tibia pilon fracture

[addman]

I just got the all clear from my ortho this week to, "feel free to push it, your body will tell you when it's too much." I'm 6 months post-surgery... It's difficult to say how to speed a recovery, though your goal to be FBW in a boot seems attainable. Definitely stay diligent with the exercises, the exertion helps to lubricate the joint and keep the ligaments and tendons stretched. I would say my biggest setback was muscle atrophy, I feel like I have chicken legs right now. With my diet I tried to go heavy on protein with a macro ratio of 50-40-10 Protein-Carbs-Fat. I also took vitamin D, vitamin C, zinc and a B-12 sublingual everyday. I avoided alcohol for the first 4 months. I really struggled with sleep... it seemed like at night the nerves in my foot would come to life and not stop firing. That has started to pass. I think the best advice I could give is to keep your head up. It sounds cliche but seriously, on crutches you tend to stare at the ground in front of you... I noticed when I would stand with a good posture and walk with my head high I tended to be more positive. There will be good times and hard times. Just remember to keep pushing and smile, you'll be cycling again in no time.

I'm about 5 weeks post surgery on a pilon fracture from snowboarding. 2 plates and 10+ screws. I'm about 3 weeks behind on my ROM which I just started working on in the last 10 days due to issues with the skin healing properly. My ankle is still extremely stiff even though the day I got the air boot I had no more than 20% range, but now I'm up to 30-40%. I was never a big runner although I played soccer and football, but enjoy skiing and snowboarding and now will be getting back into cycling which I haven't done much since spending a summer riding cross country. I would love to hear how some of you sped up your recoveries. Diet, exercise, PT, or unconventional remedy? My goal is to be walking in the boot FWB unassisted for a wedding at week 12. Staying positive and diligent with my exercises and starting to get some sleep, but would love to hear from others!

[Bett]

pilon ankle fracture

i don't know if it's because most of you guys are so much younger than me (67) but i am not a woosie and there are times that the pain is so bad i am ready to bash myself into a wall. my break was dec 23, surgery dec 30th, 14 pins, 2 plates and i was told the tib broke in 3 places, bones pieces scattering about and my fib was shattered. i walked away (no pun intended) from the first surgeon who told me 5x how severe the injury was. second young dr who did the surgery said "very very bad break and i fixed it. " when we go for our visits now, he tells me i need more time, has me now walking with a crutch. medicare now cutting me off tho we are fighting it and i will pay out of pocket if need be. i am diligent about doing whatever they tell me to do, still on oxy and going to pain management dr, next appt. on wed. i need to get off the oxy and onto something else.
at this point i went from frustrated to depressed tho that is so not me so i am battling and trying to stay positive and frustrated instead.

i too, have the purple and swollen, a decent rom (forgot the number) but stiff especially in the morning. purple goes away almost immediately after raising on pillows.
how come I'm the only one who is still in such pain?
last night i had to take the oxy before it was time, as it felt like the inside part of my ankle, which my husband tells me is where the bone was smashed to smithereens and basically is plate, felt like it was trying to burst thru and come out tho there is no evidence of that at all.

I'm not usually a cry baby and this one is doing me in.
am i the only one who still has such pain at this time?
cant take anti inflammatories (history of ulcers) and never take more that 5 pills a day tho i can go up to 6.
no drinking, no smoking as they told me even pot would inhibit healing.
please someone respond as to the pain issue.
thanks guys.

[sanjuanworm]

i don't know if it's because most of you guys are so much younger than me (67) but i am not a woosie and there are times that the pain is so bad i am ready to bash myself into a wall. my break was dec 23, surgery dec 30th, 14 pins, 2 plates and i was told the tib broke in 3 places, bones pieces scattering about and my fib was shattered. i walked away (no pun intended) from the first surgeon who told me 5x how severe the injury was. second young dr who did the surgery said "very very bad break and i fixed it. " when we go for our visits now, he tells me i need more time, has me now walking with a crutch. medicare now cutting me off tho we are fighting it and i will pay out of pocket if need be. i am diligent about doing whatever they tell me to do, still on oxy and going to pain management dr, next appt. on wed. i need to get off the oxy and onto something else.
at this point i went from frustrated to depressed tho that is so not me so i am battling and trying to stay positive and frustrated instead.

i too, have the purple and swollen, a decent rom (forgot the number) but stiff especially in the morning. purple goes away almost immediately after raising on pillows.
how come I'm the only one who is still in such pain?
last night i had to take the oxy before it was time, as it felt like the inside part of my ankle, which my husband tells me is where the bone was smashed to smithereens and basically is plate, felt like it was trying to burst thru and come out tho there is no evidence of that at all.

