tibia pilon fracture

last day at alta i took a nice fall and had a pretty bad pilon fracture (joint surface to the end of the tibia), the doctor was blown away at how it occured in my skiboot! After surg the following day i ended up with 7 screws and a plate in my tibia) its now been 5.5 weeks and the pain is mostly gone, though i can still feel my ankle swell when its not elevated for extended periods. I am still non-weight bearing for another 2.5 weeks. I was just wondering if anyone else has had ankle/tibia fractures of this nature? and what sort of recovery time/therepy i am looking at?
thanks

I also have a Tibial Pilon (Plafond) fracture. Surgery was on May 10th. On tues July 13 it will be 9 weeks post op and I will start weight bearing in a boot air cast. Not sure how much weight I will be able to apply because my other leg still is non-weight bearing for 4-5 more weeks. My Tibial Plafond was broke in 6 pieces and I have one plate with 10 screws. I have been working getting some Range of motion (ROM) the last couple weeks. I would say I'm about 50% for ROM. I would also be interested in hearing others experiences with these type of injuries and what type and time frame for physio and recovery. I believe in my case the ROM will almost get to 100% but I have major cartilage damage so I'm not too optimistic for my ankle joint having no pain.
Any comment and advice would be welcome!

sorry to hear about ure ankle man....i am roughly 11+ weeks in, i certainly know how u feel, my ankle is feeling better, but a long way off from 100% for sure....but i am fully weight bearing with a walking boot and can sorta walk normal in it although i still use one crutch quite alot of the time it makes it feel better....some days are better than others though, if i am pretty optimistic about getting back to 100% in the coming few months! i am probally like 75% rom by this point! its sorta strange because the parts that hurt the most are no where near where i injured it (achilies, calf, and lateral side of my foot and ankle! my advice to u is not get too down on yourself because it hurts, but in the coming weeks it will start to feel better and every morning it will feel just a little bit better than it did the day before, also get in the pool and do lots of swimming and get on a bike asap! tough it out bro!
sorry for the very disjointed and sub par response, but its late

Wondering how you guys are all progressing? I had a tibial pilon fracture in early Dec 2011. Was NWB for 8 weeks, and ramped up to FWB by 12-16 weeks. I've been doing the elliptical and stationary bike as soon as I could bear weight and have just about maxed on that. Tried running a few weeks ago. I could go for half a mile (and probably could have gone longer) but I definitely have a limp/awkward gait and have discomfort. My ROW is great and in talking to my surgeon it seems like one thing holding me back now is the hardware (plate and 9 pins). I have a pressure point at the top of the plate that is generating bone growth and the bottom of the plate seems to be restricting the ROW. Curious as to how your recovery has been going? Are you planning to have the hardware removed? Has anyone already done this? If so, what is the recovery time on that? My surgeon mentioned in passing that it would be 2 weeks for the incision to heal and another 2-4 weeks (4-6 total) for the pin/screw holes to fill in and heal.

Any info you have is much appreciated!!

Thanks!

I broke my tibia plateau and surgery Aug. 2, 2012. Healing is going along pretty well, but I only have about 50% ROM in the knee. My biggest problem is swelling in my foot and ankle. If I sit up for awhile, it turns purple and swells up. I have to lay down and elevate my foot for a good while until the swelling subsides. It seems like it is the same thing each day, with no improvement. I am worried that this situation may last for months! Anyone else experience this, and did it improve with time? THANKS!

A rock climbing wreck resulted in a bad pilon fracture (9 or 10 breaks to my tib-fib (mainly tibia) 2 breaks to my sternum and concussion. 3 surgeries, one plate, lots of screws and 7.5 months later I still have quite a bit of pain and significantly reduced ROM. I'm climbing again but not yet leading because of some sort of weird vertigo (severe spinning) that happens every once in a while. Hiking is painful especially downhill. Most of you seem to have had ski wrecks so I guess I'll (hopefully) hear about the ankle recovery. When (if every) have you recovered ROM and are able to hike or play hard without severe pain? BTW, swelling is still an issue although seems to be improving.

