Hello Dr. Mark.   Well the unfortunate happened yesterday as I just putting around Crow Hill Mx track in Templeton Ma on my warm up lap. Somehow my foot got caught up I can’t even explain how it happened. I didnt fall, but the bottom line is it did happen and I have to deal with it.    

Here are the facts:  I'm 25 year old male self employed need to be on my feet for work. 163lbs athletic build.

Yesterday I broke my tibia and fibula and was ambulanced to Umass Hospital in Worcester Mass.  I was given a ton of morphine and pain killers. Here is how the day went.

Injury happened at 11am.
Ambulanced to hospital arrived at 12pm.  
Put in a splint for xrays that happened at 2pm
Finally met with orthopedic at 6pm where they said they are going to give me two medicines. One sedates me, the other is a stronger pain killer than the Morphine.  
They put this full cast on and set the bones and said it probly will need surgery check back in a week.  

Thats where I am lost. I was really expecting surgery right away and in this full cast I can still feel the bones moving    My question for you is what should I do next about treatment?   This cast weighs a ton and I am stuck in my bed and cant not move. It is also not constructed right where my leg needs to be at the right angle to avoid pressure points in the cast. It's still extremely painful. I was given perkasets but it is not enough if I have to move.

I live 1.5 hours from the hospital I was brought to. What do you think is the best way to treat this and what should I do tomorrow to get immediate treatment?  Was hoping to visit my local orthopedic

Thanks again,
Jeff

I do not have xrays from after they set it. But these are the before

If you came to my clinic with that x-ray, which shows a highly unstable fracture most likely to heal crooked and between one half and one inch short, I would stabilize it with a rod.  

Afterward, you could start immediately walking on it without a cast as well as work the range of motion of the ankle and foot.

It should be healed by four months, and you could ride about a month later.

amnesia622 - that is exactly what happened to me earlier this year - except mine was trail riding....  I regretted not at least asking Dr. Mark if he might be available and willing to operate.    If there is  anything at all I can do PM me, learned lots the hard way regarding nuances of crutches...


best of luck to you

Some xrays if you want.
http://i54.photobuck...C_0337Large.jpg
http://i54.photobuck...a/DSC_0360x.jpg


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I think your local ortho doc is an idiot!!!! That thing needs attention ASAP!!!!!!!!!

Dr. Mark hit it on the head....get your leg fixed man....whew....

Buy a Southwest Airlines ticket to Houston.  Stay for three  or four days, and at least you will know its fixed right.

Thanks for your help I think they have it under control.  I met with my orthopedic today (back in Connecticut)and we did the following. Out respect the hospital that was in the ER of did call me today and had an Orthopedic that could see me tomorrow  but I feel i already should have had surgery at this point.(Tuesday)

1. Took new xrays... obviously it wasn’t set in that cast.
2. Put a new cast on before surgery. The new one is below my knee and much more comfortable. It was a fun adventure with his cute assistant holding my heal up as I ground my teeth on the table. Hurt like hell.
3. Debated the options... They are getting me in for surgery on Thursday. He's moving people around and getting me in (I'd find someone else if they didn’t)

Dr. Mark they left me with two options.  One the rod as you said. But he really wants to go for a plate and screws. IF he feels that if they get in there and the plate wont work they are going to switch and end up putting the rod in. I wish I could provide you with his EXACT reasoning but I do not have it verbatim as to why he wants to go plate and screws first.  What do you think?

a rod works better at that location.  You can walk on it within days.  A plate keeps you on crutches for three months.

If you doc can't rod it, change out the doc.

I should make that clear that they did leave it up to me..... Rod it or plate it.. But his opinion was go with the plate IF they can...   What about the long term of a plate vs rod?  

Also what gets done to hold the fib back in place?

A rod is load sharing and may never need to come out.  A plate takes most of the weight and the bone under the plate weakens.  For this reason most plates need to be removed.  One more operation.

The fibula can just be ignored in this fracture.  It doesn't need anything.

Hello all I just wanted to post some updates with the “progress” that’s being made. We ended up going with the plate. I know I know… get the rod.  Here is a timeline of what’s been happening…

Sept 9, 2006  Broke the tib/fib and the xrays that you see above when it was NOT set were taken.

Sept 11, 2006  Met with my orthopedic back in CT and they took xrays, put on a new cast and got me in for surgery on Thursday. The 5 days from the break to surgery were some of the worst days of my life dealing with the bones shifting in the damn cast everytime I moved my leg.

Sept 14, 2006 Surgery at 9am a plate was put on the tib/fib. When I woke up from surgery around 12:30 noon I felt great. Wanted to go home. Watched the nationals on OLN at 6pm and was released at 7.  Was soo glad not to have to spend the night in the hospital and got a good nights rest.

Sept 15, 2006. Not as smooth a day from the day of surgery. Could not stand up for longer than 2 minutes due to the blood rushing into my foot it felt like it was going to exploid. The best part though was no more bones shifting and I was in a splint wraped in a bandage. Also somewhat of a throbbing pain coming from the bone but bearable.

Sept 17, 2006  Finally left the house after being in bed for 2 straight days. Went down to the local track got some fresh air but still hurt like hell to stand up I HAD to keep it elevated. I was also catching a cold…. Which made for another week of hell. Especially dealing with running my business.