I'm not usually a cry baby and this one is doing me in.
am i the only one who still has such pain at this time?
cant take anti inflammatories (history of ulcers) and never take more that 5 pills a day tho i can go up to 6.
no drinking, no smoking as they told me even pot would inhibit healing.
please someone respond as to the pain issue.
thanks guys.

you gots to get off of the pills,,,,pot is good
been two years since my injury, son of a bitch still hurts some days..and looks like the cankle from hell...but i can walk and back on the snow.

[Mike89]

Agreed on the pot. I talked to my doc and he said use that over the pain pills if it helps. It's the chemical in cigarettes that inhibit healing. Marijuana is just fine from what I've been told.

[mrg_photo]

Agreed on the pot. I talked to my doc and he said use that over the pain pills if it helps. It's the chemical in cigarettes that inhibit healing. Marijuana is just fine from what I've been told.

did you have any complications with your recovery from pot? i recently acquired a pilon fracture on my left tibia. My OS prescribed painkillers but id much rather take a more holistic approach to healing.

[Mike89]

I did get an infection and had to get it washed out. Unrelated to weed though. A fairly high percentage of these fractures develop infections. 6 months antibiotics and then will have the hardware pulled out in a year. But I digress. My doctor still says it's perfectly fine even after this complication.

[Menschita]

Pilon fracture from hell

All, I've been reading and following this thread for a few months... It's been really helpful for me to hear from kindred gimps and to hear about your progression of healing. I was hit by a drunk driver while riding my bicycle last January. He hit 5 of us - all of us injured in some form. I was first and suffered the worst of the injuries - 3" gash to my right elbow, fractured pelvis and a pilon fracture to my right ankle - 20 screws and two rods, and plenty of road rash on my right side. I was thrown into a ditch. Anyway, two surgeries later (the second one being 7.5 hrs), I started the long road to recovery.

I'm an avid cyclist and a tele-skier. Wheelchair for 3 months, then NWB for another 2 on crutches. Currently I am weight bearing and doing PT 1x a week, plus a wide variety of other stuff. Back to riding and can spin although standing on the pedals is pretty painful. I am working on flexibility and strength. The dorsal flexion is the worst, it just isn't coming around, and I continue to have pain 24/7. Swelling and heat coming off of my ankle.

My Doc sez no on taking out the hardware, although the last xray showed a bone spur that looked to be in the way, causing some of the pain while flexing. So he has recently said that he would clean that up and take out hardware next January - a full year after the injury. From what I'm reading here and around the internet, I can expect up to 2.5 years before I reach the new normal.

I don't care if I don't run again - was never good at it anyway - but I want to walk normally and fit into my shoes (that's a complete challenge now), and I want to get back to where I left off in my riding (ultra-long distances), and I want to drop that knee into pow in the winter. And I want to get back to rockclimbing. I'm not thrilled at having a cankle - my legs were my best feature! but mostly I want to stand on it and feel like it will hold me, which right now, it doesn't. It feels weak and tender. And the tendon of my big toe is pretty tight, achilles too - neither of which were troublesome before the collision.

Am I asking too much?

Finally, have you all ended up taking the better part of the year off from the sports you love at the same level you participated in them? Dialed it back so to speak? And if so, how long before you were able to dial it back up?

Thanks for any and all advice. Yours in gimphood!

[Red7]

How much pain to allow when weight bearing as tolerated in boot?

