Feb 9, 2015 Surgery day

The first week has been okay. I have been able to bathe by laying in the bathtub with my splinted limb on the side. Being clean makes a huge difference to feeling well for me.

Here are some things that I wish I had studied more and discussed with my surgeon:

• Injury type. Yes, I know that it is a tri-malleolar break, but I wish I had known about these classifications. These classifications determine what type of care will be done and why.
• How will the surgeon determine if the syndesmosis has been torn and what will be done about it? See here and here. There are a lot more. My google search terms included "hook test for syndesmosis." Since there is some controversy about how to test for and treat syndesmodic problems, I wish I had asked and learned why my surgeon suggested which treatment.
• Exactly how they will fixate each part of the break. My medial malleolus and lateral malleolas are fixated with plates and screws, but I am wondering why I have the posterior  floating fragment and where it will eventually attach.
• Whether you are a candidate for the Strayer procedure. (gastrocnemius slide) I did have this done, but I wish I knew more about how serious a surgury this was prior to agreeing to it. It has its own boot time of 6 weeks. It has been pretty uncomfortable in the splint.
• I wish I had asked for a temporary handicapped sticker. Weeks later, when you can drive, crutching from the far end of parking lots hasn't been cool.
• Ask for either a knee scooter or wheelchair prescription. It is nice to be able to get out beyond what crutches do. 
• Ask about what you can do. Wiggle toes? Gentle ankle flexion and extension? Stay seated as often as possible, or gentle exercise? Modified chair yoga? Icing when the boot is off, or leave it alone? So many questions and unless you ask, they often don't get answered.
• Ask about a popliteal and saphenous knee block if your surgeon doesn't bring it up. This was WONDERFUL post-surgery.
• How does your surgeon feel about a bone supplement? I am taking this, that has done well in clinical studies of osteoporosis bone regeneration.  My nephew used this for a broken arm and had his cast off two weeks early, so we'll see if it has any impact at my next visit.

Here is a picture of the post surgery splint/wrapping with kitty and vitamin D therapy:

I had to give a cute kitty pic first. Go back and look at the kitty after you see the next Frankenstein pics. Two weeks post surgery, we take the splint aka "nastycast" off.

P.S. It will stink:

This is actually not as swollen as some that I have seen. I attribute some of this to taking arnica post-surgery. I used these gel caps.  I only had to take pain meds 48 hours after surgery and haven't needed any more. I think it is because the swelling went down rapidly with elevation and those gel caps.

 The yellowish color is from the betadine used in surgery. So don't go imagining anything worse

 I did end up having a gastrocnemius slide performed. That is the wound closer to my knee. It has internal stitches that will dissolve. This has probably given me more discomfort than the ORIF surgery.

See my floating bone chunk? I'm going to ask about that at my next appointment.

 All ORIF'd

 See the little bone chunk at the bottom of my fibula? Turns out that I had previously broken that piece off when I thought it was just a bad sprain. Get x-rays every time, people!

Traded in my splint for Betty Boot. Hint: get comfortable knee high socks instead of keeping it wrapped in an ace bandage. Much more comfortable.

Feb 2, 2015 Week one of trimalleolar breakage

 Disclaimer: I assume you are here because you have suffered a similar break. This will be TMI for everyone else. Read on at your own discretion!



Here is a photo of the death trap. The five lovely models on the left are mine :)

I thought I would test out for my chidlets how this apparatus would work. No one else was on it, and I was trying to run up the left side of it. Hamster style.

Turns out that it moves much faster than my legs can race. I had this horrible feeling that my left foot was going back too fast and I was going to be doing the splits, so I quickly leaped off over the highest point of the circle (a whole foot and a half high) landing with my right foot in the worn track in the wood chips around it. Something about how I was running or how the track wouldn't let my foot move with the rotational forces caused my foot to twist....

 Right off my leg. Well, within the skin anyway. I can be a bit dramatic! You are warned.

Eww factor is ginormous right here. I looked down and it appeared I was briefly standing on my tibia, with my foot medially perpendicular to my leg. I fell over onto my backside and thought about what to do next. This was a closed fracture. I don't know how my skin stretched so well.

I didn't really hear a pop or sound, just looked down and saw my horrifying leg. I knew instantaneously that it was very broken. My husband had suffered a tib/fib fracture a few years earlier, so I knew this wasn't going to be a mere cast situation.

I tried to stand up with the thought that I would hop on one leg to the van.

No way. It wasn't painful, just wrong to have gravity pull my foot away from my leg.

So I sat down, decided that I didn't like my foot that way and put it back where it should be and held it together with my hands. I am so happy I did that right then, when I was in shock. None of this hurt yet.  My husband happened to be at the park with us that day and just picked me up while I held my foot and leg together.

We were minutes away from a hospital and got into the E.R. quickly. I had an I.V. and drugs probably within 20 minutes of it breaking, so I never really was in super pain. In fact, laying there in the E.R., I was in worse pain from a chronic neck injury, so the ankle  wasn't too bad. I do remember being deeply in shock. I couldn't stop my body from shaking and my b.p. was too low for a regular dose of pain med, so I only had half a dose, which still worked well to control the pain. I was also very concerned because all five of my little kids were there with me and I was trying to be tough and laugh it off for the kids, which was a great distraction for me.

I didn't have to be moved much for my x-rays. Just a little up and down and turning a little and I had all ready fixed my own dislocation YAY! I have since watched videos of dislocations being fixed and am glad I missed out on that.

I was put in a splint and sent home with referrals to orthopedic surgeons. I was given .5 of Percocet and took them every 4 hours for the first 48 hours. I was able to sit with my leg  up on the recliner and still homeschool my children, although I needed help with all the other household tasks.

I met with the surgeon the following day and scheduled the surgery for the following week to allow the swelling to go down. This break would require ORIF surgery. We also discussed performing a gastrocnemius slide at the same time, as I have very tight calves and tendons that can contribute to sprains.

In the meantime, while waiting for surgery, my mom was there to care for me and the children. I was able to go out in my splint to several stores and things on crutches and using a wheelchair. Because I was doing so well, I stopped taking Percocet after the first two days and nights as it made me feel nauseated and constipated. The side effects were worse than the pain, despite taking stool softeners.
I'd apologize for TMI, but I won't, because I don't think hospital staff adequately addresses that pain meds cause constipation and that you can actually prevent this from happening, as if you aren't miserable enough all ready! Don't let this happen to you!

One thing that I wish I could have changed is that when we went to the surgeon's, he cut through my splint in order to see my leg and ankle and then just wrapped the same splint up again with gauze and an ace bandage. I felt like the integrity of the splint was compromised and was constantly moving the splint around to find a comfortable place and it wasn't as firm or as molded to my leg as before. If I had it to do again, I would have requested a resplint.

My next entry will deal with what I wish I would have known prior to surgery and xrays of my ORIF procedure.