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Broken Tibia and Fibula - recovery advice great fully received

Hi there,
My name is Phillip.I am 27, in good athletic health. On 8th September 2012 I was playing football (soccer) when the force of a tackle gave me a broken tibia and fibula. It was a closed and complete fracture through both bones. I have had a rod put into my tibia. I have no cast.
I was bed bound for 6days after my op (due to pneumonia as well I must add) and then I was on crutches to get around for about 6 days after that. I have since been walking without crutches fairly OK.
My pain is varied and seems to be happening in different ways. For example last week my knee was giving me the most pain and for the last couple of days the pain has been focused on my ankle, my ankle has also suddenly become quite swollen.
I have been taking approx 1 pain killer a day, as I don't really like to take them... I hadn't even taking a paracetamol before this accident.
I have been given some small exercises to do from the hospital. but other than a few leg raises and knee bending to help with stiffness they have not suggested anything further. Although they did tell me to only do things and exercise to what the pain would allow. What I would like to know is, is all of this normal?
Do you have any suggestions for a better and/or quicker recovery?
Is it worth getting an aircast oxygenised leg brace or something similar that has the same effect?
Is there a risk of my doing to much too soon. I would like to be getting into the gym for upper body weights and into the swimming pool too.
Many thanks for any help that you can offer.
It will be very great fully received.

Many thanks
Phillip
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First Helper User Profile Gaelic
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replied October 6th, 2012
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Footballer200,

You are actually doing very well. The swelling in the ankle is probably because you are pushing yourself. You do have to listen to your body.

Since you were allowed to weight bear almost immediately, you most likely have a transverse fracture pattern, which is good. The transverse pattern is very stable and can withstand weight bearing immediately. (As opposed to the spiral, oblique, or comminuted patterns which have to have healing before weight bearing is allowed, or they may slide and displace when stress is applied.)

The knee often is uncomfortable after an IM (intrameduallary) nailing of the tibia. The patellar tendon has to be retracted out of the way to get the nail down. So, again, it is not uncommon for the knee to bother patients.


Again, you have to listen to your body. You are pushing the envelope a little. Tibia fractures, the low energy ones like yours, usually take 10-13 weeks for the tibia to unite. So, you are just four weeks out from your surgery (8 Sept to 6 Oct). Your bone probably is not even healed yet, so just the nail is holding the bone in place. And, the nail, while pretty sturdy, is not designed to take a lot of extreme stress. You can actually bend a tibial nail over your knee, just using your hands. It is designed to be an internal splint, not to be your total weight bearing structure.


It is good to apply controlled stress across the fracture site. This will stimulate the body to heal the fracture, which is known as Wolff’s Law - bone will respond to the stresses applied to it. Which is why the surgeon allowed you to weight bear and do activity within the limits of pain, as tolerated.

If you are having significant discomfort around your fracture site, it is best to back off a little. You can get a fancy fracture brace if you wish (AirCast, CamWalker, etc). But, it will not make the bone heal faster. And, it sounds like you are already confident enough (and strong enough), that you do not need the extra support. But, that is up to you.


There is not really anything (except time and some stress across the fracture) that will make it heal any faster. There are some things that will slow it down. Do not smoke. Nicotine is the single most detrimental thing there is to fracture healing. Eat of well balanced diet, with extra protein. Protein provides the body with the building blocks needed to rebuild tissue. You also need calcium, vitamin D, and magnesium. You can take supplements of these if you do not get them in your diet.


As to the gym and upper body weight, that is a great idea. You can also work on your core muscles. Exercises in a pool are also great. The warmth of the water makes the tissues more pliable. The buoyancy makes the exercises essentially nonweight bearing (in chest deep water). In some pools, they have weighted vests which allow patients to run in the water. A lot of elite athletes do this when they have lower extremity injuries, to stay in great cardiovascular shape.


So, again, at four weeks, you are doing very well. Listen to your body. Eat a good diet. Do not smoke.

Good luck.
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replied October 11th, 2012
Thanks for this information! It's brilliant and great to know. Over the last couple of days i have started to go quite dizzy. Often when I stand or turn, no matter how slowly I move. It's been going on for about 3 days now. Also my toes feel very hot, well to me anyway, if somebody else touched them they tell me that they do feel hotter than my non surgical foot but that they are not too hot or anything. My operated leg is also significantly warmer than my other leg- is this something to get checked out?
Thanks again!
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replied October 11th, 2012
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Footballer200,

As to the warm, it is something to keep an eye on. But, it is not uncommon for there to be some increased warmth, and even a touch of pink, in the lower leg after a tib-fib fracture and surgery. The first stage of healing is the inflammatory stage and that can cause the increased warmth/redness.

