Broken leg/ankle recovery--regaining ROM?

[amastrike]

I’m officially done with Broken Leg Ortho, and am now only going to ACL Ortho. Broken Leg Ortho never told me much of anything, except that I’d be non-weight bearing 6-8 weeks post surgery. Then I was told weight bearing as tolerated at 5 weeks post surgery. I’m now just over 6 weeks, so I figure at this point, I really should be ok.

ACL Ortho said that the rod is the reason I am able to bear weight–it’s keeping the tibia lined up so it won’t get displaced. I think the ankle fractures are healing pretty well… they aren’t really visible on the x-rays, anyway.

Leg after being splinted in the ER.
Tibia and fibula breaks just after surgery.
Leg at 5.5 weeks post surgery.

Hm… I might see if I can move my next appointment up a week. I’m trying to limit how much I really use the leg. When I do a lot with it, it gets very achey for a day or two, even when it’s resting. It’s hard, though, because my other leg isn’t much use, either, and sometimes I just have to put a lot of weight on the broken leg because the torn ACL in the other leg is bothering me more than normal.

:sigh: I’m hoping to be able to really ride (read: do more than sit on my horse and walk around on a long rein) before winter comes.

[txladybug]

FWIW I am recovering from surgery to repair medial malleous fracture (bottom of tibia) and ruptured lateral ligaments in my ankle. My doc who is an ankle specialist said continue NWB cast for four weeks, followed by LWB black boot and PT. He strictly forbid me from riding my horse for 6-12 months. He said that dismounting from that height is about the worst thing I could do to an ankle with reconstruction surgery.

Heal well.

[Graymaresrule]

@JA;4960391

Sounds like your ankle guy is an idiot IMO!

For sure

Looking at your xrays the break in my fib was more slanted than yours and lower and that took the longest to heal. My surgeon initially said 6-8 weeks NWB but wouldn’t let me put any weight on it for 11 weeks until it healed completely

[wateryglen]

Nurse chimes in here!

Those xrays tell the story…you have a major & serious coupla fxs. Take your time for crying out loud. That fibula fx needs to be fully calloused in before you do a danged thing imho. I don’t see any yet. (Callous is calcium/bone deposits that fill in the area between the bone ends.) This is gonna take some time. Settle in for a longer wait and don’t push it…unless you want to limp for the rest of your life…just sayin’…:yes::eek:

And ANYONE with lower joint/back/hip/knee/ankle etc injuries or problems should avoid jumping down off a horse. Sometimes permanently. Start using a “dismounting” block or stump or bench or whatever. Or get a shorter horse!!! :winkgrin: The pounds per square inch of compression can be very high and bad for you especially if you have any extra weight on you or you jump off or you come off fast or awkwardly. Save you rself. We only have so many dismounts left in us ya know!!! :yes:

[amastrike]

My new ortho doesn’t have a problem with weight bearing… nor do the two doctors I work for :lol:. I do worry a little, though. Unfortunately, there’s no way to get in to the ortho sooner. I’m probably doing more than I should. Being able to walk is so new and exciting that I sometimes get a little carried away. I started using Voltaren/Surpass on my ankle, and that helps a bit. I don’t think the broken ankle is a huge deal… it’s more of an “oh, and look, you broke your ankle too, isn’t that special” type thing.

For now, I’m trying to find a balance of moving enough to keep things from stiffening up and keep from going insane, and resting and using the walker enough to prevent pain. And I’m working on a list of things to discuss with the ortho at the next visit. I probably won’t be riding for a few months thanks to the torn ACL, but I will definitely be dismounting onto a block! My poor legs won’t be able to handle the drop (from my 15.2hh horse :rolleyes:).

Not riding is getting frustrating now. I find myself thinking about how I can’t wait to go ride and the things I want to do… and then I suddenly remember that I can’t ride :(.

[TSWJB]

