Advice on recovery from ankle fracture

[middleview]

"I didn't break anything, but I scared the shit out of myself. I do have a bad sprain and damaged ligament/muscle below knee on calf."

Today, 6 days after my getoff/getunder I went to have x-rays just to be sure. I have a clean break on the fibula about 6" below the knee . This explains why I continued to have reasonably acute pain on the anterior of my calf to touch or pressure even when my ankle felt much better. My wife has renamed me knucklehead for waiting so long to go check it. I agree.

That's my contribution here - if you ended up under a bike like a GSA with any body parts that hurt a lot afterward, it's worth having the look. Good news for me is they didn't put me in a cast - break didn't move even after 3-4 days of walking around gingerly, so they handed me crutches told me keep weight totally off and I can live without the cast. This obviously simplifies the bathing/showering scene but also means I have to be damn careful not to inadvertently get on it.

Also means I'm off my bike longer than I'd hoped - I had delusions of grandeur by the end of this week! Well, alright then...

[PETDOC]

Originally Posted by middleview

so they handed me crutches told me keep weight totally off and I can live without the cast. This obviously simplifies the bathing/showering scene but also means I have to be damn careful not to inadvertently get on it.

If you've not used crutches before make sure you transfer 100% of your weight through your hands and arms to your shoulders. If you bear weight on the top of the crutches you will compress your brachial plexus and in addition to the immediate pain it can cause more lasting damage if done for a prolonged period.
Good luck on the healing!

[Eyes Shut]

I found several informative videos on the use of crutches. Here was one:
http://video.google.com/videoplay?do...04327865061134

[middleview]

Originally Posted by PETDOC

If you've not used crutches before make sure you transfer 100% of your weight through your hands and arms to your shoulders. .... Good luck on the healing!

Thanks for that tip, PETDOC! They gave me the wrist style here, but my post medic will probably swap them out for armpit-style. Now I'm on the hunt for a soft cast to help with sleeping. Meanwhile, getting caught up on ADVRider

[middleview]

Originally Posted by Eyes Shut

I found several informative videos on the use of crutches. Here was one:
http://video.google.com/videoplay?do...04327865061134

Thanks for the tip, Eyes Shut! It's the little things that make a difference! Cheers!

[PETDOC]

The pieces of my life are rapidly being reassembled. A friend drove me 250 miles to Spartanburg, SC so I could ride my GS home. Friends had asked me if I was at all nervous about getting back on my motorcycle after fracturing my ankle. I told them in regard to screwing up and crashing, absolutely not; however, the thought had occurred to me that my 4 plus decades of on-road riding without a serious incident may have been more luck than skill and I wondered if the law of averages was about to change my fate going forward. One friend suggested that logic was analogous to having a mortgage with a looming balloon payment. While gearing up for the first time since November 12 I found my left boot to be a very snug fit, but I know that will change in the months to come. Within 30 minutes of beginning my ride home all thoughts of luck influencing my safe return were quickly obscured by the absolute joy of motorcycling that I have experienced since my first ride at age 16.
I generally ride back roads, only using interstates through necessity; however, for anyone who has never ridden I-40 from Asheville, NC to Newport, TN I highly recommend it. It is a spectacular trip anytime of year, but more so in the Fall.

[NJ-Brett]

Glad you are back riding.

Bah, I think you can ride almost safely on the street, I have been doing it (in New Jersey!) for 35 years without injury.

Dirt riding, not so much....

[derangedhermit]

Originally Posted by PETDOC

[...]My left ankle when measured around the malleoli is 2 centimeters larger in circumference than the right ankle. It looks like a small tree trunk. The orthopedic surgeon said it will be a year before the swelling is gone and she suspects the swelling is the biggest impediment to me regaining normal range of motion

I had a very similar injury in spring of 2008: spiral fracture of distal fib, with some crushing at the end of the bone where it helps form the ankle joint. And a distal tibia break, cleaner than the fibula. I have a plate 6-8 inches long, carefull custom-shaped down by the ankle, and 8 rather long screws at various angles to hold it all together. I thought a long-term report might be of interest to you, now that you are concluding phase 1 recovery. The ankle size slowly settled at about 1.5" larger in circumference than the other one. No swelling is evident on most days. I'm not sure why it is larger, but it is, and I expect it to remain so.