It is probably nothing to worry about, but do keep a check on it. If you do develop a lot of redness/warmth, swelling, and a significant increase in pain, then those may be signs of an infection.


As to the dizziness, make sure that you are staying well hydrated. That is the most common cause of dizziness in the post-op/post-injury patient. Also, be sure to eat enough. Your body is healing, thus it requires a few more calories than normal to rebuild the tissues. Try not to skip meals and even have some snacks in between meals.

You are far enough out from your surgery, that you should have replaced any blood loss that might have occurred during surgery. In orthopedic surgery, a tourniquet is used, to decrease the amount of blood loss during procedures. So, again, by a month out the small amount of blood you lost should have been replaced by now.

Make sure you get enough rest, your body needs the recuperative time that sleep provides, especially now. Limit your alcohol intake, that can also drain you and cause dehydration.


But, if the dizziness continues, you might want to see your physician for an evaluation. You might be anemic, but still that is probably unlikely. You could also be coming down with a virus or something. So, if it continues, have it checked.


Hope you are doing well otherwise. Good luck on your recovery.
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replied October 18th, 2012
Hi there, I have another question, a lot of people have been telling me about growth hormone (hgh) to help with my recovery. Apparently it will help my leg to heal better and quicker as well as stripping body fat too. Is this a good idea? if so, what sort would you suggest? I know that there are various sorts available but i would be very grateful for an experts opinion on the matter. All I really know is that you have to be very carefully to take the correct amount and strictly monitor the takings too.

Many thanks
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replied October 18th, 2012
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Footballer200,

Currently, human growth hormone is not approved for the treatment of fractures in adults who have normal levels of HGH.

If you read the scientific literature about using human growth hormone for fracture healing, it has mostly been done in rats. There is some evidence that in adults with low HGH levels and osteoporotic fractures, that it does help in these situations. There is one study out of the European Journal of Endocrinology which did show increased healing in closed tibia fractures, but not in open tibia fractures. This has not been replicated by studies done after it.

So, currently, the use of HGH is not recommended by the American Academy of Orthopedic Surgeons (AAOS) or the European Orthopedic Research Society (EORS).

So, if you want to use it, you would probably have to obtain it on your own. I do not even know what doses are used by those who advocate its use.

Good luck.
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replied October 28th, 2012
I was in a severe car accident on the 18th of September 2012. I hydroplaned getting off of an exit ramp driving back to college and hit a concrete barrier at 45 mph head on. Since my foot was on the brake pedal so hard, I broke and dislocated my big toe, I broke my tibia and my fibula mid shin, they were folded under the seat behind me, and I also had a multiple fracture to the right knee, as well as breaking my left collar bone from the force of the seatbelt.

I had surgery to implant a rod the next day and was put in a walking boot and knee imobilizer because my leg was still swelling too much to cast. A week later, on the verge of pneumonia, they decided to plate my collar bone fracture to speed the healing bc I am left handed. I had to with draw from classes for this semester becuase of the injuries I sustained and bc I was in the hospital for 24 days. I am now able to walk in a boot with a knee brace and crutches to help balance and support me. I went back for my six week x-rays this week, but the tib/fib fracture and the patella fracture show little to no signs of healing yet. There are still about an inch at least between each bone that broke and the tibia has an IM rod with screws in the ankle and just below the knee.

I'm still not cleared for physical therapy on my leg yet, only on my shoulder. However, I was wondering, how long am I looking at for a full recovery where I can walk normally and run again? Or possibly ever be pain free? I'm only 19 and everything hurts already, my knee, my ankle, my shoulder?
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replied October 28th, 2012
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PER7113,

Sorry about your accident and injuries.

As to everything hurting, you are only a month out from your accident. You are just barely getting into the healing stage, let alone the rehab stage. You still have a long way to go.


You state: "the tib/fib fracture and the patella fracture show little to no signs of healing yet. There are still about an inch at least between each bone that broke”. If there truly is an inch gap between the fragments of the tibia, this will never heal. Bone should have some apposition (fragments touching) for the callus to bridge the fracture. Usually, when assessing the reduction of a tibia fracture, no distraction is desired. Any distraction > 1.6 mm will affect the length of healing times and a 5 mm of distraction may increase healing time to 8-12 months.

