tibia pilon fracture

[Bett]

bett here- off the gabapentin as it made me rather nuts. got a date for pre surgical testing and a date for surgery, feb 25 (or is it the 26th). i am beyond nervous. anyone have stores of success after hardware removal? i've now become from funky to depressed and scared. to death.

[Red7]

Metal fatigue of hardware in ankle

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!

Hey Mike and others. Thanks for the post. Here's an update. I'm now at 8 months post op and I have come a long way and can walk without too much pain and a slight limp. I can walk without any limp but it hurts a lot more so I only do it any certain situations.

So I went to a different ortho for a 2nd opinion (my surgeon was in a city 2 hrs away where mx track was) about 6 weeks ago and he took new xrays. First thing he said was man, I sure hope your surgeon added bone from a graph (which he didnt). Next thing he said was, I'm concerned it's a non-union or you have an infection because the bone isn't healed that we'll (I'm not sure if I can add a photo of xray here. They had me get a triple (nuclear?) bone scan and they couldn't rule out an infection but radiologist doesn't think there is a non-union or infection. I didn't think there was or I would be in more pain but you can see in xray where a triangle in the tibia looks not very dark in the xray so it's not dense.

There is an ortho on a mx forum that is supposed to be really good and does a lot of surgeries on mx guys so I sent him my xrays to look at. His comment was bone is definitely not healed, that I should not ride, ski or have any impact, and that the 2 metal plates and hardware would definitely be fatigued after 8 months. He said it's not designed to be supporting the bone for so long (before bone gets dense and takes over supporting). He said I should have all hardware removed, bone compressed to stimulate growth? (I have no idea what that means) and have new hardware installed. He said if not the hardware could give way at which time I'll be in a world of hurt.

However, the past 2 weeks have been my best to date so I feel like it's getting better and have no desire to start over with new hardware. My hope is I can get bone strong enough that I can get fatigued hardware out.

Though I do think this ortho is a bit of a doomsdayer, I wouldn't be surprised if the metal is fatigued because the xrays do show a gap between bone and plate so it might be flexing when I walk.

Mike- you mentioned you work with UCSF. Is the metal fatiguing a legitimate concern and am I playing Russian roulette by not replacing it? I did get an Exogenous 4000 bone stimulator and have been zapping it so maybe that's what's making me feel better.

My goal is to be good enough next winter to move to Colorado and buy season passes and teach my 7 and 11 y/o to ski for a couple months as a last hurrah since I realize I will eventually likely need it fused which will greatly effect my ability to ski.

Thanks for any help you can give!

[Red7]

Here's my most recent xray where you can see the area where the bone is not solid even after 8 months

[lemmycaution]

good luck all with your decisions about how to move forward, wish i had some meaningful advice but i am just 2-1/2 weeks post-op here. got my external fixation off and plates and screws (a shit ton of them) installed. those were my first surgeries ever- man that sucks. keeping your foot elevated sucks, the "grapefruit foot" sucks. the tingling burning from the sutures sucks but had my follow up which went well, switched over to the cam-boot and started PT which does not suck. my dr says to live in the boot and rarely take it off, whereas my pt says i can stay out of the boot for extended periods of time- what do/did you all do with that?

[doubled9]

Random Pilon Fracture Questions

Hi all, I am now 4 weeks post op from my "accident" stupid hockey! lol been playing for 30 years and just now I decide to lose and edge full speed about 3' from the boards and a split second later I'm on my belly looking back at my ankle pointing the wrong way. Didn't really hurt til later that night but more frustrating because there goes my winter.....no more hockey, snowboarding, vball, or any sport for that matter. I guess one positive thing from this is I weigh about 20 less lbs. from giving up beer and eating better. So now starts my questions for the veterans out there that are a year or 2 post op. What is life like that far in. What are your limitations? I was told I will probably never run or jump again which limits me on a lot of my activities. Is there anyone out there at least trying to run or jump or is the risk of completely wearing out the cartilage too strong. Another concern is Range of motion. Where should I be after PT. Is 100% realistic or will it never be the same again? Last question. If I can gain access to a bone stimulator, what are peoples thoughts. Are they worth a damn? Thanks!

[lemmycaution]

doubled9- take this with a grain of salt because I am in roughly the same time frame as you but everything I have heard tells me that the statistics are that there will be limitations to your activities- less because of strength than because of range of motion. That being said, medical statistics are just that- statistics and every fracture, treatment and PT regime is different so it will vary pretty widely. Cartilage wear is more if the repair did not make the joints perfectly smooth and co-planar which is part of the point of the surgery and fixation in the first place so that depends a lot on the skill of the surgeon and again the particulars of the fracture (and how the healing goes also) as I understand it. Personally, I am working hard on my ROM to get as close to 100% as I can- seems unlikely though compared to my other foot at the moment. That is all you can do as I see it.