Originally Posted by PETDOC

I asked about hardware removal. She said to wait for a minimum of 6 months. Based on research I discovered that with a plate removal the risk of re-fracture is 2% and virtually all occur within 90 days of the surgery. I didn't ask, but suspect at the very least after plate removal I'll be back in the boot for some time. My current plan is to schedule plate removal for November[...]

The plate and 8 screws are still in. I see no reason to have more surgery to have them removed, unless / until other work needs to be done. Occasionally it is an inconvenience when fitting boots or when a screw tip close to the surface catches or rubs on something. But mostly I have no issues with the plate and screws staying in there.

Originally Posted by PETDOC

I want to sincerely thank everyone who shared their experiences/advice regarding ankle fractures on this thread. When I sat up in the dirt after the crash and saw my foot flopped over at a right angle I didn't know if I would ever walk again normally. It was a very scary moment for me. I am ecstatic at how much I have recovered to date and now expect to eventually return to normal.

You might consider establishing a new normal. It may never be as strong or stable as it was. The bones may heal and approach former strengh, and with luck stay in good alignment to fit in with the matching bones at the joint, causing no further problems. The soft tissue damage may be a different issue. I have much less stability in the ankle now, and I attribute that to soft tissue damage. Along with the reduced stability, I get pain on the medial side of the foot, below the ankle, and pain in the arch area below. I think this is because the remaining soft tissue is insufficient to hold the ankle / lower leg in the joint properly, and it wants to slide to the inside.

Between the reduced stability and the extra give toward the instep, I need to wear boots, not shoes, with firm soles and footbeds with arch support that fits my feet. I wear Asolo leather hiking boots, after trying many makes, and they do very well. I wish they were 1-2" taller, since it would help to have support up as high as the damage goes. I also wear Sidi leather OnRoad touring boots a few days a week, The ankle box on these is roomier, so I use a neoprene compression sleeve around the ankle to fill the gap in a comfortable way so the boot supports the ankle better.

I limp on bad days, and occasionally need to take hydrocodone to dull the pain enough so I can sleep.

A few months ago, I was doing some heavy manual labor (moving a wheelbarrow full of dirt), and the ankle suddenly complained. For the next week I had a rectangular bruise outlining the plate and some blood pooling on the other side below the ankle. I think maybe the screws (or bone) gave somewhat and the plate moved, and the lower leg put unusual pressure on the inside of the ankle joint. It has slowly improved, but I may go back to the ortho guy and take a look at what has changed.

My suggesion, again, is to forget about "back to normal" and find a new normal; consider it as permanently weaker than before and act accordingly. And keep up the exercises long-term, to strengthen whatever ligament and tendon structural support remains.If that works, you should be in pretty good shape, and the new normal may approach the old normal. If not, welcome to the club; life goes on.

Ask questions if you have some specific area of curiosity. Best wishes.

[PETDOC]

Derangedhermit,
Thank you very much for the review of your recovery to date. The link I posted quite a while ago reviewing ankle fractures (http://www.rcsed.ac.uk/fellows/lvanr...nkle/ankle.htm) indicated improvement may occur up to 9 years post-fracture. Recently my restoration of dorsal flexion has plateaued at +8 degrees (normal +15). I walk normally, but can feel the lack of normal flexion when ascending, and especially descending stairs. If by next Fall I have not achieved a better range of flexion I'm currently willing to endure the discomfort associated with plate removal. Ultimately it may not improve my status, but the gamble seems worth it to me.
If and when I get the hardware out I'll post my final results here for consideration by those who may yet fracture their ankle.

