I’m now 6 weeks post-op, though I’ve been lurking on the forum for a month, so I feel that I already know many of you and have had you in my thoughts and intentions. I’ve been fortunate to have a job I can partly do from a recliner chair, so I’ve been busy and just finally found time to get all this typed out. Hopefully, I’ll can make up for the late report with a good one.
On February 10 I was skiing with two friends at Snowbird, last run of the day on a fast runout near Tower 21 on Peruvian Lift. I either caught an edge or hit an unseen bump and went head over heels. The skis released, but I took what must have been a hard, twisting impact with my left boot. I skidded to a halt, looked first uphill to see how far I’d have to walk to get my skis, and then checked myself for injury. My left leg had an obvious extra bend between the boot and knee. I shouted every skiier's nightmare: “I’ve got a tib/fib break,” and two fellow skiers were immediately on cell phones to the patrol, while others helped me unzip the bottom of my ski pants, unbuckle the boot, and pack snow around the break. There was no prompt pain, I suppose due to shock. Page and Bjorn of the Ski Patrol were quick getting me down the mountain on the sled, escorted by my friend James, who was still in earshot when I called out my injury. The Snowbird clinic provided Dilaudid and initial x-ray. It showed a spiral tibia fracture extending toward the knee, clearly beyond their means to fix, so they helped me remove the boot (no fun), and put me on an ambulance to the Level 1 facility in Salt Lake. The ambulance crew called ahead for a roll-through emergency admission, put me in a hospital bed, and they scheduled me for surgery the next day. Another x-ray series indicated the fracture extended up to the lateral plateau, which was markedly depressed.
A follow-up CAT scan showed the plateau fragmented into many pieces, another small, undepressed fracture at the posterior side of the plateau, as well as some great imagery of the ice bags.
The OS was fantastic—the best doctor I’ve ever worked with in skills and bedside manner, though during the procedure itself, he was laser-focused and didn't talk much. The anesthesiologist offered me a wide menu of options, so I went with a spinal block plus opoids (in/around?) the spine. As I understand it, the spinal block didn’t work but the opoids did, because I had fairly complete sensation throughout my leg and could feel everything they did, screws and all, but with absolutely no pain. The OS said he’d never seen anything like it before, but I was warm, awake, and comfortable, content to be at least a passive participant. About halfway through, I asked the anesthesiologist what all the monitors were for, and he connected the one near my head to the live x-rays, so I could even watch with x-ray vision. It took over three hours to screw together the tibial shaft, push the platform pieces up and screw them back into position, add some allograft underneath, install the upper plate, and thread a suture all the way around the meniscus. By that time I was getting more sensation and just a touch of pain, so they put me under for the final steps of installing a long LISS plate and closing up. Overall, I count 18 screws, one of which he somehow curved (!!).
It wound up being a five-day hospital stay, due to compartment swelling, a fasciotomy, two days on a wound pump, and then a successful closure. There’s some hopefully temporary damage to sensory nerves, which has probably been a blessing in terms of missing the worst of the pain. My wife flew out the second day and back with me on the fifth, sleeping in the hospital room. She’s been an absolute saint, attending to me. All the medical staff were fantastic: Utahns are second only to Canadians in cheer and kindness.
The OS’s discharge orders anticipated partial weight bearing around 6 weeks. Back home in Northern Virginia, I chose a local ortho trauma surgeon based on personal recommendation, medical website ratings, and a video of one of his lectures to other doctors about proximal tibia fractures. Insurance coverage is solid, after completing my maximum annual co-pay. So I’ve been on 2-3X weekly PT for aggressive ankle ROM and gentle knee. The ankle still needs work, but I can go about 5 degrees above neutral and have fairly good extension. He's also gradually gotten my knee to within 4 degrees of full extension. That’s equal to my uninjured knee, so presumably I’ve been walking like a leprechaun all my life. Knee flexion is about 110 degrees.
The local doc has been fine, but his entire group seems to consider 12 weeks of non weight bearing to be a Standard of Care for TPF, and he regards that as a completely settled question in the literature. So I did some reading, and that does not seem to be the case at all. In fact,
http://www.ncbi.nlm.nih.gov/pubmed/21586783 documents fine results with immediate partial weight bearing after platform repair with screws and plate.
After my 6-week checkup, I got a copy of the x-rays on CD, set it up for download, and went back to the OS for a second opinion. He communicates very well by e-mail and responded with a recommendation that I should go to 25% weight now with a knee brace, gradually moving to 100% in another four weeks (which will be 10 weeks post-op). So I’m going with his advice and will figure out how to communicate that to the local surgeon at my next appointment in six weeks. I’m not sure what the etiquette is if I waltz in when he still expects me on crutches.
I’m now looking forward to PT tomorrow, so I can learn how to properly do the 25% and finally start using my now-wasted calf, quads, and hamstrings. It will also be the first sense of how my much-changed knee is going to work under load.
Thanks to everyone who has posted and poured out their experiences, thoughts, wishes, and sometimes souls. Your intentions are always appreciated!
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