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Compound fracture of tibia and fibula recovery

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Zorana Dicic · · Unknown Hometown · Joined Apr 2018 · Points: 0

I had a ski accident on Feb 25th 2018 that resulted in compound fracture of tibia and fibula.  They broke inside my boot, close to my ankle.  I had an emergency surgery that evening in South Lake Tahoe, they installed a 315mm titanium rod in my tibia and fastened it with 3 screws.  They made an incision above my knee and inserted the rod through the knee.  They explained the procedure as routine with 100% recovery. I was released from the hospital the next day.   We went back to Bay Area, to my Kaiser Permanente insurance.  Since the surgery, I saw an orthopedic PA at Kaiser only 2 times, once a week after the surgery, and once a month later.  They basically took an X Ray, and both times there was no bone growth, so they just sent me home and told me to elevate and ice the leg, and come back in a month.  I am now almost 7 weeks into this, and no PT has been prescribed to me yet, they said I wasn’t ready. My current situation (7 weeks after surgery):

  • The pain is better, but still hurts at the point of fracture and in the knee. 
  • The knee and ankle are locked. 
  • The muscles on the entire leg atrophied and it is so weak, I have to move it with my arms. 
  • The incisions around my knee are closed up and clean, still sore, and the incision around the puncture are still bloody and very painful. The puncture point is still bleeding from time to time and painful. 
  • I have several completely numb spots on my leg, around the fracture and incision points. These numb sport border very painful spots, a very strange and unnatural feeling.  
  • I have a boot, I keep my leg elevated most of the day, and I use crutches to get around the house. 
  • I eat all the foods rich in minerals and vitamins needed for bone growth. I eat very healthy and a lot. 
  • I massage my leg with gel for swellings, and with oil to stimulate some blood circulation.
  • I work from home, lying on the couch. I am falling apart from lying on the same position all day and twisting in order to use my laptop. I try to do some upper body workout, but still while sitting with one leg up. 
  • And I wait…. 
I would like to hear about experiences of those who had similar procedure done.  I get so little information from the doctors, and they always have the same answer to all my questions- “it depends on a person”.  I would like to know some timelines and milestones so that I can manage my expectations during my recovery, and also to get some hints on what I can do to recover faster.

  1. The swelling- my knee, ankle and foot are swollen and my leg is blue from knee down. There has been a significant improvement on the knee since the beginning when it was like a balloon, but its’ still swollen compared to the other knee which I believe restricts the range of motion. Any thought on who to reduce swelling and bruising?
  2. Procedure impact on the knee- how much did this procedure disturb my knee? How to recover it? Will this procedure cause any knee pain in the future? 
  3. Locked joints- my knee, ankle and now even my hip became stiff. I cannot move my knee, its locked, and my ankle also, but it’s just so close to the injury I wouldn’t try to move it yet. How do I do about trying to start to move them, and when?
  4. PT- what kind of rehabilitation therapy is most effective? Where should I seek PT (my insurance or private studios)? How should I ask my insurance for it (since they are not offering any other than a person manually moving my leg, and even that not yet)? What can I do on my own? When to start? How to start?
  5. Numb spots- anything I can do about this? How long can I expect them to be numb for?
  6. Scars- how to minimize them? What to use, when, and for how long?
  7. Impulse stimulation- Does anyone recommend buying one of those impulse stimulators online? 
Thank you all in advanced for your thought and suggestions, and sorry for the lengthy message.
M Alexander · · SLO, CA · Joined Jun 2015 · Points: 21

Hi Zorana, I am sorry to hear about your injury, I had a relatively similar injury in May of last year. I had a compound fracture of tibia and also broke the fibula, but closer to the ankle than the knee. I was in a cast or boot for roughly 4 months. 

