Tibia Fracture insight?

[SlugInfinite]

Sort of long winded most likely - had a tibial fracture today at Abasin. Went to St. Anthony's West off of Union and 6th in Lakewood - ER was packed so I wound up seeing a PA. He spoke with a few orthos, the consensus was I'll need surgery with a plate and screws. They couldn't get me in today, so I need to set up a consult with Panoramic Ortho in Golden tomorrow, Monday. I've always heard good things about Panoramic, so I'm feeling pretty confident there. PA seemed pretty laid back with the whole thing, suggesting I could go several days before the procedure without issue.

The whole ER visit seems like blur so I'm just not recalling things well - I've attached the radiograph, I don't think this looks like a spiral fracture, more of a comminuted fracture? I read typically that is three or more fragments from fracture. They did tell me to watch pain and swelling closely for compartment syndrome - of course following Pollard and reading the tibial fracture threads I could find here - I'm pretty concerned. I'm in almost zero pain now, just light throbbing, so I'm assuming the pain associated with compartment syndrome will be really differentiated?

Does anyone have any experience with Panoramic, any specific drs, insight, questions, etc?

Thanks - sorry this is not really super cohesive.

[Orthoski]

Hard to tell without seeing a picture of the whole bone, but may be able to treat it with a nail, which would have the benefit of letting you weight-bear immediately.

Best of luck to you!

[LightRanger]

Looks familiar: http://www.tetongravity.com/forums/s...-and-TFH-Folks

Mine was a spiral. Yours looks different to me, but I'm not an ortho.

I had massive swelling almost immediately that lasted for months. Ortho I saw much later thinks it may have been mild compartment syndrome. That and/or tissue damage caused me to develop this: http://www.podiatrytoday.com/treatin...s-after-trauma It went untreated for four years (including a non-indicated surgery by a podiatrist who didn't know what he was doing) before I self-diagnosed it and took that to a local (young!) ortho who fixed it in December 2012. He posts here from time to time.

My experience is pretty rare, so don't let it scare you too bad, but something to keep an eye on.

Best of luck man, and definitely keep us updated. Being able to talk to people who've had similar experiences is a good thing, IMO.

[SlugInfinite]

Thanks for the responses and the info - appreciate having info to know what to look for. Here is a larger picture of the entire leg - sorry it's a pretty garbage quality.

[chadr2]

I had a very similar break just over a year ago. Received the nail less than 4 hours post accident. I had the nail removed at Thanksgiving due to ongoing issues. Feels great now, and am back on the hill. My work was done by Vail/ Summit Orthopedics in Frisco. Dr. Janes put it in and Dr. Dorf removed it. I'd have no problem recommending either of them. If you'd like to talk timeline or have questions I might be able to answer, I'd be happy to discuss. Best of luck with your recovery. -Chad

[SkiTurtle]

Panorama is great. I had surgery on 1/29/14 for a Tibial Plateau Fracture. Dr. Rowland is great and understands athletes that want to get back out there (FYI - that won't be for a long while - sorry for the bad news).

Edit: just looked at your x-ray and it doesn't look like a plateau fracture. That is good news for you. I would still ask for Dr. Rowland. He is one of their trauma guys and also plated one of my collarbones for me in the past. Quick healing and good work. He will also listen to your endless questions about how quick you can do PT, when can I ski again, etc.

[SlugInfinite]

Thanks for all the input guys - met with Dr. Desai at Panorama today - he was the only available ortho for the next few days. Have surgery scheduled for next Tuesday - at 24 hours post accident my swelling was too great for the procedure now. I'll have just what Chad had, rod into tibia, nail in the top and two at the ankle. Said I should expect to be weight bearing within a week and a half - then standard PT to follow.

[XXX-er]

IME write the season off, do pt asap, get the hardware asap, ski next season

[Jax]

Sucks you have to get a nail for that, displacement doesn't look bad at all but I'm totally qb'ing from the imagery. This will now fuck with your ankle and knee which are probably perfectly fine at the moment. ++vibes

Spiral/distal tib/fib Fx here....my ortho was Mitch Robinson (the younger one, his dad's an ortho there, too) at Panorama, maybe get his second opinion if not too late? He knows full well how skiing is important. Going on three years with IM rod + 1 screw below knee and 2 in ankle to anchor the rod and have now gotten to point where pain is intolerable around the screws, will have to get removed. Timing wasn't good for removal after first year, still only 3 of 4 sides union so decided to push through pain of screws in ankle and knee, plus had change of insurance, what a PITA. Can't deal with it anymore and hope to get it all removed soon. I miss trail running too.

IM rod insertion is no minor surgery, the hardware takes some getting used to afterwards. Yes, no skiing for you for rest of season unfortunately. Good luck. Post pics of your cool hardware after and welcome to the club.

I highly recommend Johnny May at Panther Physical Therapy in Littleton, he had rods in both legs, also had them both removed. He's a skier, knows what it takes to get you back on track. They are right off C470 and Bowles, across street from Tipsy's liquor.

[Jax]

To add, your doc is a trauma guy, not necessarily one of the orthopedic sports doctors at Panorama. Not sure if it matters, just throwing it out there. Be adamant and clear about your goals for recovery and future sports participation.

http://www.panoramaortho.com/about/doctors

[LightRanger]

^^^ Get that shit out. I had my nail in for way too long (almost four years), and man was it nice to get out. I got the screws out at 10 months post-op.

Weight bearing in 1.5 weeks is great, sluginfinite.

[SlugInfinite]

Thanks for all the follow-up responses guys. Had a few other orthos take a look, the consensus seemed to be that a rod isn't mandatory, the displacement isn't terrible. However if they cast and I sit non-weight bearing for 3-4 months, I might not heal correctly, and I'll have 6 months of PT. Seems like the lesser of two evils is the rod, cut down on loss of muscle and flexibility, then see how it goes. Seems like I'm hitting 50/50 in the camps of removing the screws and rod. Few docs have said they will probably have to come out, few docs have said there is a good chance I'll adjust.

Thanks again for all the insight - surgery isn't for 4 more days still, 8 days on the couch is too much time to sit and think about everything that can go wrong.

[LightRanger]

Seems like I'm hitting 50/50 in the camps of removing the screws and rod. Few docs have said they will probably have to come out, few docs have said there is a good chance I'll adjust.

I saw six orthos and two podiatrists over the course of treatment. I got the same responses (roughly 50-50), which is why I didn't get it out for so long. Bones flex slightly. Titanium, not so much. Mine got to the point that skiing wasn't possible due to overwhelming pain, snowboarding I could only handle for an hour or two (and on smooth snow, at that), and it would ache mildly just walking the dog. Once he pulled it, it was like magic. Just one data point, but I wish I'd gotten it out earlier. The iridescent coating on mine was rubbed off in the fracture zone--indicating that the callus that developed was rubbing on it.

[SlugInfinite]

Thanks again for all the info from everyone - really helped in working through the process.

As an update - I've been less than impressed with Desai - I should have pushed harder for a more specific ortho. My cousin is a sports medicine ortho in Montana, so I've had a few things bounced off him which have been reassuring - but the little questions or specifics have pretty much gone unanswered as I'm half way through a sentence with Desai walking out the door. His assistant has been more than eager to let me know he does 40-60 procedures a month though - like that is some type of consolation. We've had some tense moments.

PT is going really well - they basically said there is nothing more I can do to improve until my walking boot restriction is removed and I can start rebuilding muscle. My five week follow up appointment is tomorrow - I'm really hoping they tell me I can ditch the boot and start getting serious about PT, but I know that's a little optimistic with the typical heal time at 6-8 weeks.

I definitely have localized pain in my knee at and ankle, both at the site of the screws. I'm not sure if it is just in my head and I need to cool-it and see how the next 3-4 months go, but it just seems like getting the hardware removed is the right choice. If that's the case, I'll definitely be electing for a sports medicine guy at Panorama to do that procedure.

[XXX-er]

I had 3 screws in the ankle from a a prior accident so when I broke the tib fib 2 years later buddy ortho said "you got hw still in that ankle from last time so I will have to plate instead of rod "

Pain from HW aside the pro's will tell you it is unnecessary to remove HW but IME when HW was left in the body the next time I broke a bone it got in the way of the next procedure, tell em it hurts and get your HW out soon as you can, recovery from an HW removal is nowhere near as painful as when you had it put in, I was supposed to be chaired out after the plate removal but I insisted in walking out of postop and I took the staples out myself

I am not even remotely an orthopedic surgeon but imagine the complications of breaking a tib again but with a titanium rod inside it ?

I got hurt in Feb of a season which is when they put the plate in, they took the plate and 2 of the 3 screws (one screw is stuck in there ) out next dec and I skied that season, that leg is probably > the leg that has never been broken

12 yrs later the twice kacked ankle is still slightly bigger than the other but no pain and 100% good

[SlugInfinite]

I am not even remotely an orthopedic surgeon but imagine the complications of breaking a tib again but with a titanium rod inside it ?

This is pretty much exactly it for me. I understand the rods are engineered now to function more in line with bone biomechanics - but it sure seems like the reality is a high impact or forceful twisting that caused the first break, would create a lot more structural damage with than without a rod. I know they're horror stories, but I've also read a couple of accounts of the rod bending with a new break, and creating all kinds of chaos on removal.

Ultimately, I just don't want to constantly the thinking about impact while skiing, or mountain biking, or anything really - it'll just make me hesitant, and that'll just get me hurt again.

[SlugInfinite]

Month later update - I said screw the walking boot about a week after my last post, and have just been walking normally, hitting PT hard and getting range of motion back. Had my next to last appointment today - Desai apparently was pleased with healing and removed all my restrictions.

Said I could get back into biking and running as soon as I felt like my leg/muscle strength had returned sufficiently enough to manage that type of exercise. He also asked me to keep an eye on the screw sites and pay attention to pain there, suggesting I would probably want at minimum the screws out at some point this summer. That was interesting to hear since I had pretty much zero feedback on the hardware up until this point.

Ultimately, I have to say 2.3 months post accident and almost 2 months to the day post surgery, I'm really happy with the way things have gone. I'm not completely out of the woods as far as rehab is concerned, but for him to have the confidence to remove any type of weight bearing or exercise restrictions makes me a fair amount happier. Either that or he saw my earlier posts and is hoping I screw myself...