If you truly have an inch gag (15mm), that should have been bone grafted. Or, possibly, if this was an open fracture, the surgeon may just be holding the bone out to length with the intrameduallary (IM) nail (statically locked with interlocking screws at the proximal and distal ends). Then, he/she plans on going back and bone grafting the bony defect once the soft tissues have healed. Again, an inch gap in the tibia cannot be bridged with just healing callus. You need to find out if you actually do have that big of a gap, or if it just looks that way on the x-rays. Sometimes, spiral or oblique fractures can look “funny” on the radiographs, because of the overlap of fragments (taking a three dimensional object and putting it onto a two dimensional picture). Or if you have a butterfly fragment, that may make it look like there is a gap, but there really is not one.


As to healing times of fractures, usually the clavicle and patella will take about 6 to 8 weeks for bony union. However, you should understand that fixing a fracture will not make it heal any faster, and in some cases, internal fixation can actually slow the callus formation and union times. Fractures are fixed to obtain adequate alignment, so that the fracture will heal in the best possible position, not so that they will heal faster.

In the tibial shaft fracture, the usual times given for bony union are the following:

- low energy fractures (sports injuries): 10-13 weeks;
- high energy fractures (motor vehicle accidents): 13-20 weeks;
- open fractures>
. Type I, 2, 3A: 16-26 weeks
. Type 3B & 3C: may take up to 30 to 50 weeks for consolidation;
- distal tibial fractures may be more prone to non union than proximal fractures due to absence of muscular soft tissue envelope;
- in one report, the authors studied 64 consecutive patients with a tibial shaft fracture;
. 12 months after the injury, 44 percent had not regained full function of the injured leg, although all but two of the patients had returned to preinjury working status;
Reference: “One-Year Outcome After Tibial Shaft Fractures: Results of a Prospective Fracture Registry”; J Orthop Trauma. Skoog A, er al. 2001 Mar-Apr;15(3):210-5.


So, in your description of having your leg bent backwards after the fracture, you had a high energy fracture, most likely with a significant amount of soft tissue injury. You have to understand that not just the bone is injured in a fracture. The periosteum (the soft tissue sheath covering the bone, which supplies the blood vessels and nerves to the bone) is ripped apart, and the damage to this structure is what determine how well the bone will heal (for the most part). The muscles are torn off of their attachments to the bone. The fascia, tendons, ligaments, peripheral nerves and blood vessels are all stretched and twisted during the time when the leg is unsupported. All this damage has to heal and it will heal with scar tissue. The scar will mature and soften, but that is a lot of damage to rehab.

It is not uncommon for it to take a year to 18 months for full recovery from a tibial shaft fracture. And, this is just with an isolated tib/fib fracture. You also state that you also have a fracture/dislocation of the great toe, “multiple fracture to the right knee”, and a left clavicle fracture.

The fractures of the great toe and knee are going to complicate your rehab of the tib/fib fracture. As will the upper extremity injury.


If you were able to apply weight to the tibia fracture fairly soon (but with an inch gap, that won’t be possible), that would help with healing. It is known that placing stress across a fracture will stimulate the body to lay down callus and heal the fracture faster. This is known as Wolff’s Law - bone will respond to the stresses applied to it. But, again, with the defect in the tibia, along with the knee and great toe injuries, that may slow down your weight bearing.


With the knee fractures, that is going to slow down regaining your range of motion. It is very important to regain motion in the joint as soon as possible. However, it is known that anytime a patient fractures into a joint, that increases the chances of developing traumatic arthritis in the future. This is another reason to fix fractures which involve the joint surface. Any step-offs or gaps in the joint surface (articular surface) makes the incidence of traumatic arthritis go up.


So, you have a long road ahead of you. As to how well you finally do, that is up to you, a lot.

Your recovery will not “just happen”. It takes a lot of hard work, effort, and diligence. The more you put into your rehab, the more you will get out of it. You are going to hurt. That should get better with healing of the tissues. But, you are going to have a lot of aches and pains. Every patient is different, every fracture is different. Patient’s pain tolerance is very variable. But, you are going to have some discomfort; you have been in a very significant accident and sustained several significant injuries.

Again, you will get out of rehab, what you put into it. You are going to develop a lot of muscle atrophy, which you are going to have to rebuild. You will lose range of motion in your joints, which again, you are going to have to regain. We usually tell the athletes, that for every day they are out of practice, it takes two days to get back into shape. So, if you are down and not doing a lot for a couple of months, it is going to take four months of rehab to get back into shape. That’s why you can see how it can take a year or more for full recovery. That is not to say that you will be totally laid up for that long, but that it can take that long till you know your final outcome.