Areed - sounds like you had an absolutely horrible injury and I'm glad to hear you're back hiking/climbing. There's some reassurance to be had in that you're able to be active after only 7.5 months and you're able to engage in the activities that you enjoy (albeit I'm sure not yet at the same level as before). Furthermore, unlike many orthopedic injuries, symptoms after a pilon fracture have been shown to continue to improve over a longer time period (2.4 years on average in one study) than many other orthopedic injuries. Thus, bear in mind that any quoted statistics from research studies start falling apart when they apply to an individual like you because it doesn't matter how everyone else does - it matters how YOU do.

The tough part, however, as you probably already know, is that pilon fractures are among the most difficult of orthopedic injuries. There are two often-quoted studies that followed patients longitudinally after an injury like yours, both in the premier orthopedic journal (Journal of Bone and Joint Surgery). They found that returning to recreational activities, esp. if they involve running, can be tough, but you've already outdone that statistic with the recreational activities important to you. Thus, when you read the snippets below, I cannot stress enough that with your determined mindset and with what you've already managed to do, I would absolutely be positive. Furthermore, a lot of people do fine - it's just not the same class as a "standard" ankle fracture that most people refer to when they say, "I broke my ankle." Best of luck!

Study #1
J Bone Joint Surg Am. 2003 Oct;85-A(10):1893-900.
Outcomes: 35% of the patients reported substantial ankle stiffness; 29%, persistent swelling; and 33%, ongoing pain. Of sixty-five participants who had been employed before the injury, twenty-eight (43%) were not employed at the time of follow-up; nineteen (68%) of the twenty-eight reported that the pilon fracture prevented them from working.

Study #2
J Bone Joint Surg Am. 2003 Feb;85-A(2):287-95.
Outcomes: The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.

I suffered a pilon fracture of my left tibia/fibula at the talus February 23, 2014 (after getting taken out by a snowboarder listening to music and not paying attention to others around) while skiing in Mammoth. Surgery was March 7th ( a plate on each side with a total of 8 screws) and am still not walking 9 weeks po. 50% WB with crutches and ROM is coming along but it is so stiff that I cannot imagine me getting anymore out of it. The swelling has mostly dissipated but still gets really red when I have it down for anymore than 5-10 min with throbbing. I have been trying to be diligent with my PT exercises and have 2 big goals coming up so I am very motivated to get walking soon. My daughter graduates in June and am taking my mom back to Europe to be scattered on the Duna (Danube River) with a 2 week trip with the family through Italy (not sure I am actually looking forward to the flight let alone the walking!).

Most recently I sprained my SI joint which was also a joy. I think my right side finally said 'Uncle'. Still recovering from that joy of an experience. At least I had some other pain that was more excruciating than my ankle for a moment in time.

Uh not sure how all this is going to work out for me and am angry, depressed and super frustrated. I watch my salt intake as I find anything salty tends to inflame the ankle since the blood flow has been restricted considerably and it just can't flush it out. I have one screw that sticks out and can't wait to get the hardware taken out and I'm not even walking yet. I basically spend my days with my legs propped and elevated with small walks across the house and exercises 2-3 x's per day depending on the ankle.

Any wisdom, personal knowledge or ideas on how to move through and beyond to walking, as well as what to expect would be greatly appreciated. I have read the above posts and it seems everyone's story and accident is just a little different and unique.

Thank you!

My pilon fracture was on Feb.2, 2014. It occurred when landing flat on my snowboard. Surgery was on feb.7 which included 12 screws and a plate on my tibia. I was non weight bearing for 9 weeks and then partial weight bearing for the following 3 weeks. I have been in physical therapy 2 days a week for 7 weeks. ROM is about 90% with some swelling still present. Im not sure if i will get to 100% until the screws come out. It has been slower than most injuries and thus, aggravating and painful. On a positive note my physical therapist told me that I am 1 month ahead of where I should be. I ride the bike 6 days a week and try to push it a little more each time.
-----Originally the doctor told me that the screws would come out early fall and then I would be good to go for snowboarding season. Today I saw the doctor for my 4 month follow up. He suddenly changed his mind and said that he wants me to be NO impact for the entire summer. This means no running, jogging, skateboarding. I am limited to hiking, biking, and swimming. He went on to say that he wants to take the screws out in the spring and that I should snowboard with the screws in. What didn't make sense is that he said I can snowboard but not run. I feel like I am ready to start light impact training and I'm not sure what to do. I'm not sure its a good idea to go from no impact right into snowboarding. The doctor said that cartilage needs time to heal and that running wouldn't be good for it. I am determined to snowboard next season as well as recover 100%. Is it just me or does the no impact for the rest of the summer sound a little over pre-cautious? Does anyone have any advice?
Good luck to everyone else with an injury!

