posted in this thread last year not far from this timeframe, so my memories are still pretty fresh.

I don't think it's surprising that your calf is wickedly painful: When you fractured your bone, you tore the sh*t out of a bunch of soft tissue in your lower leg. Obviously, you'll need to keep a pretty close eye on it, though.

As for the swelling, I cannot recommend enough getting next to a wall, with your butt as close to it as you can tolerate, and elevating your leg on that wall for as long as you can tolerate it. I think I worked up to 20+ minutes at a clip. It really helps with the swelling. It may not seem like it, but it does.

When you do that, also let gravity flex your knee for you while keeping your foot flat against the wall; help it back with with your other foot, and repeat several times. It, too, helps with the swelling, and it helps keep your flexibility in your ankle and knee.

Finally, get yourself a gate belt, and use it to flex your ankle by hooking a loop to your forefoot and pulling lightly. Repeat this several times each session.

These things were recommended to me by a friend who's a PT, and I started all of it on day two after surgery. I think I had darn near full range of motion in my knee when I went back in for my two-week check in with my surgeon. The doc was surprised at that.

Fwiw, I'm skiing, working my way up to hitting it pretty hard again this year, and I'm 13 months removed from the same style of injury you have. Keep the faith; you'll be back stronger than ever.

Best of luck in your recovery!

cheers,
john

[LightRanger]

Lower calf/ankle was so swollen I basically couldn't dorsiflex for three months.

Follow jrredho's advice above. Dorsiflex your ankle and pull your toes toward you as much as you can bear. I developed this from a similar situation and it's given me serious issues: http://www.podiatrytoday.com/treatin...s-after-trauma I think if I'd hit the flexion harder it might not have presented itself (as strongly at least?).

[couloirman]

Thanks guys, and congrats to everyone healing up well.

Most of my pain is getting better (right now about 20 days post-op) but still having crazy bad stinging pain on the dorsal aspect of my foot. Off of pain killers now though which is great. When I just brush the dorsal aspect of my foot it lightly with my finger it is probably 5/10 in severity. So weird, feel neuropathic in nature. Virtually no range of motion in my ankle still, dorsiflexion is way less than 90 degrees with a towel right out of a warm shower. I had bad ankles to begin with but starting to worry about ever even walking normally again. Still can't flex my big toe downward at all at the IP joint, but can flex it at the MTP with quite a bit of pain over the tendons on the top of my foot as well. It is so weird it's as if my body just totally forgot how to do that motion, and when I try really hard and think about it really hard and feel like maybe I am almost there I get a crazy pain on the back of my calf around near where the break was.

Maybe I am jumping the gun worrying this early, but hard not to sitting on the couch 24/7 thinking about all the spring/summer bike trips I had planned I just cancelled on. I was going to race the Arizona Trail 750 in April, bike the Oregon Outback 364 right after, the Colorado Trail race this August, now, well, I am just going to sit on my fat ass until I start residency in June. Oh well, I guess it's good I am still going to be able to graduate on time and not have to take another year off, but damn this sucks. Hopefully will be partial weight bearing 12 weeks after surgery if all goes well and there are no complications. Had the best spring ever planned before entering internship. Probably won't be able to take time off to get the hardware removed for at least 3 years now as well. And to think it all happened on a damn green run when I jumped a tiny ass roller, caught a tip and didn't release. This is my first ski injury ever, and it happened on a green run. Pretty much the most boring story ever.

Oh well, woe is me, I'll stop complaining now. First world problems I guess, at least we have the technology to fix these things now.

[LightRanger]

Best of luck man. Shit sucks, no matter how it happens. Stay positive and hit the PT as hard as you can as soon as you can.

[jrredho]

Sorry to read that you're having some problems with pain and flexibility!

A couple of things to remember is that, first, you may have sprained your ankle badly in your fall. Second, there is no doubt you tore a bunch of soft tissue in your lower leg when you broke your leg. These may have something to do with your issues. If you're really concerned, especially about the flex part, you really should consult your surgeon or even a neurosurgeon, and think about getting another x-ray or MRI to determine the source of those problems.

In the meantime, I'm not kidding, stay after that elevation and knee flexing thing as much as you can tolerate. It's slow and painful, but it's a key pathway to a better recovery. I'm walking, anecdotal testament to that.

Okay, a couple more things:

Hopefully will be partial weight bearing 12 weeks after surgery if all goes well and there are no complications. Had the best spring ever planned before entering internship. Probably won't be able to take time off to get the hardware removed for at least 3 years now as well.

You got the nail, which means you should be bearing weight as much as your pain threshold can withstand now. It helps the bones heal to put them under load. Don't overdo it because the nail is not as stiff laterally as a rod, but you really need to put some weight on that bad boy now.

Also, don't fret about the hardware bridge until you have to cross it!

I am putting off getting the screws out until this summer, 18 months or so after my surgery due to a ski trip I have planned for April, and later spring skiing. As a time-line activity gauge for you, I was on the bike trainer at the end of December, took my first steps without crutches the second week of January, walking and light hiking in February, road biking in March, mountain biking in August, and skiing on December 1. This is after getting the nail on December 2nd 2013. And I still have all of the hardware. I'm not entirely painfree, so who knows how much better it'd be with all or some of those things gone, but it's tolerable with no pain meds, including NSAIDs. I intend to take it a step at a time; the screws go first, but I hope to be able to leave that darn nail in my tibia. I know that this is counter to what LightRanger has experienced, but I'm leaving my options open for now.

One thing you should not do, which happens to be exactly what I did, is to lay around and drink a bunch of beer while catching up on all that TV time you've been missing over the past several years. The lbs are slooow to disown.

Good luck with everything, and keep us posted on how you're doing.

all the best,
john

[couloirman]

Finally starting to bear weight again (at 12 weeks post op now). Might be dealing with a non-union unfortunately though so probably going to need more surgery in the near future. I guess the first thing they do is just remove the screws holding the tibial IM rod in place and that allows the top and bottom fragments of the tibia to push on each other harder but the rod still stays put to keep the fragments aligned but the extra weight on the fractured ends I guess promotes bone growth and repair.

But man oh man I have horrendous anterior knee pain just when trying to walk with partial weight bearing with crutches. Anyone else dealt with knee pain after this surgery? This sucks. Luckily my parents have a recumbent bike at their house and I am riding that a lot without much pain, but walking is just awful on my knee. I hear the knee pain is often permanent even after full hardware removal so not looking good, but I will try to not jump to conclusions until I heal fully.

[LightRanger]

You thinking the pain is related to them pushing the patella around to get it in there? I had significant pain from the patellar tendon area for quite a while after putting it in there. Also after taking it out, but much less.

Nonunion sucks man. No good. They give you one of these?: http://www.bioventusglobal.com/produ...d-bone-healing That was one thing they prescribed for me out of nonunion concerns.

[couloirman]

No ultrasound machine. I don't think they push the patella to the side anymore but I could be wrong. They put a vertical incision down the center of my patellar tendon instead and spread that to slide the nail in but not really sure what the pain is from. Weird that I can hit the recumbent bike hard but every step I take is excruciating. Seeing the surgeon for a consult tomorrow morning so we shall see what they say...

[couloirman]

OK my bone is healing! No non-union-- yay! But WOW the knee pain in unbearable. Don't know how you guys got tibial IM nails and got away without having knee pain. Biking while seated is OK so that's good but I can't stand and pedal and can't walk without crutches or a cane. Walking is WAY harder than biking. 100 days since injury, 97 days since the surgery. Hoping this starts to get better soon.