Hi! Sorry to hear about your broken leg!
For some very good information and support go to brokenleg.com! I haven’t been on COTH much due to being on brokenleg.com too much! LOL I am starting to work my way back here!
I shattered my tibia and fibula in spiral fractures with bone shards on February 12th. I was admitted to the hospital and had surgery on February 14th, 2010. I have an IM rod in my tibia with 4 screws. Nothing was done for the fibula. I was realeased the next day. I had a splint for 9 days and then went into a cast for about 4 weeks. The cast was taken off at 4.5 weeks and I had some healing on the tibia. Nothing on the fibula. I was non weight bearing.
At 6 weeks I had some very good healing on the tibia and fibula showed some healing. I was now allowed 50% weight bearing but still on crutches. I started PT.
At 8 weeks I had really good healing on both bones. I was now allowed to wean myself of the crutches. But gradually wean myself off. It took to 10 weeks to get off the crutches. They did not want me walking funny on it.
At 11 weeks the doctor gave me permission to ride, but I had no bone growth from week 8 to week 11 so he was concerned since I had been healing and I was now weight bearing. He talked about bone stimulators etc. weight bearing creates bone faster than anything else but you cant weight bear until your leg is stable enough to tolerate it.
At 14 weeks I had enough bony bridging to consider myself healed. The xrays still look like I have a broken leg to me, but the OS said it will take up to a year to fill in. that they look for bone bridging to consider healed. The doctor told me to ride as much as I can because he felt the bouncing would help loosen up my ankle and I would gain strength in my legs.
I am now going on 21 weeks and I still suffer from lack of range of motion. Its really frustrating. I still go to PT. My screws in my ankle and my knee are really bothering me lately. For awhile it was shin pain, but that has disappeared and now all of a sudden the screws really hurt when I walk. The dr said I can have them removed after 6 months.
If you are unsatisfied with your dr, you should try to get a second opinion. My dr has never rushed me and he takes a lot of time to watch me walk, he measures my range, he even helped me take pictures of my xrays.
If they will not write a script for PT then try to go on the internet and get some exercises. I can type some later if you want them. Maybe go see a personal trainer. Its about gaining strength and flexibility. And riding does help a lot! My dr let me ride before my leg was healed but he did say I could not fall off, so I only rode my young horse who is very sane. I have a friends horse that I waited to ride until I was confirmed healed.
But I will say I still swell and have pain at 21 weeks. I also wear a compression stocking which helps to keep the swelling down.
Good luck!

[Graymaresrule]

@amastrike;4968525

I don’t think the broken ankle is a huge deal… it’s more of an “oh, and look, you broke your ankle too, isn’t that special” type thing.

For now, I’m trying to find a balance of moving enough to keep things from stiffening up and keep from going insane, and resting and using the walker enough to prevent pain…

RICE is still your friend, and will be for a while. A broken ankle can indeed be a very big deal, depending on the break.

When I was cleared to ride I would keep a cooler of icepacks on my “handicapped access” mounting block. There were times when I would dismount CAREFULLY landing on one leg, loosen my mare’s girth, remove my boot and sit there, icing my ankle until I could walk far enough to put her up.

Despite GM’s opinion, jointed stirrups are a blessing as well.

[TSWJB]

i just looked at your xrays. you actually broke in the middle of your tib and fib. that actually is alot easier to heal from. my dr and PT’s say the lower down you go towards the ankle, the harder it is to heal. mine is very low. they dont usually use a rod to fix it because its just above my ankle. but the dr said that the skin is very thin there and there is alot of chance of infection and lack of healing. plus my fracture was very unstable.he wanted to do a rod.
i am having alot of trouble with my ROM due to it being so close to the ankle. you might be lucky and have an easier time. my dr put a rod in another patient a week later whom i met in the waiting room. my dr keeps comparing us and he said that the other guy is doing much better with ROM due to his fracture being higher.

[Graymaresrule]

@TSWJB;4970906

the dr said that the skin is very thin there and there is alot of chance of infection and lack of healing.

About 10 days after my surgery they took the splint off to replace it with a cast and the skin on mu ankle and foot was a mess. I had a huge blister about 1 x 3 inches at the base of my toes where the splint rubbed after the swelling went down and another at the front of my ankle. The skin over the lateral incision was severely compromised as well.

The good news was that it could not be casted, I had to wear an air boot which was a lot more comfortable. However it took about 6 weeks for the skin to close. I had a perscription for a cream that is often used on diabetics. The list price of the one tube of cream was $591.00!

[SerenaGinger]

I’ve broken both of my ankles (distal fibula), one 8 years ago and the other last fall. Both needed hardware that I had removed after a few months. Different states, different surgeons, both didn’t prescribe PT. I live in Florida where a PT needs a prescription from a doctor to see patients.

My chiropractor turned out to be very helpful, but I had to ask. He showed me kinesio taping and did Graston on my ankles/Achilles tendon.

The kinesio taping helped especially while regaining ankle strength when my ankles became laterally wobbly. The Graston feels like razor blades cutting into the skin, but my ROM on my fresh break is now better than my old break. I started the Graston six months after the second break. Of course my operations (techniques, the breaks were almost identical) were completely different, so it is hard to know what contributed to the better ROM in the fresh break.

I went back to riding (the easy horse!) two and a half months after the break. It hurt, mostly burned, and there was no way I could replicate that pain/stretching on the ground. Maybe a PT could manually stretch the ankle and get the same results, but fresh air at the barn is a lot better than any PT building I’ve been in, they all get a little gym-y.

From the look of your x-rays and your knee issues, you might have a different set of issues than limited ROM in your ankles. I would suggest a knee scooter instead of crutches or a wheelchair, but it would mess up your knee worse. I had a knee scooter for 4 weeks, and it took 6 or 7 months after for my knee to stop hurting when resting.

