Tibial IM rod Removal

[wboarder]

Oh, I'll add this: The neoprene patellar tendon straps were totally like magic for me. Massive reduction in patellar pain. [They're used for Osgood-Schlatter disease.]

They're cheap - like $20-25 on Amazon, or cheap knock-offs on ebay for half that.

Did I mention - they were totally like magic. I was completely blown away. Seriously. Like 80% pain reduction. If someone had claimed that kind of result before hand, I'd have said they were smoking the good stuff - 'cause that just seemed so unlikely. [As far as I can tell, there's no good idea in the medical literature as to why they work either. Perhaps some change in the angle of attack/pull on the tendon is the most likely I've seen.]

Anyway - for super cheap, it's worth it to try. Heck, I'll send you mine, if you like.

-Greg

Thanks for all the good intel Greg. Ok I'm gonna check out that strap action. I definitely am
Motivated to back on the slopes.... Epic pass and a new demo pair of On3ps that I need check out.

I pushed to get the surgery done ASAP and the Ortho was cool with that action.

Thanks again

Brandon

[COMMISH]

I am a 46 year old male recovering from a tib/fib spiral fracture in March. I ski 40-50 days a year when healthy. I have been crushing myself in the gym and riding my bike since early July. I would put my recovery at 75-80% of where I was pre-injury. I have a tibial rod and I have had the top screw closest to the knee joint removed. I do not have pain to the touch in the break area. Getting close to the start of the season and I have all sorts of questions....

Tele or Alpine? I do both and my initial thought is tele. Is there a downside to this?
Do I need to get new liners for my boots?
Will my leg get cold?
What can I expect my limitations to be once I am on the snow? Powder? Bumps? Jumps?

Finally, my doc, an experienced ortho with skiers, feels that I will ski pain free and said only one in ten patients have the rod removed. The consensus on this board sounds overwhelmingly in favor of rod removal.

Any opinions are welcome.

Feeling nervous!

-COMMISH

[LightRanger]

I am a 46 year old male recovering from a tib/fib spiral fracture in March. I ski 40-50 days a year when healthy. I have been crushing myself in the gym and riding my bike since early July. I would put my recovery at 75-80% of where I was pre-injury. I have a tibial rod and I have had the top screw closest to the knee joint removed. I do not have pain to the touch in the break area. Getting close to the start of the season and I have all sorts of questions....

Tele or Alpine? I do both and my initial thought is tele. Is there a downside to this?
Do I need to get new liners for my boots?
Will my leg get cold?
What can I expect my limitations to be once I am on the snow? Powder? Bumps? Jumps?

Finally, my doc, an experienced ortho with skiers, feels that I will ski pain free and said only one in ten patients have the rod removed. The consensus on this board sounds overwhelmingly in favor of rod removal.

Any opinions are welcome.

Feeling nervous!

-COMMISH

Yo dude,

My thoughts:
1. Tele or alpine shouldn't matter if it doesn't hurt. My injury was based on a tele non-release at frightening speed at Squaw, so I switched to alpine. Happy. Plus I doubt I'd tele effectively with the residual Checkrein Deformity and lack of toe flexion that I have.
2. Liners depend on how it healed and if your leg shape is the same. I like Intuitions, but it may not matter in your situation.
3. I doubt your leg will get cold if it didn't get cold before. IM rod should not affect that.
4. Not sure until you try it. I had significant pain at the fracture site and couldn't ski (due to excruciating pain, not physical inability due to it) until I got it out. Others have had totally different experiences and have no limitations at all. Most of the time I did not have pain to the touch at the break area either, for what it's worth.
5. Like the last response, it seems to depend. I saw something like four+ different orthos over the years for my issues and it was split down the middle on getting it out. But I couldn't even snowboard until I got it out because it was so painful, so it was ultimately an easy choice for me and I wish I had gotten it out sooner. The relief for me was immediate. Was in for close to four years before I got it removed.

Keep us posted on progress. Sounds like you're well on your way.

[gregorys]

You've seen my post up above, I assume?

First, just because it works for me doesn't mean it does for you. If you [or I] are "unusual" that's just fine. People are who they are and have the limitations they do. Don't settle for "average." Beta like mine is useful in helping you decide what to look out for - but it's only a weak substitute for your own experience. You may find your experience is way different than most everyone else's. Just because the average shoe size is, say 8, doesn't mean you should hell-or-highwater make yourself fit 8's. [Seems obvious, but it's something to keep in mind.]

>Tele or Alpine.
IMO Alpine. Tele is, IMO, more likely to re-stress the spiral fracture. As noted by LR, if it's truly healed, it shouldn't matter any more than it did the first time. [I assume it's no-release tele stuff - unless you've got the Voile plates. That might change the calculus for me a bit.]