Sept 25, 2006   Met with doctors 11 days after surgery. Had the staples removed (was cake didn’t even feel it and had some sitches out. Just a pinch hurt way more than staples and actually the cut they stitched was seeping a little where the stapled part healed way faster.  Was moved into an aircast (hard boot that is removable) Still very swullen and still had to keep it elevated

Oct 2, 2006  Still getting better. Easier to get around I can stand up now without having to elevate the leg due to the rushing of blood. Still leg and foot turns blue in the shower ect… Started going to the gym 3 days a week

Oct 16, 2006  Back to doctors. New x-rays asked about working out on my trainer. Doctor gave the ok but said go easy. That day I couldn’t get over 50 cadence and put my mountain biking shoes on instead of roadbiking shoes cause I couldn’t fit due to the swelling

October 23 2006  Finally could it in road shoes and reach a 70 cadence for 15minutes Range of motion now with the ankle is getting better. I can not bring it up all the way but can almost point it down all the way.

October 29 2006 , Finally reached 85 cadence for 30 minutes at a 130hr I cant really work myself much harder or my ankle hurts

October 30 2006  (6.5 weeks since surgery) Here are some pictures went to the doctors said I could be partial weight bearing. I have been able to use my foot really for the past 5 days to balance myself when standing on two legs. I can also be a little less careful with my leg in the air cast when like getting in and out of cars. Also I don’t like sleeping with the aircast on and I can do so now pain free.

My worries:   1. the swelling? Do you think its normal      2. The healing of the fib. What’s going on! Is it healing properly??  

The alignment and the X-ray look good.  I, personally, would have also fixed the fibula, but it probably will heal ok anyway.  

I would get you a TED stocking to help compress the veins and return blood to the heart.  

When you are not walking, you should be elevating the foot, and I think that you can start taking weight on it.

Aww man I made fun of my dad for those after his open  heart surgury. Now its my turn.  Think I'll be back on the bike for Feb?

Pics look similiar to my right leg, I broke my tibia August 19, and now am starting to walk on it.  I have slightly less swelling now and the more I can get my ankle to move the less the swelling.  Physical therapy started yesterday and things have really improved since.  I did go and buy one of those T.E.Ds and hopefully swelling continues to go away.

Any advice on what to do?  Just as things were getting wayyy better swelling was down. I could actually see my ankle again and putting 50% weight on it.  I was carrying something into my kitchen out of the aircast,  tripped over my right crutch, and put my left foot out (the broken one) and land right on my foot. I can tell you it has not hurt this bad since the surgery. It feels like a really bad sprain and it has swelled up again like in the pictures although I'm not as purple anymore.

When standing it hurts enough where I lose focus and I can feel my pulse at my ankle and it hurts to put 50% of my weight on it. Also lost range of motion. It hurts like hell to move my foot up

Any advice on what to do? Go in to the doctors? (I'm one week out from an appointment) Ice it? Elevate it?   thanks for any input. I'm devastated.

That needs an urgent apt with the doctor.

I just wanted to keep this updated. I just aggravated the muscles and tendons that have not been used. I'd say this fall set me back two weeks since I was driving a manual transmission car again for a week and It took me another two weeks after this fall before a I could again.

So here we are...


November 5: Able to put 50% weight on it. still on crutches

November 8th: Fell out of the aircast on it. really bad sprain. reswelled up. Not able to put weight on it. No longer able to push a clutch in on a car without tons of sharp pain

November 20: Able to drive a manual car again. Back where I was before falling on it. Doctor said I can put all my weight on it.

November 22: Able to walk in aircast. It felt like walking on your wrists and hurts to put weight on it. Can only go about 300ft a day on it before being back on the crutches. Started physical therapy

November 28: Able to walk now in the aircast without the use of crutches. This is 12 weeks after the injury.

December 4: Able to walk without the air cast for half the day

December 6: Able to walk without the aircast all day with a limp


right now it's still swollen but better than those pictures I posted. I feel pretty good on it but can not put all my weight on the ball of my foot. It just hurts really bad if I try but is getting better each day.

dont break your leg....

Ohh this is interesting too some of the bills. Why do they tell you how much it costs after? if you dont have insurance this could set you back for YEARS.  Thank god I have insurance.

Ambulance ride  (30 miles)  850 dollars
Emergency room that day: 2300          orthopedic
Each visit to orthopedic (they bill 300 but don’t get it I think they are getting 200)
Xrays: 35 a picture (seems like only thing that’s reasonable)
Surgery: The hospital bill for the DAY (I didn’t spend the night) for the plate and 12 screws to be installed was $12,882.   Are you serious?!?!!?
Anesthesia: 840
physical therapy: 80 a visit for 8 visits


So right now I think its somewhere around 17,000 dollars

That's some serious jack.  I think I should move to Conn.

California is the worst.

   Hospital bill for three days  $37,000
   Doctors bill for surgery        $3,100
   Two cat scans at               $1,400 each
   x-ray                               $129          
   Phsical therapy 3 times a week.  Pool and land for 2 months $3,500

Phsical therapy is a joke. I do my own therapy now. 24hr fitness $55.00 a month

What did you have done?

My bad the ER was $5362.42   and I left there with my leg looking like this in the cast of hell: