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Rehab suggestions for tib/fib break?

post #1 of 20
Thread Starter 
I know that several skiers have been through this injury, as the surgeon told me that he sees it all the time. If this has happened to you or someone you know, what exercises have been beneficial, or a waste of time? My background fitness is pretty high, as I was riding around 12 hours a week before the injury, and would like to hit the ground running when I can get back on my bike in August.

I had heard that some opportunities would be underwater running and riding a bicycle trainer. Any others that I should be thinking of?

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post #2 of 20
What happened? And why can't you bike again till August?

I can't give you any advice because my fitness background is not high, was not high, nor will ever be high.

However, I only had 11 physical therapy visits, so I must have done something right. I just kept it moving all the time, from day 2. Never let it atrophy.

* I just found that thread and posted in it. VailSnoPro and Noodler both have had those injuries, too. Pick their brains. :

I just had the rod out, and I was walking unassisted 5 days later. It's much easier without the broken bone and trauma to deal with. The same stuff applies: RICE. Swelling is your enemy. Keep it up for faster healing.

Extend your leg straight as much as you can, point your toes, then bring your foot up to 90 degrees. Rotate your ankle. Bend your knee as much as you can without pain (soreness is a different matter) and use a band to push against. Keep it moving. You'll be ready for other stuff when the stitches come out and you have better mobility.

Being upright at this point is not the best for healing. Relax. You've earned it.
post #3 of 20
Dawg! Did you break your leg? I missed this...found it here Unmarked wind-lip/bad vis, and manky snow: tib-fib troubles!
X-ray pics and toboggan ride trip reports are in order. :

Sorry to hear the bad news. We had several high level skiers with this injury 2-years ago. VailSnoPro put together a number of threads on the subject.
http://forums.epicski.com/showthread.php?t=51002
post #4 of 20
Quote:
Originally Posted by dawgcatching View Post
I know that several skiers have been through this injury, as the surgeon told me that he sees it all the time. If this has happened to you or someone you know, what exercises have been beneficial, or a waste of time? My background fitness is pretty high, as I was riding around 12 hours a week before the injury, and would like to hit the ground running when I can get back on my bike in August.

I had heard that some opportunities would be underwater running and riding a bicycle trainer. Any others that I should be thinking of?
I assume you had an IM nail?

A significant percentage of patients develop both an ankle and subtalar capsulitis - stiff joints. This is an associated condition, not a direct result of the fracture; likely due to immobility, disuse, and local inflammation.

For skiers, subtalar joint mobility is critical, so I usually suggest seeing a physio early in the healing process to do some traction/mobilizing work on these lower joints.

Also, ART (active release) is a useful way to maintain good gliding of all the muscle groups (specifically posterior and lateral compartments).

Both these soft tissue issues are relatively under-recognized and undertreated because the focus is - of course - on bone healing.

Get a good sense from your surgeon re. his/her protocol on progress to partial weight bearing. With a nail, you can do this quite early, and the bone will respond to weight bearing stimulation by healing more quickly.

The pool & bike are good ideas .

Best of luck with your progress.

Regards,
Matt
post #5 of 20
I know it's not me that has the question, but I have no idea what you just said, Matt.: I'll need to get a dictionary and do research!
post #6 of 20
Thread Starter 
I am meeting with the surgeon on Thursday, and will find out what lies ahead for me. Speaking with his assistant on the phone yesterday, they said that the immobilization and non-weight bearing protocol was not due to the leg not being strong enough to hold weight, but to allow the damaged soft tissue to heal. Even though this wasn't a compound fracture, there was a lot of associated soft tissue damage.

This is relatively good news, as I am due to be in a walking boot once I get out of the splint on Thursday. I may be able to start PT ASAP, and once the pain is down, I can imagine getting on the bike sooner rather than later. I will have to see how this all goes.

One other thing I tend to worry about is the effect of the hardware inside of my ski boot, and on my range of motion. I hear that it can be a negative thing, but at this point, I am probably stuck with it until I am fully healed.

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post #7 of 20
The hardware inside a ski boot may not be an issue for you at all. I could feel the screws, but then again, I'm one of those 'Princess and the Pea' kind of people who feels everything a little too much for comfort.

It won't have any effect on range of motion. Zero. Nada. However, I've been told that if I intend to engage in risky behavior....like skiing...that could break that leg again, it would be best to have it taken out. Since I'm a klutz, along with other issues, it came out. EZ, too, and I would recommend it.

Everyone is different, but I was told it has to be in a year minimum for the bone to heal. There is additional healing of the bone after the hardware is out, also, and more down time with non-weight bearing time (grumble grumble).

If your doc says no weight bearing, I guess it's best to listen to him, even though you may have a 'walking' boot.

Do you have the cast off yet? Or is that on Thursday? Watch it, your leg will float off to the ceiling.
post #8 of 20
Locking screws can generally come out (if necessary/bothersome) at around 6 months. Nails should stay in for at least a year, but are often a total b*tch to get out, so be aware that you might keep it for life .

FYI, the nails are designed to flex with similar characteristics to bone. However, you need to be aware that a big fall could cause a catastrophic injury, i.e. bone 'explosion' around the nail. This tends to be seen more with fake joints, the implanted ends of which act as stress risers (so-called periprosthetic fracture), but some of the same potential stresses are present with IM nails.
post #9 of 20
Oops, copied the previous post (edited).
post #10 of 20
Thread Starter 
Quote:
Originally Posted by jdistefa View Post
Locking screws can generally come out (if necessary/bothersome) at around 6 months. Nails should stay in for at least a year, but are often a total b*tch to get out, so be aware that you might keep it for life .

FYI, the nails are designed to flex with similar characteristics to bone. However, you need to be aware that a big fall could cause a catastrophic injury, i.e. bone 'explosion' around the nail. This tends to be seen more with fake joints, the implanted ends of which act as stress risers (so-called periprosthetic fracture), but some of the same potential stresses are present with IM nails.
Yikes. That sounds ominous. But, then again, I wasn't told about nails, just screws in there. I will be sure to pick up a copy of my X-ray to see what the leg currently looks like. There is one person I know of who had the same injury as my self, but he was having a bit of trouble with range of motion on his tele skis, so he had the rod removed a few years down the road. His take on it was that his leg wasn't fully 100% until he got it out of there: once the removal was done and he recovered from the surgery, he was as good as new. It is interesting to see the different issues that patients have had to face with this injury, and gives me an idea about what I might encounter.

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post #11 of 20
Quote:
Originally Posted by dawgcatching View Post
Yikes. That sounds ominous. But, then again, I wasn't told about nails, just screws in there. I will be sure to pick up a copy of my X-ray to see what the leg currently looks like. There is one person I know of who had the same injury as my self, but he was having a bit of trouble with range of motion on his tele skis, so he had the rod removed a few years down the road. His take on it was that his leg wasn't fully 100% until he got it out of there: once the removal was done and he recovered from the surgery, he was as good as new. It is interesting to see the different issues that patients have had to face with this injury, and gives me an idea about what I might encounter.
Bonni's orthopod referred to the rod on a couple occasions as a "nail".
post #12 of 20
Rod = Intramedullary, or IM, nail
post #13 of 20
Thread Starter 
Update: I saw my X-rays for the first time, and I had a large fracture on my tibia, with a small 3rd part of the bone broken away. My fibula was also broken. The bone had a wide fissure, and the surgeon said it was a pretty severe break. Now, I have an IM rod, and 5 screws holding everything together. At the 2-week mark, there wasn't too much evidence of calcification, and therefore I am on a 15lb weight bearing limit for now.

Yesterday, at my first PT session, I mainly did some ankle flexion exercises, to overcome my very limited range of motion (measured at 5 degrees!). It is already starting to loosen up though, mostly because I am now in a removable boot and can get the ankle moving when doing these exercises. My PT also has me icing (which was impossible before, due to the splint/cast) and that is really helping to decrease swelling and pain. And, he said I should be getting on my bike (trainer) within 2 weeks. He wants me on it as soon as I have a range of motion of 105 degrees in my knee (right now my knee is stuck at around 90 degrees, due to swelling). He was confident that I would likely be at least partial weight bearing by 4 weeks more, and mostly weight-bearing by 6 weeks, but the X-rays will tell the story (next appointment is a month away).

So, I am on the road to improvement. The weirdest thing is feeling the lower screws when doing exercises (they are right above the ankle) and I will almost certainly getting them removed at a later date. The surgeon recommended that I not have the IM rod removed unless absolutely necessary, as it a significant procedure.

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post #14 of 20
Funny but we just got a survey form from Stedman-Hawkins Clinic in Vail. For my oldest son, Daryl who had a break a few years ago. Filled it out today. His rehab went quite well but he was only 20 when his happened. He was up and around on it rather quickly. Bike riding and swimming pool therapy worked wonders. Luckily, we have an inground pool and running in the pool against the jacuzzi jet was great. Unlike Bonni, his rods and screws are still in place and haven't given him any problems at all. The clinic told him as long as they don't bother him, leave it alone. The risk of complications and infection taking out the rods and screws aren't anything to gain.

I had a theory a year ago or so about boot top breaks being tied to new ski design and binding design not keeping up maybe causing this type of break to be more common than not. I staerted to notice more of these breaks as a Patroller. VSP kind of took the idea and ran with it but some good discussion came out.
post #15 of 20
Thread Starter 
Quote:
Originally Posted by Lars View Post
Funny but we just got a survey form from Stedman-Hawkins Clinic in Vail. For my oldest son, Daryl who had a break a few years ago. Filled it out today. His rehab went quite well but he was only 20 when his happened. He was up and around on it rather quickly. Bike riding and swimming pool therapy worked wonders. Luckily, we have an inground pool and running in the pool against the jacuzzi jet was great. Unlike Bonni, his rods and screws are still in place and haven't given him any problems at all. The clinic told him as long as they don't bother him, leave it alone. The risk of complications and infection taking out the rods and screws aren't anything to gain.

I had a theory a year ago or so about boot top breaks being tied to new ski design and binding design not keeping up maybe causing this type of break to be more common than not. I staerted to notice more of these breaks as a Patroller. VSP kind of took the idea and ran with it but some good discussion came out.
I had figured mine was a boot-top break, but it seemed to be more of a break around the second buckle on the cuff, so closer to the ankle. Mine wasn't the result of anything that would come from the design of a shaped ski, but instead, was just a forward twisting fall over a heelpiece that didn't release when a tip stuck in punchy snow on a traverse.

The boot-top breaks that you are referring to: do they occur in falls, or as a result of the forces generated with the newer crop of skis with sidecut? How many have you been seeing: 1 fracture per 5000 skiers? I always wondered what the injury rate of tickets sold to skier injuries were.

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post #16 of 20
dawg,

It's true it isn't easy to remove a rod, but it isn't brain surgery, either. I am sailing through it with no more pain than a meniscus tear repair (after the 3rd day, that is!)

Those screws near your ankle that are annoying....will most likely stay annoying. I had trouble after 14 months with footwear like hikers that pressed on the ankle......it was extremely uncomfortable to the point where I wouldn't even try to put them on. Not good.

If your surgeon recommends leaving it in for the reason it's too difficult to remove......get a second opinion. My ortho was more than willing to do it if it meant my comfort and peace of mind.
post #17 of 20
Quote:
Originally Posted by Bonni View Post
dawg,

It's true it isn't easy to remove a rod, but it isn't brain surgery, either. I am sailing through it with no more pain than a meniscus tear repair (after the 3rd day, that is!)

Those screws near your ankle that are annoying....will most likely stay annoying. I had trouble after 14 months with footwear like hikers that pressed on the ankle......it was extremely uncomfortable to the point where I wouldn't even try to put them on. Not good.

If your surgeon recommends leaving it in for the reason it's too difficult to remove......get a second opinion. My ortho was more than willing to do it if it meant my comfort and peace of mind.
The thing with my son was Dr.Steret from Stedman-Hawkins told him there was no need to take them out unless it was bothering him. Ceertainly if they did bother him, i'm sure he would want them out. Still, the point was made that just to take them out for the sake of taking them out is an un-necessary risk due to the chance of infection.

I really doubt any surgeon would consider the procedure of removing them any more difficult than installing them. There is much difference between a 20 year old atheletic leg and that of a middle aged man or woman. Reguardless of how good a shape they're in. That said, who knows down the road one year or 20 years from now, they may start to bother him, and they may have to come out.
post #18 of 20
Bonni & Lars,

It is often very difficult to get nails out.
post #19 of 20
Quote:
Originally Posted by jdistefa View Post
Bonni & Lars,

It is often very difficult to get nails out.
Then I consider myself lucky to have an ortho doc who didn't even flinch when I said I wanted to remove it, and that my 50+ year old bone could handle the process with ease.

Of course, it was only in for 14 months. That might make the difference.
post #20 of 20
HEAL UP QUICKLY DAWG!

PS.... PM Me if you need some info on PT. I've been through it twice before.

Bonnie is right, make sure and get a second.

One thing I'm succeptable to is a change in the barometric pressure. My knee hurt sure does hurt when a storm's comin' in. I guess that's a good thing.

HB
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