I had a bad pilon fracture 16 weeks ago on Memorial day while riding motocross. I've got a plate on my fib and a long one on my tib with a total of about 18 screws holding all the pieces together. My xray in early August and early September are showing that the bones in my tib just aren't growing and not much has changed in the past 5 weeks. My surgeon isn't sure why but told me I'm going to need to sh*t or get off the pot and start weight bearing on it even though it's not really ready. So he cleared me to start weight bearing as tolerated in my walking boot but I don't know what that means. He told me to start with 2 crutches and then go down to one and then just boot if it didn't hurt too bad. I have a high threshold for pain so I could walk in just the boot now but it hurts a good bit. One crutch or cane is moderate pain. However, my PT said pain is not good without there being enough bone to support the injury and that I should not go to one crutch or cane until I have zero pain on 2 crutches. How much pain did you guys allow when transitioning? It seems that my bone isn't going to grow so I may be months waiting around if I can't stimulate it to grow. What's crazy is my xray going back to June appeared to show a lot more healthy bone than what I see in the August or Sept xrays so I feel like I'm going backwards or maybe it's just a slightly different angle appearing like less bone density. Until I can function with a cane and boot I can't work and I am the sole breadwinner for our family so I've got to get back to making money as it's been 4 months with zero income. What else did you guys take or do (like bone stimulator) to promote bone growth? Thanks so much!

[Mike89]

Menschita - You're not asking to much, but you need to be more patient on the recovery (something I've slowly been learning). I have the same issue with the big toe on the injured ankle, but it does slowly get better. I am unique case in the sense that my joint has almost completely eroded due to the infection I have and will likely end up getting my ankle fused due to the number of complications. I've heard 2 years as well because like me I assume your muscle has atrophied a lot and that takes time to build back and get you to normal especially if you aren't able to work out as hard due to pain/weakness.

I will say in the interim between now and getting a second opinion compression socks have done a lot for slowing the build up of swelling throughout the day and overall blood flow, which is part of the problem for improving flexibility and tightness in the toe. I have an infection and my ankle was extremely red and hot before getting a washout surgery to put it at bay, but that may be something to make sure your doctor can confidently tell you that you don't have.

If you are unsatisfied with your progress or doctor I would recommend getting a second opinion on potential options to improve flexibility through surgery. Harbor View in Seattle has some of the best orthopedic surgeons in the world which is where I'm going next month. I've pretty much had every possible complication minus anything serious like losing my leg, but there are a lot of things that you can't mess with on this recovery and I think trusting your surgeon 100% is important because shit happens and you want to be confident that they will get you as far as you can in getting to the new normal.

Interested to hear how your cycling is going since that's about the only way I've been working out, but yet to take it on the actual road since I can't get out of my left clip due to my ankle stiffness, but will as soon as I can.

Red7 - While your PT is correct that you shouldn't be in excruciating pain the only way to start getting some of that flexibility back is to put as much pressure as you can handle on the foot. One exercise that helped me was just standing next to a wall or table and slowly shifting weight from your strong leg to the injured one as much as you can take without pain. It will slowly get better and trust me I was scared as well to give it a strong push, but just started walking without my boot this week and was shocked how fast I've been able to start feeling better. If your doctor thinks you can start weight bearing with the bone I would trust him or as I stated to Menschita, go get a second opinion. Pilon fractures as I'm sure you have heard are pretty horrific injuries to the joint and bone, so a good doctor is crucial. I was lucky enough to have one of the best surgeons in California with a highly competent team work with me the last 8 months. I trust them fully and if you don't feel the same way it might be a good idea to see someone else just to understand your options.

Sorry for the diarrhea of the mouth, but I feel like I have been working with an incredible orthopedic staff at UCSF and since I've had a ton of problems I have been working through lots of different options for improvements. Happy to add more tailored advice if you have more questions because I know this injury sucks!

[Bett]

ok, bett here. now dr wants to remove all hardware . i have early jan appt to make a date, and then out it comes. he told me it's an outpatient procedure, i walk out, and do what makes me happy . no gym for a week. sounds almost too good to be true and i am now, a nervous wreck. still on pain meds and they added (pain dr) gabapentin which makes me loopy and crazy. thoughts?

[Mike89]

Brett- I am also getting my hardware out because of an infection which can't go away until it comes out. It's no big deal to take it out most people just leave it in to avoid going back in for surgery, but it's very non invasive.