[DJM19]

Long Recovery for Tib/Fib Pilon FX

Hi Red, I had a skiing accident 2/23/14 w ORIF surgery 3/7. NWB for 2 months. PT for 3 months and went back in Dec 14 to see about HWR. No go. Still wasn't healed. Disappointed to say the least but now understood the pain I was having. Still broken. Hated the hw. I finally started feeling good this last Dec and went back to my surgeon nearly 2 years later. All healed, so I scheduled HWR for 1/25/16 and am back walking again. Still pain but so much better. I have some very large holes (8) you can distinctly see in both tib(3)/fib(5). Should eventually fill in. Stay positive. I have a high threshold for pain too but it didn't feel right. I'm 48 and it just took longer for my bone to finally heal. Everyone's journey is different and in time if no infection/non union, you'll get there. Hope sharing my experience helps.

[Red7]

DJM19- Thanks for sharing your experience! A couple questions for you. Was your original hardware in that entire 23 months or did they change out the hardware due to metal fatigue? It sounds like you had the same hardware in which is encouraging because I finally learned about Wolff's law so I've been pounding the payment with lots of walking and even light jogging, extra weight bearing with squats and dead-lifts to stimulate bone growth but I feel like I'm playing Russian roulette where I'm in a race to get the bone solid before the metal snaps and so does my bone. However, I feel like the bone is getting stronger by the day. It started out quite painful but 6 weeks later and I feel like things are really starting to turn around so I know the bone is becoming more dense even though I haven't had an xray. Unfortunately, my surgeon never discussed Wolff's law and instead gave me the impression that the clock was ticking and the more I used my ankle, the sooner I'd need it fused. Maybe that's true but if I'm not using it enough to get the bone to heal then what does it matter. In other words I waisted several months by babying my ankle when I needed to get out and start using more than cycling and swimming which were good for the joint but does nothing to strengthen the bone.

Questions 2: After they removed your hardware, how was the recovery? Were you in a boot NWB for a good bit or could you walk immediately and just have to baby it so as not to cause a fracture where the screws were? Did they tell you how soon you could resume normal activity?

It may be ambitious but my plan is to walk and gimp-jog everyday, increase weight bearing with progressively heavier squats and dead-lifts, and keep using my Exogen 4000 bone stimulator (which I also stopped using until 6 weeks ago because my surgeon had told me it wouldn't do any good) with the hopes of getting my hardware out around the 1 year mark. I plan to move my family to Tahoe next winter to get season passes and teach my 7 and 11 year olds how to ski so I have one goal in life right now and that is to get this ankle in shape so I can get the metal out and be skiing next winter. I think ski boots with the metal plates still in would be painful as hell so I've got to get the metal out a few months before the ski season so all the holes will fill in.

[lemmycaution]

any tips for working on dorsiflexion? it seems that i go to a certain point and hit a wall. its hard for me to even get to a stretch on my achilles tendon, it stops in the front of the joint before i get there.

edit: or anyone get good (lasting) results with talus mobilization?

[lemmycaution]

maybe this thread is just becoming my blog, but.....

now i am 14 weeks PO. went in for my "12 week" appt with my surgeon last week- i had been "toe tap" weight bearing, and went to FWB, no cane no nothing- weird sensation to come in on crutches and then walk out of the hospital into Manhattan (I live in Brooklyn) on my two feet after so long being so careful. Advice i would give anyone is be very diligent with the PT- as soon as i was able, i started stationary bike every day and in all my spare time working on ROM. i am def not 100% and probably will never be as i see it (especially inversion on my ankle) and i still cannot squat but using your feet as normally as possible helps a lot. I could feel my bones getting ready to bear weight but even at 12 weeks i was not quite ready, i felt much more ready at 13. i am thinking i am pretty lucky as i dont think i did much damage to my cartilage (it was not really a huge impact injury with me) and no infection/rejection issues. going back in a few weeks to talk about hdwe removal which sounds good to me. already put on my ski boots and i have the dorsiflexion for that already- still cant walk down stairs without dropping the last couple inches yet.