Hi Denny,

You are way ahead of me and my accident was on the 23rd of Feb. Since I wrote the above post not much has changed for me. I too go to PT 2x's a week (now going into 8 weeks) and I started Pilates last week to help get range of motion ramped up as my dorsal flexion is minimal inhibiting me from really getting a good bend when I walk. My doc said I could have the screws/plates removed in December. I am not sure if removing the hardware will change the ROM. In my case I have very little skin on my ankle and you can see the plates and screws poking out and pretty sure I would not be able to get my ski boot on without some pain from rubbing.

My doctor said it all has to do with the bones healing ... did you have an x-ray on your last visit? Even though my doc said my bones were healing well (5/23) he was surprised I was still on crutches. I don't seem to be able to walk without pain, swelling and it getting dark red. My doctor said use it and don't be afraid, it is stronger than it was before the accident. Maybe get a second opinion?

Are you actually riding a bike or in the gym? Also curious do you have a plate on each side or just on one? I feel like I am moving at a snails pace with rehab and feel stuck at the moment. Super frustrating. I hope it works out for you and congrats on the 90% ROM. A bit jealous.

Hi DJM,

Yeah Im still trying to get my dorsaliflex back to 100 also, I have a pressure point on the front of my ankle if I get too deep into a knee bend. I feel like once the hardware is out the ROM will improve. Mine still swells up from time to time and looks slightly bigger than my other ankle. I try to ice and elevate as often as I can but haven't been doing it as much lately.

What does your PT have you doing? Do you ride the bike at all? I ride a mountain bike that I found in the garage. There's this hill on my street that I go up. At first I was doing it on first gear, I keep going with a higher gear so its challenging every time.

I did have an xray on my last visit. My doctor looked at it in a different room and didn't discuss it much. He just came in and said that I should get the screws out at the end of next snowboard season as opposed to in the fall. Yeah I think Im going to try and get a second opinion.

My plate is an L shape and goes along one side and the bottom of my tibia. The 12 screws appear scattered about on the xray.

Yeah it seems to be going so slow. I've tried to jog a couple of times and I cant do it without limping. Some days it feels like its not getting any better but then when I look at how far I've come(since crutches/not walking) its a little more reassuring. Good luck with yours, keep pushing through it!

I had a type 3 distal pilon fracture in my right leg in December 2014. While playing hockey I lost an edge and crashed hard into the end boards. I ended up with 2 surgeries, 4 plates and 20 screws. At 10 weeks post-op I can walk unaided in a boot and can 1 crutch it with shoes on for short distances. I'm dying to run again, want to get back out on the ice and for sure am looking to mash gears this spring. My surgeon has suggested that running may be gone for good. Which is a bummer because I ran my first trail marathon last summer and was looking forward to many more. My ROM is at about 75% with the benefit of therapy twice a week. I think the hardest part for me is the tingling/burning sensation in my foot, it keeps me up at night; though it's definitely getting better. Interestingly my fracture sight is seldom painful anymore, it's mostly the foot. Have others had this experience? I'm curious how your outcomes have resolved, are you boarding, skiing, climbing like you used to?

Pilon fractures have a range of outcome based on severity as well as other factors. They're quite significant injuries, and if you look at surveys that try to measure overall function, pilons on average are more detrimental to level of function as heart attacks. The key words, however, are "on average", and it sounds like you're on quite the good end of the spectrum so I would continue to be positive about how you're doing. That being said, if it were my ankle, I would avoid running and certainly marathons. The joint simply isn't pristine anymore and you're going to be prone to post-traumatic arthritis as it is. Skiing however, involves a cast-like boot that supports your ankle and a powdery, cushioned surface. Enjoy and speedy healing!

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!

Write the alphabet with your feet. A,B,C...

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.

Quote:

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Originally Posted by Mike89

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!

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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.

Quote:

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Originally Posted by Bett

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.

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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.

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.

Quote:

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Originally Posted by 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.

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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.

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.

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!

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!

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!

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?

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.

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.

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

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.

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.

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.

Quote:

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Originally Posted by Mike89

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!

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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!

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

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?

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!

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.

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.

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.

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?

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.