My timeline was (roughly) as follows:

- A week in and out of hospital for two surgeries, first for a external fixator and then the second for plates and screws. Morphine and oxycodone constantly.
- A "soft" cast for a month or so with almost constant elevation and rest, only lowered my foot for the bathroom and to move rooms. Dropping my leg below my waist made it swell tremendously and hurt something fierce. Oxycodone at first, then switched to hydrocodone once the pain went down somewhat.
- A plaster, hard cast for two weeks. Dropping my leg below my waist will cause my leg to swell and change a horrible purple color, still pain and itching if I let it drop for too long. I think this is when I got my stitches and staples out.
- Another plaster cast for another two weeks I think, the bone and soft tissue hadn't healed quite enough. I think the soft tissue was the limiting factor here, did not want it to split open. Same reason I had the external fixator surgery too.
- A removable boot for about two and a half months. I was non-weight bearing for the first month or so. Being allowed to put weight on it was super weird, my heel was the sorest spot by far, the actual bones that broke didn't seem to hurt. I think it was my foot muscles had atrophied so much and were not used to bearing weight.
- After the two and a half months, got the boot off and limped pretty hard for a while.

Took about a month to be able to use my calf muscle in my step. I went climbing the day after I got my boot off and biked ~8 miles the day after that. Biking for me is where I notice it the least, climbing was hard at first because I could not stand on my toes, my calf was so weak and I was terrified of falling on it all for a few months. Now I don't notice it climbing at all, it came back fast. I didn't do any upper body work outs besides crutching for fear of injury. My calf is still a little weak because I think I baby it, working on that still. My ankle is still stiff, maybe about 80-90% flexibility. It hurts when I try to run, and sometimes going down stairs or the like. Climbing and biking are basically unaffected by it now.

I followed my orthopedic surgeon's advice religiously, I know some people begin weight-bearing or PT prior to doctor's orders, but no way was I risking anymore time in a cast or boot. When I say I kept it raised except to use the bathroom or move rooms (maybe twice a day) I mean it. My surgeon was awesome and was very clear with me about timelines and expectations, all I can say is I'm sorry you seem to be getting the run-around. Your injury also seems to be more severe, I had little damage to the joints which I heard helps a lot with recovery and the need for PT.

Numb spots: Still have some, but they are shrinking slowly. I also have that weird, painful feeling if the numb spots or spots near them are hit, does not feel good.

Scars: I have a scar on both sides of my leg, one side is fading fast, the other, main scar is large and probably will never fade. I am not actively trying to do anything about that, I don't really care what it looks like and it has a decent shape to it.

PT: I did none. Luckily for me it would have been covered by my insurance, but the doctor said I probably did not need it given my age and active life style, just doing things would strengthen it. Also, with the business of the last year of college, I didn't really have the time.

Sorry for the wall of text and the general rambliness to it, I wish you the best in your recovery. I was lucky that the fire chief who assisted on the rescue had a similar injury and was able to keep me informed about what to expect, I would be glad to elaborate or talk about anything else if you have any more questions or concerns.
Perry Norris · · Truckee · Joined Nov 2014 · Points: 45

The ex-rays give me shivers. Trust your doc. Get a second opinion.  

Check your dins. Energy goes somewhere.

It gets better. Do your PT. You'll be back in months. (Sorry to be vague on your direct questions; it's bad luck, but with work it repairs.)

mediocre · · Unknown Hometown · Joined Jul 2013 · Points: 0

I’m going to respond to your post but I have never experienced a similar injury, though I have a lot of experience around people that get fucked up.
MDs and people in the industry always talk about things like they happen every day. They do, the MD probably does multiple similar surgeries a day, but your body has not been through this before, I’m assuming since you’re asking. In my humble experience lower limb surgeries from traumatic injuries take a long time to heal. Do your PT. I can’t emphasize PT enough. It’s as instrumemtal to healing as the surgery itself.
 If you don’t trust your MD get a second opinion. I took my car into the shop last week and they said I needed 1500$ in brakework. You bet your ass I got a second opinion and that’s a car, not my leg. 
Hang in there though. It looks and sound like a nasty break, it’s going to take time. 