[Bett]

ok, bett here. all hardware removed feb 25. feels better but now waiting for the two,or three incisions (one small one in center of ankle) to fully heal, as if anything rubs against it, the pain is not good.
the weather in ny has been cruddy which affects my pain level a lot.
going to gym/pt 5 days a week, but pt which is all done according to medicare, only once every two weeks. don't need it. dr thrilled with everything, pt thrilled with everything, and i would be thrilled if i could find shoes that didn't rub the incisions. so far, i keep them covered with gauze when out, unless the weather warms up and i put on sandals with little support but no rubbing on the incision.
still do my 2-3 hours at the gym, they told me to slow down the treadmill (was doing a mile in 22 minutes, not trying to win a race but that's how i walked) so now doing a mile in half an hour and holding on with one hand . if they think I'm ever letting go…..yeah,not happening.
press 70 lbs with leg press, then the same with toes, and then the last one, with the right leg only (only ten times for that one). doing all the other ankle things they want, i may pull the thing i don't know the name of where they put a belt like thing around my waist and i walk straight ahead, first front, then backwards, then drop it to my back of knee and bend.
i am for sure, at 18 months the VP of the pt place.

getting kind of tired of the pain, but now i think it's mostly weather related, probably arthritis, (swell) and the incisions healing. almost done.
glad the dr and pt are so happy because I'm not always smiling.
just checking in and letting everyone know where I'm at.
pilon ankle fractures with a dislocation are not for 67 yr old women.
grrrr

[mb0915]

Slow and Steady

Hi all, I'm so glad to find this forum. I'm about 9 weeks post-op a pilon fracture of left tib/fib with plate and screws. I've been NWB up until about a week ago and now PT has me doing short walking with boot and walker. It's been gnarly, that's for sure. And I'm NOT an athlete but a 57 y/o woman who fell off an improperly installed handicap ramp! Seriously. Healing has been slow but steady. I also have common variable immunodeficiency (CVID) (crappy immune system) so risk of infection after surgery was big concern. So far so good although one incision is still a bit pinkish. I also had pre-existing peripheral neuropathy (from previous chemo many years ago) and the numbness in the fractured foot is severe, and affects my balance. My current mobility is wheelchair 90%, walker 10% with boot only. It is good to know that so many others have healed from this injury and that recovery is slow for most of us - not just me.

The CVID is probably why my surgeon said it's not necessary to remove the hardware if it isn't problematic. Anyone still have hardware past a year? I'm curious as to how long it can stay in.

Probably most of you had to have the "cage" or external fixation. I only had the cage for a week but my dr said he's had patients that were in the cage for months - he said they develop "cage rage."

[CarlX]

expectation to walk normally

First I feel very lucky to find this post which has lots of information about what to expect.

My wife unfortunately failed off during bouldering (around 10 feet height) and right now has a external fixation installed. The diagnoses was "Closed Displaced Pilon Fracture of Left Tibia", we are looking for another surgery of ORIF in a week. It looks like not an easy task to get recovered to the new norm and keeping her positive is another challenge down the road in addition to the PT.

I'm very glad to see lots of you recovered very well and able to do sports again. My biggest concern is that would my wife be able to walk normally. By normal I mean if she can walk several miles a day so she can travel like before, and will she be looking normal instead of crippled cause her work requires attend lots of public activity and public exposure.

Right now I'm trying to let her not thinking too much about the consequences but focused on recover and getting ready for the ORIF surgery (can't do before swelling gets better). But for long term we need to adjust the expectation so she won't get frustrated.

Thanks for your advise. I hope you all a speedy recovery and best of luck.

[Bett]

I'm coming around to 19 months post accident. dr thinks I'm awesome, pt thinks I'm awesome.
and I'm still crying 5 days out of 7 from pain. shoes? sneakers or very limited. incision freshest-19 screws and 2 plates removed (that the hospital won't allow me to have) feb 25th.
i wonder if i ever will be semi normal again.
sorry for the bummer but I'm not in my 30's and i guess i really did a beauty of a job (one freaking step, while taking care of my husband who had an ankle fusion. you cant make this up)
i go to therapy/gym/pt now 5 days a week as my dr thought i was becoming obsessed. walk great on the treadmill that i hate, let the pt do what ever it is he's doing now (some thing on my foot and then attaches weights, i think, at the toe area). great great great.
but i don't feel great.

[lemmycaution]

i am now about 5 months PO. went in for my 16 weeks and surgeon said the hdwe has done what it is going to do, the bone is healed so it is up to me now, cleared for whatever i am able to do. doing pt at a place 2x/week and on my own at least 3x- it does steadily get better, limited what you can do when you are NWB or PWB. i lost a lot of strength even though i started pt 2 weeks PO, not sure why especially in my foot. i have 3 plates and 14 screws and my surgeon says to only take them out if they really become a bummer, not sure on that yet. started running again, not far- up to 1.5 miles + stairs for like 10 minutes. if you can do it, and have a delicate midfoot impact (no limp, no bounding), there is nothing like it- my mobility is best when i get back. not sure i will ever be able to run close to i used to but maybe slowly i can get there. its a serious injury but there are degrees of it also- i had a bad break but no complications, healed well and did not (i dont think, unconfirmed) screw up my cartilage. i also had medical leave so i could really focus on the PT.