A note: since you have both upper and lower extremity injuries, as soon as your wounds will allow, you might look into getting into a pool for therapy. The warmth of the water makes the soft tissues more pliable. The buoyancy will allow you to work on range of motion and strengthening without worrying about weight bearing. The buoyancy will also help with shoulder range of motion, because in neck deep water (or sitting in shallower water), it will allow you to raise the arm and move it around without having to worry about placing bending moments on the clavicle fixation. In the water, you can work on gait mechanics, again without worrying about weight bearing. In some pools, they have weighted vests that allow you to “run” in the deep end of the pool. This is how a lot of athletes stay in shape when they have a lower extremity injury. So, even if you cannot swim, you can do a lot in a pool.


Again, sorry about your injuries. You have a long road ahead of you and a lot of hard work. Hope you get back to school as soon as you can. But, till then, follow your surgeon’s instructions. Put as much as you can into your therapy. Do Not Smoke (smoking is the single most detrimental thing there is to fracture healing). Eat a good diet; with extra protein (for the building blocks needed for tissue repair), calcium, vitamin D, and magnesium. You can usually get these from your diet and the sun (vitamin D), but if you wish, you can take supplements.

Good luck. Wishing you the best.
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replied April 7th, 2013
Hi my name is jawad Im 23 years of age. I play football. On march 14 2013 I collided wth a player ,his left knee hit me at My right side of My right some where at top side of fibula and near patela in such a Way that i felt a great jerk and fell down. That was really hurtfull. I did icing for two days but didn't feel improvement cant bend My knee completely nor i can straighten it. When i try to bend My back muscles of the knee produce pain and When i try to stretch it straight i feel some kind of resistente under patela. Please tell me what is the problem what should i do how soon can i recover s that i can start playing again. Plz help
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replied April 7th, 2013
Hi gaelic I broke my right tibia on nov. 6 2012 in a
motorcycle accident (open fracture type 3a or 3b not
really sure) note with bone loss and a gap of 1 or 1.5
inch. My 1st surgery was on nov 7 were they put ex
fix. I've been on ex fix for 2 months and on 6th of
jan. 2nd surgery IM nail and bone graft which my OS
took bones at both of my hips.. my first xray was at 5
weeks (feb 11, 2013) my OS told me that the fracture
was now consolidating he told me to come back after
45 days.my 2nd xray (march 23 2013) looks not much
different from my previous one i didn't notice any
callus formation but my OS is not worried at all he
said there are little positive changes at my my xray
but less than what he is expecting..I ask my OS if im
on a delayed union he said no..Im afraid im not
healing its been 5 months since the accident..how
long it will take for my bone grafted fracture to unite?
my next appt is on april 30...13 weeks of no
weightbearing is so frustrating.Im totally disappointed
that i didn't see any callus formation..how long it will
take to see a callus?I thought the bone graft will jump
start the healing process?I don't have any pain at the
fracture site even at my hips i don't have any
pain..thank u in advance
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replied May 13th, 2013
Hi,im Jordon and I need help. On May 23, 2011 I was walking from middle school and a car hit me. My right fibula and tibia were broken, along with my left arm. The arm is just fine but my leg is still in pain, This gets in the way in my Karate and staying fit. Can someone help me out.
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replied May 14th, 2013
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JordonX97,

Since it has been two years since your injury and surgery (I am assuming that your tibia and fibular were treated surgically), you really should see your orthopedic surgeon.

It will take a thorough evaluation to determine what is causing your problems. There are so many things which could be causing problems, it is not possible to go through all of them here.


Again, you really not to see your orthopedic surgeon for a thorough evualtion of your leg/ankle.


Good luck. Wishing you the best.
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replied September 6th, 2013
Minimal pain and swelling on 5th week
I enjoyed reading he responses of Gaelic and I hope he/ she would respond to my queries as well. My daughter sustained fibula fracture (non-displaced, closed, complete, oblique) fracture weeks ago. We consulted 3 doctors because we wanted her to heal fast and she's a ballerina. the first doctor was very conservative and told us that she would be on cast for 8 weeks. the second was too aggressive and told us that she should have not been placed on cast at all and removed the fiberglass cast on 5th week. Because the aggressive doctor didn't entertain questions, we sought another sports injury doctor. The third doctor is in between the first and the second one since he allowed the aircast. He said that my daughter can bear weight as long as there is no pain.

Question: is it normal to still have swelling at 5th week? and is pain (bruise like pain) on the heel normal?
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replied September 9th, 2013
Experienced User
I'm at 15 weeks, still have swelling, and if I'm on my leg too long, I get the whole "k-ankle" thing going on. I wish her the best of luck.
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