Turn the DIN's down. I'm a type III+ skier, and I was skiing for the remainder of the year last year as 1 DIN *under* a Type I [for my BSL, Weight, Age]. I'll probably ski this year as Type I until I really start having problems with pre-release and then I'll go up [very slowly and carefully] as needed. Since I skied really hard the last month last year, I'm having a hard time seeing that I'll ever go back to the same DIN I was using before, as I don't think I need it for retention, and the substantial additional risk probably isn't worth the few times I'll release when I shouldn't. [This is a work in progress, so it's always possible I'll come back after this next year and I'll be back at III+ DIN again - but I doubt it.]

I don't need to be as careful this year, as I'll be a full year out and less likely to re-injure it than I was at 11 weeks post-op when I started skiing last year. But in any case, I don't think I need the higher DIN.

>Do I need to get new liners for my boots?
>Will my leg get cold?

Pop 'em on and see. I sure didn't.

I inline skate on a super rigid carbon-fiber/fiberglass boot with very little padding anywhere. While the screws at my ankle are right near the top of the boot, I'm not having problems with them, really at all.

None of my screws hurt much at all. Of course, being an inline speed skater in rigid boots gets you used to some discomfort - but I don't think that's the reason I'm not having issues. I just think my screws don't bother me. [One in my knee seems to irritate the tendon that passes over it, but it's a pretty small issue. At this point, I can't see spending the cash to remove the screws.

I'm in the PNW, so really cold ski days are rare, but I've not noticed any issues or differences. Coldness doesn't seem to impact the bone or hardware. [I've not been out in anything below 15-20F or so who knows if -15F might make a vast difference.]

As noted none of the screws or the rod appear to be any significant issue. It's always hard to tell, but I think I get modest twinges of bone pain. [Or it seems like bone pain.] It's not at all certain those would be better without the rod and screws. The vast majority of the time no issues.

So, as noted - I started skiing at 11 weeks post-op.
I had my first double-eject at 12 weeks, I think. Was skiing groomers, and just caught an edge in some soft new snow at the edge of the run. I was really apprehensive when I went to get back on my feet. I was totally amazed at no pain at all. Just went and clicked back in. [Remember I'm skiing at DIN Type I--]

Over the next month, I ski a bit harder each day. Right at 15-16 weeks or so, I go back to skiing nearly as hard as I ever did. But pain was way down before I would turn up the volume more. [I never, ever, skied with any drugs on board. Not even advil. If it was going to hurt, I wanted to know. I might pop two advil at the end of the day, but not before.] And if it did start hurting - especially bone pain, I'd turn it down, or go home.

You'll be a full 6-8 months. If your xrays show good solid bone, I think you're good.

As for rod removal. Simply see how it feels. Clearly some here have been really miserable. I'm way on the other end of the spectrum.

I'd watch this before I considered it: [Warning - not for the squeamish! Think tongs and hammer. It's a IM nail removal video. Poor guy on the table. His leg is not going to feel great tomorrow. It's 2:30+m of full on hammering to remove the IM nail.] Ugh!
https://www.youtube.com/watch?v=HiC8Iue5iMg

As an epilogue. I did re-crack the top portion of the "butterfly" you often get in a spiral fracture. I did it the last day of the season, while cruising through the terrain park hitting the edges of the smaller kickers. But I think I caused a small hair-line fracture a couple of days before, while picking up a very heavy desk. It felt really odd as I picked up the desk, but no pain or anything else - so I thought I imagined it. I skied off the mountain, essentially, on one leg and limped home. The next few days were pretty lousy, but in 3-4 days pain was way down again.

I was gimped for 2-3 weeks, but didn't do any substantial damage to worry about. A follow up in the last few weeks indicates full bone healing and I was told "go enjoy life." [I did miss a couple of months of skating at the beginning of the summer. But having a couple of months of skiing to use as "payment" seemed like a trade I'd make all over again, in a heartbeat.]

I couldn't ask for more, really. All said, it could have been and/or be so much worse.

HTH
-Greg

[COMMISH]

LightRanger and gregorys, Wow. Thanks for the prompt response and thoughtful feedback. This is really solid info. I should add that I am headed to Winter Park on 11/18. I don't expect much terrain to be open, but it will be my first time on snow post-injury. Also, this is where my cold concern comes from. I ski Tahoe and WP and the temperature variation between the two regions can be fairly extreme. I think my takeaways are to turn my DIN lower to start and see if my gear works (boots, etc). I am going to start with my alpine set up.

I will absolutely report back.

Thanks again!

COMMISH

[gregorys]

This is an interesting discussion about DIN release values - and is part of why I, generally, think I'll live with lower release values.

http://www.vermontskisafety.com/vsrfaq5.php

The TLDR; version is: I think I, in the past, selected a DIN purely on what a chart said. But I think the vast majority of the time, I really don't need that kind of retention. (This based on skiing at what I previously would have considered a "ridiculous" release value - thinking I'd blow out all the damn time. Imagine my surprise when I didn't.)

That paired with my Tib/Fib fracture got me more interested in safe bindings/release values. I'd already gotten some Knee Bindings [don't tell anyone, I'll lose all my cred as a skier!] too, but still haven't mounted them yet.

I was also Tele until about 18 months ago, and I decided to go to Alpine because I was skiing so fast on newer tele gear I borrowed from friends. [I'd mostly stopped skiing for a number of years, other than a little skiing when I was climbing volcanoes here in the NW. So, my tele gear, which was releasable, was super old.] Yet my tib+fib was on Alpine gear. So, go figure.

Perhaps this is all tilting at windmills, but I'd just like to avoid an[other] injury if I can.

-Greg

[wboarder]

Ok my nail is coming out this coming Thursday and yes I've watched and shared that video several times- scares the sheet outa me. So I will update you all on the process/recovery.

Ok now to Commish:

I have have had my nail in since Feb 2011. Skiing deep in West Bowel Squaw. All was good until about 8 months ago including lots a skiing and tahoe paddle boarding - 14 miles races...etc.. so this removal to me is a big deal cause all was good until recent. I am having sharp pain at the break area and then it radiates out. I have gotten a second ortho opinion and he said all is healed based on 2 CT scans 6 mos apart.

Have s good one~ you'll hear from me in the near term.

Brandon

[roverdoc]

Regarding the video above. That is not typical. Video demonstrating a atypical situation of incarcerated nail. Just FYI so dudes are not getting scared. Nail comes out much easier typically and does not usually require the windquist universal nail extractor. Simple slide hammer and it comes out. Good luck with surgery.

[COMMISH]

Brandon-

Good luck with the removal. I will also keep all in the loop on my progress. As I mentioned, I am back on my boards in 13 days. We shall see how it goes.

-COMMISH

[wboarder]

Ok had the nail and screws out Thursday afternoon and as of today I'm able to walk ...sort of hobble without crutches. And I am not on the hydrocodone at this point. The dance between pain control and expelling waste becomes tricky- focusing on the waste this morning

[wboarder]

Took off all the gauze and wrap today

[gregorys]

Yeah, I hear hydrocodone does that to some people. I never had the problem. [Oh, I _could_ tell there was a difference, but it wasn't much of an issue.] But then again, I only took a 15mg dose for a day or two, then 10mg for another day or two, and then 5mg for perhaps another week.

I actually felt tramadol was pretty good at 25mg, along with 200mg advil. HC was good for pretty intense pain [often at night/evening], but tramadol was great once I was out of the most intense pain.

I hear colace helps substantially.

[gregorys]

And don'cha love that edema!?

"Yeah, my legs always look like the Michelin man's!"

[anotherVTskibum]

So I realize I'm bumping an old thread, but I figured I might as well add my own experience.

I fractured my tibia in a classic boot-top manner on Dec. 25, 2014. The ortho-on-call declared that I needed surgery, and he installed an IM nail (rod) and three screws that night.


(10 days post-op)

I was "weight bearing as tolerated" even before being released from the hospital, and I think it was about three weeks before I was hobbling around on one crutch and four before I could limp my way to work, two short blocks away. I was cleared for cycling, snowshoeing and hiking in early March, did a bit of low-angle skiing on three-pin gear mid-March, and had my first lift-served "turns" in early April (about two weeks before being cleared to do so). I did develop a bit of arthritis in my left knee, and my PT and I both suspect that is likely a side effect of the surgical procedure rather than a direct result of the original injury.

I will say this: if you sustain this sort of injury, I'd strongly recommend getting to see a physical therapist as soon as possible. I had to ask, "Can I start PT now?", and the surgeon looked at me a little funny and then said if I wanted to, he'd write the referral. I assume he'd planned to suggest it at the next follow-up appointment, another month later; as it was, I'd lost a lot of strength in both legs, and I wish I'd started seeing the PT sooner if only to work on preserving fitness in non-injured parts of my body.

I still have the hardware installed and am generally loathe to go in for surgery of any sort without a damn good reason. It doesn't bother me at all, and I'm back to skiing frequently and often skiing fairly hard (albeit with lower DIN settings on all but my GS skis). My understanding is that the risk of leaving the rod in is that if I should manage to break the same tibia again, it would imply also having bent the rod...and then they'd need to remove the bent rod from the broken leg, which sounds incredibly unpleasant.

Also, I was initially worried about the calcium lump at the injury site causing boot-fitting issues, but by the time the following lift-served season rolled around, I was back to about the same cuff tightness on both boots, and it doesn't seem to have had any significant impact on alignment.

[XXX-er]

https://www.facebook.com/peter.nicke...94042302785405

dunno if you can see this but i'm pretty sure its rod removal not knee surgery