[nicotheman]

Great to see this thread still alive. I had referenced it when I had my pilon fracture in October of 2014.

History: Hit a big double on my mountain bike, overshot, ditched the bike and landed to flat, my ankle everted outward 90 degrees.

Surgery was the next day. It was a mess in there. Comminuted fracture with a loss of 2x1cm cartilage loss on the talar dome. Multiple small fragments of cartilage were floating around along with bone fragments that had to be removed. I also had a midsubstance tear of the deltoid ligament that required another incision on the medial side of ankle to repair it. The syndesmosis joint also rupture requiring two screws to go from the tibia into the fibula to hold them in place to heal.

My left ankle broke the big toe and had a massive bone bruise on the calcaneus as well as a chip avulsion fracture malleous.

Im guessing I hit the ground going 30mph+ and just piledrove my legs into the ground.

My heel was completely numb throughout my healing process. I figured I toasted a nerve and would never feel on the bottom of my foot again. Feeling slowly came back throughout the year, which is awesome, there is something very strange about a numb heel when walking.

Fastforward to January 2015 I had the syndesmosis screws removed. I was weight bearing right around new years and had been in PT since around thanksgiving. I was feeling great, my gait was pretty screwed up but I WAS WALKING! My PT was pushing me constantly and we were seeing great progress through all of January.

Somewhere around February I woke up with my ankle very swollen and red. It was Sunday morning and I figured I just overdid it. Stayed in bed most the day with what I remember as a slight fever as well. Barely slept that night. Woke up and it was more swollen, and so sensitive that I couldn't even have a bed sheet touch it. Call up my dr and he tells me to come in immediately.

They lance it and pull out a bunch of puss. He tells me that they need to take me into surgery that day and clean it out. He sent out the puss for culture to see what the infection was caused by.
I get admitted to the hospital later that day and it get put in an isolation room, which later I understood why, the culture came back as MSSA Staph. So after all that progress, all that bed time, I am back in the hospital sitting on my ass. Two surgeries later, they removed all the hardware they could and are pumping me full of vancomysin (hardcore antibiotic). I get sent home at around day 8 with a PICC line and antibiotic pump. I have to wear a fanny pack with a pump that pushes some hardcore antibiotics into me for 6 weeks.

Fastforward to summer. Ankle feels great, I get released from PT and have a fun summer biking and freediving (including hitting all the major ski resorts of my bike in Colorado and Utah). Somewhere around mid-summer start getting pain when first waking up in morning. So after it feeling great initially, I am actively seeking help to see what happened. I have major pain in the morning in the anterior ankle. When I wake up in the morning it takes about 5 minutes of stretching to even get out of bed without experiencing shooting pains. I can generally go a day with normal activities but it becomes stiff in the evening.

I will update with more progression as It happens if you guys are interested. I feel this thread is a great resource for those with pilon fractures as it helped me a lot when I was nwb with mine.

[Bett]

ok, going to dr tomorrow to get a date for hardware removal. in the midst of this stress, asthma has started. great and oh yeah, they no longer will cover the one of two antibiotics i am not allergic to, and the nebulizer liquid. just really?
i made a list of questions for the dr, my shrink friend is coming with me, but things I'm reading on the internet (i know i know) say if you had pain with the hardware, chances are , you still will. how the hell can that be and maybe I'm reading the wrong articles? anyone have experience with hardware removal and pain or lack of afterwards. i am now ready to be scraped right off the ceiling, it's freezing in ny and i am now limping like i did months ago. i guess the cold and metal isn't a great combo. thanks for any info.
bett

[lemmycaution]

jeez. checking into this thread for the first time. pilon fracture a week ago today. home between surgeries for a few days with my external fixation on, plates and screws in a few days. took a weird little tumble on skis- nothing special and ended up with this. faaaak. avid runner and skier, modifying my expectations but cautiously hopeful and impressed with the courage i see here. no real pain yet (except that first night) but girding myself for a long haul. will post when my head gets back on right.

[LightRanger]

Read up on Kelly Cordes's ice climbing accident and gnarly pilon fracture (he blogged about it a bunch). And then check into what he's doing now. Keep the chin up.