Dave

[Mimic]

Just got the nail down the middle of the tibia done two weeks ago. Previous plate and screws removed. Told to get aggressive with putting weight on it right away, no boot, no cast. This thing is finally going straight since June 15 of last year. Leg feels totally different now that the metal's gone. Knee is still tender because of the displacement required to insert the nail from the top. A good knee tensor and Robert's your father's brother. I'll never take walking normally for granted again.

[PETDOC]

Originally Posted by Mimic

I'll never take walking normally for granted again.

Amen to that!

[acesandeights]

Wife had a severe ankle fracture, specialist called in who'd never seen one as bad. It's been I guess around eight or more years now and it's significantly larger than the other ankle, gets sore from time to time, pops and catches. She had the hardware removed because she could feel it when she walked.

I broke my ankle approximately 20 years ago and did not know it. It was excrutiatingly painful, but I was on my parents insurance at the time doing something I wasn't supposed to be doing, so I just let it go until the initial pain subsided, and learned to live with the chronic pain. A bone floated and fused in the wrong place and after the 20 years of increasingly significant chronic pain whenever I went up or down a ladder or uneven terrain, I had surgery and the bone had to be chipped/chiseled out and removed. That was four years ago. It continues to bother me, but not in any way as badly as before; although, walking uneven terrain (ie. hiking, off camber) will mean I limp for the next two days. Also, I have significant pain the day after riding as my left foot does not appreciate the movement involved in shifting. I have popping, clicking and arthritis in the joint and it is loose (as there is a missing bone). I have to wear an orthotic to position the other bones in the ankle in such a way as to create the most possible support.

The reason I posted those two instances isn't to be a downer, but to reiterate what has already been said. Don't wait to see if you'll get to normal. Understand you'll have a new normal. It may be close to how it was, but probably will never be the same. It'll also probably deteriorate (get old) more quickly than the other ankle.

[PETDOC]

Originally Posted by acesandeights

The reason I posted those two instances isn't to be a downer, but to reiterate what has already been said. Don't wait to see if you'll get to normal. Understand you'll have a new normal. It may be close to how it was, but probably will never be the same. It'll also probably deteriorate (get old) more quickly than the other ankle.

Not taken as a downer; thanks for the post. Despite your, your wife's, and Derangedhemit's outcomes, my present expectation is for an excellent long term resolution. My closed fracture was textbook with a spiral fibular fracture (6 screw plate) and transverse medial malleolar fracture (1 screw up the tibia). Within 10 minutes of the accident my ankle was reset in the field by 2 orthopedic surgeons and shortly thereafter splinted by the ambulance crew. In the emergency room I identified myself as a veterinarian and asked to see the radiographs. Because I couldn't get to the digital screen, the radiology technician took a look and told me my ankle looked pretty good, all she saw was a small bone chip (i.e., the medial malleolus). She missed the spiral fracture of the fibula. When I finally saw the radiographs my ankle and fractured fibula were almost perfectly aligned, hence the reason the tech missed the fracture. Within 6 hours of the fracture I was in the OR, and the post-surgical radiographs show a normal ankle except for the hardware. I asked the surgeon how he felt the surgery went and he said excellent; however, warned I may have arthritis down the road. When I got home the orthopedic surgeon after viewing the 10 day post-op radiographs said it was an excellent repair. I believe all the stars (and bones) are aligned for an excellent out come. I know it may not happen, but until proven to the contrary that is my expectation, and the reason should I not regain near full flexion I will opt to remove the hardware.

[acesandeights]

Best of luck and I hope you have the speediest and best recovery possible.

[Patriot4570]

I am still non weight bearing on my right leg after my accident on 11/25/11 .I broke my tibula .fibula and right ankle.Have plates and screws holding bones together.I have been using a walker to get around the house and go back to the doc the end of this month to see if I can start putting weight on leg.I cant wait to be mobile again I hope that I can get back to work and riding when all healing is done.Heal fast and ride safe.