ColterB · · CO · Joined Feb 2013 · Points: 0

I experienced a similar break almost a year ago, although it was not compound, and had the same surgery as you did. The first 2-3 weeks were the worst due to the swelling and pain. I'm not sure why you haven't been prescribed pt yet as I started it the day after surgery. The first few weeks were mostly just massage and very light mobility exercises but they helped a ton and got me out of the house. I'd recommend starting pt as soon as you can, it was by far the most helpful part of my recovery. My doctor also told me I could be weight bearing on it basically immediately depending on my pain tolerance. He said the quicker I started lightly using my leg the faster the bone would heal. The first two weeks I could barely put any weight on it because of the pain and the swelling. 3-4 weeks in I saw dramatic improvement in the over all pain and was able to put 50% or more weight on the leg. 5-6 weeks in I was able to put 100% weight on the leg, but very carefully. The most annoying and worst part of the rest of the recovery, besides the first 3 weeks, was the lack of mobility in my knee and especially my ankle. It was a very slow process but between pt and the exercises they gave me to do at home I slowly started to regain mobility in my ankle and knee.

I wouldn't worry too much about the scarring and numbness for now unless it gets worse. The scarring, once the swelling went down and the incisions healed got better and better. Almost my entire foot was numb after the surgery and it still hasn't completely gone away, but it slowly got better and better. Basically my doctor told me there was very little they could do for the numbness because it was likely just irritated nerves, it would just take lots of time for it to heal and eventually its gotten to the point I rarely notice it.

As soon as I could, I started top-roping with one leg and the boot on. I very gradually started to put more and more weight on the leg on top-rope as it was very easy to control exactly how much weight I put on it. I actually started this about 4 weeks out from the surgery which is probably not advisable, but I took it very slow and was as safe as I could be and in the end I think it made my recovery much quicker. The pt was still the best for recovering mobility and I would highly recommend starting it as soon as you can.

It sound like you are still in one of the more frustrating stages of the recovery but you are through the worst of it and it should start to get better faster at this point. Especially if you can start pt and being more active.

Good luck! 

Trisha Cullen · · San Jose, CA · Joined Aug 2018 · Points: 0

I feel your pain because I had the same injury as you describe and I had Kaiser (at rhe time).
It sounds like you’re 4 months into Your healing process, you have a long way to go.
Here’s some advise (I had my accident 20 years ago & STILL have chronic pain) regaining Kaiser-
1. They will not give you enough post break PT unless you fight hem.
2. My tibia & fibula we’re set crooked - it was a BAD break. I looked down and my ski boot was facing backwards and so was my foot). In shock, I grabbed my bot to turn it around. My boot just flopped back again. It was gross!
3. Did you have metal screws placed in your bones? If you did and you feel burning on our skin (or just hotter skin) GO IMMEDIATELY BACK and see your surgeon. You may have an infection. I did and had my pins removed.
4. You’re in this for the long haul UNLESS you get at least six months of PT and REST your leg as much as possible. When your cast is removed don’t be like me and hop right back into normal life. You sustained a serious injury.
5. The rest of your life you will have issues. It’s a sad fact. Your injury was life changing. I am so sorry to tell you.
6. If you are working make sure you have a desk job for awhile. Again, the recovery process takes time!
7. Follow up and demand to see a sports med or orthopedic surgeon at least every three months for a couple years. Kaiser is great at giving its patients the least amount of care without being sued.Demand care!
8. Forgive yourself. We all fall.
Good luck!

Paul Hutton · · Kansas City, MO · Joined Mar 2012 · Points: 740

You done broke em gooooood! I've shattered my femur. Compound fractures to my humerus (not so humorous) and clavicle. Yep, recovering from compound fractures takes forever! You can do your own ROM exercises to speed up recovery. The human body calluses and strengthens when stress is applied. I've had a fracture that I didn't get treated at ALL. I'm fine. I'm one of those stubborn dudes that tries to be the hero. The doctors have done all they can. The only thing they needed to worry about was nosocomial infection -- take your antibiotics.

Get the metal removed if you can find a surgeon that's willing! That metal causes pain years down the road!  Get well soon!

Guideline #1: Don't be a jerk.

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