[JA1]

I just looked at your x-rays and have got to ask why wasn’t the fibula pinned? It is still displaced which will give you a madrid of problems? The articulation at with the tibia and talus is also off… Sorry I’m a graduate student in osteology and paleopathology and have taken 1 too many classes on fractures and bone! IMO you need to get a third opinion.

I’m 5 months post tib/fib ankle fracture and despite having full range of motion I am still having major issues due to extensive soft tissue damage. I got a second and third opinion and will be having surgery to fix the soft tissue and non-union fracture in the fall (trying to finish my dissertation in osteology/paleopathology first)

[EasternMkt]

As long as we’re sharing x-rays, here’s the photo of my ankle 2 months post-op/break when the OS decided that the tib was healed enough that I should start to walk on it (w/ cane and splint) in hopes of stimulating healing in the fib.

http://farm5.static.flickr.com/4117/4796652282_3efc020847_b.jpg

Turns out he was right, and at my 3 month follow-up this Monday, we all did the happy dance at the appearance of a nice bone callous around the big crunchy gap that was once my ankle.

These types of breaks (mine also involved a dislocation so I have plenty of soft tissue damage) do take longer to recover from than a simple fracture. It has been a challenge at time to remain patient, but the OS has finally cleared me to go back to some easy riding in about 3 weeks (at about the 4 month post-break mark). Don’t rush things as it can set back your healing process. While being unable to ride for 4 months stinks, not being able to ride for 8 months would be much worse.

[Puglet]

Gotta love ankle stories! Here is mine http://www.facebook.com/photo.php?pid=30081417&l=db21de2402&id=1302392789

tri-malleolar fracture

My first surgery was 2 years ago when I broke my leg. One year ago, I had the hardware removed. My surgeon is a well known ankle guy in my state. I asked him about PT and he said I could go if I want, but he could just give me exercises to do on my own. I’m guessing his advice was based specifically on my injury. I didn’t have major tendon/ligament damage.

I have never been to PT, but my range of motion is almost identical to my non-injured leg. I was on crutches for 11 weeks. I took my time getting back on a horse and listened to my body. Stationary bikes and swimming pools (walking in the pool and water aerobics) were my friends for the initial regaining of motion.

My advice…don’t be in a hurry, let yourself heal!

[amastrike]

The broken leg is healing well. Turns out the fastest way to get working again is to have surgery on your other leg to force it to shape up :lol:. Bright and early Thursday morning I had my knee surgery. I now have a nice new ACL. The surgeon also fixed a meniscal tear that didn’t show up on the MRI. Oh, but it’s most likely that the meniscus wasn’t originally injured… no, it was probably torn one of the times that my knee gave out. In other words, the cartilage tore because the doctors at the hospital ignored my concerns and told me there was nothing wrong with my knee :mad:.

The broken leg is feeling pretty good. Not full ROM, but comfortable. I’m not sure when I start PT for the ACL… they’ll probably tell me what to do for the broken leg when I go. I have another appointment with the ortho next Monday, so I’ll find out what the plan is then.

The ACL has been MUCH easier to deal with than I expected. I have this ridiculous brace that goes from mid-thigh to my ankle and keeps everything straight. It gets taken off a few times a day so I can work on completely straightening the leg. I have a cryo cuff which I absolutely love. It’s this thing that goes over the knee and hooks up to a cooler that pumps in ice water and pulls it back out, so you have compression and cooling. I can bear weight as much as I want as long as the brace is on, and I’m allowed to drive. Woo-hoo! The only pain I’ve had is where the tendon to create the new ACL was harvested, and even that isn’t horrible.

[Almost_Heaven]

Sounds like good progress and good news!! Congratulations and best wishes.

I broke leg, dislocated ankle, & split/shattered ankle/socket playing football as a teenager. No surgery that long ago, they just put it back in the socket, casted it, and let it heal. Couldn’t bear weight for 4 months and even then it hurt like hell. Range of motion was near zero.

Just made up my mind I’d do the best I could; was playing basketball (not well, but playing) in 6 months, played spring football at 9 months, and then a full season of baseball. Been “normal” ever since. The ankle is still twice the size of the other and range of motion not particularly good, but it’s functional and I’m thankful.

Best advice - walk. Walk every day. It gets better with exercise, not rest.

[amastrike]

Meh. I’ve felt like crap for the last day and a half, and it turns out I have a bit of a fever. My knee isn’t all that painful, but it’s a little worrying. I figure if I still have a temp in the morning I’ll call the surgeon.

On the bright side, my broken leg is doing GREAT. The ankle that was bothering me hasn’t been a problem at all (well, ok, maybe once a day it’ll be a tiny bit painful, but then goes away quickly). And I haven’t said “damn tibia!” in days. The leg feels much better and stronger than it has since the accident.

Now the ACL needs to heal up and I’ll be set. Set aside from the extensive PT I’m sure I’ll need.