I had a spiral fracture 3 inches above my ankle and a higher fibial break. It happened on May 15th 2011, I stepped off some gym equipment and fell very awkwardly. I live in the UK and it was roddded, I wasn't given a choice, but then our treatment is free so choices are limited, and we Brits don't like too argue with Doctors.
I am now suffering from what I believe is called referred pain
I seem to be suffering more referred pain than from the original injury. When I am laying down for any length of time I get awful dull pains in my hips and a nasty sharp pain in the back of my knee, almost like it locks. I am sleeping for about 2 hours, waking up in pain, changing positions and so on all thru the night...
It isn't helping my healing as you can imagine!!
It has now been 12 weeks and my last x ray showed that there is still a big gap in my tibia and the fibial bone has hardly healed at all.
Is this normal have other patients had this after pain or taken so long for it too heal?
The usual minimal healing time for a low energy tibia fracture is placed at 11 to 13 weeks. If there is even 1.6mm gap or distraction in the fragments that can delay healing. If the gap gets to 5mm, then healing is delayed to as much as 8 to 12 months.
If there is a gap between the fragments, and the IM nail was locked (which most are), then at this time, most surgeons will dynamize the nail. Here, one set of the interlocking screws are removed, so that more stress is applied across the fracture site with weight bearing. But, to do this, there has to be enough healing, so the the fracture fragments do not rotate.
By applying stress across the fracture site, the body should be stimulated to heal the fracture faster, according to Wolff's Law.
Fractures in the distal third of the tibia have a notorious habit of delayed healing, due to the poor soft tissue envelope and poor blood supply.
Hope you begin to show more callus across the fracture. Good luck.
hi i m tushar..i m 19 yes old.i had an accident on 27 august 2012.so there i had broked my fibula.and there is a gap approx 5mm in fibula..so the doctor siad for surgey and they putted a nail.so plz tel me by how much time it will take to heal.and when will the doctor remove my nail
my plaster is removed..bt still there is swelling..so what to do?.
It is rare for an isolated fibular fracture to be treated with an intramedullary (IM) nail. The fibula is just so small of a bone, that it is very difficult to get an IM nail up the medullary canal.
If an intramedullary device is chosen, it is usually a Steinman pin, which is solid. Sometimes a hook is bent on the end so that is can be hooked into the lateral malleolus. This makes it easier to remove.
But, most of the time, distal fibular fractures are treated with an anti-glide, one third tubular plate and screws. However, the surgeon has to select the type of internal fixation on what the fracture pattern is and what is the best way to fix that particular pattern.
Usually, it takes about 6 weeks for a distal fibular fracture to unite. This is just the time for healing of the bone, it does not include the time needed for rehabilitation.
As to when the fixation will be taken out, that is up to you and the surgeon. If the hardware is not causing any problems, it does not need to come out. But, if it is decided that the hardware will be taken out, then it can be removed once the fracture is completely healed. Usually, the surgeon also wants the soft tissues to be completely healed and the scar tissue has matured. If the soft tissues are violated too soon, there can be problems with wound healing.
It is also very common for patients to continue to have swelling for some time after fractures in the lower extremity. The venous blood and the lymphatic fluid require muscle action to get back to the body core. Also, the veins and channels can be disrupted during the injury and subsequent surgery, which will have to reconstitute. So, as you use your muscles more and the tissues regrow the veins and lymphatic channels, the swelling will decrease. But, it will take some time. In the mean time, you should elevate the foot as needed. Also, you might want to wear some support stockings or compressive hose, to help with the swelling. There have been some ads here on the website for athletic compressive hose, you might look into one of them.
Speak with your surgeon as to when he/she will be able to remove your hardware. Good luck.
Thank you so much sir.sir i have uploaded my fibula nail x-ray on my profile picture..u can click on my profile picture..and see my x-ray.Sir plz tell me it can be removed or not?.and what type the fibula is treated its an intramedullary (IM) nail or something else.sir plz reply..and Thank u very much for the reply
You have an intramedullary pin placed. This is a solid piece of metal, a few millimeters thick. I cannot tell from your avatar picture if the end has been hooked or not. Also, some of these types of pins actually have a flattened end, with a hole in them. This is for when they are taken out, a hook can be used to grab the pin to pull it out.
Again, I can't see the end of the pin well enough on your avatar picture (even when I blow it up) to tell if the pin is protruding a little, or if the surgeon has buried it in the bone.
If it is buried, then it was probably meant to be left in forever (as it will be hard to get out). If it was left proud (sticking out of the bone just a little), then it was probably meant to be taken out once the bone was healed. But, that is not to say that it could be just be left it, if it is not causing any problems.
Intramedullary devices such as this are not used too often on distal fibular fractures, because it is hard to control rotation of the fragments with it. But, in your case, it looks like the surgeon used a very long pin and put in a long slight bend (to match the fibula), to help control the rotation of the fragments.
So, again, once the fracture is healed, which usually takes about 6 weeks for a fibular fracture, the hardware could be removed. I can’t tell from your avatar picture if the pin was left proud. If it was, it is not too hard to remove (just find the end of the pin and pull it out with some pliers). But, if it is buried, then the overlying bone will have to be removed before the end of the pin can be found, which makes its removal a bit harder (but not impossible).
You will have to ask your surgeon about having the pin removed. He/she is the one who knows what type of pin this is, and if it was left in a position so that it could be removed.
I met an road accident on this 13th of February. A motorbike hit me while I was crossing road and my tibia & fibula both are broken. Fibula just broke from one place and tibia broke in triangular piece coming off from the main bone and one of the broken bone came out as well tearing my skin apart. I had 3 operations first they put external fixator to keep my bones in alignment, second did plastic surgery for the lost skin and third they have put circular external fixator on my leg which has kept my bones in place but one of the side of triangular piece has a big gap. Now the problem is that doctors are saying that they will give me a device for faster healing but they are not sure that it will heal the bigger gap as well and the want to do 4th operation in which they will take bone from my hip to fill the gap. I need second opinion as i want my bone to heal naturally.. if you want i can send you my x-ray pictures as well... please i desperately need advice...
It sounds like you have had a pretty significant open fracture of the tibia. The triangular piece is called a butterfly fragment.
Most of the time, in closed fractures, if the fragments can be aligned well, they are will unite together. But, in this case, the fragment has a proper blood supply to it.
In an open fracture, the butterfly fragment may be torn away from any of its soft tissue attachments. If this happens, it is a dead piece of bone. It cannot be put back into the fracture.
Since you had pretty significant periosteal stripping, with loss of cortical bone, you would probably classify this fracture as around a 2B, according to the Gustilo/Anderson classification.
So, these are usually treated just the way you were: external fixation with debridement of the wound. The external fixator will bring the two pieces of the tibia back together so they are touching, but the question is whether or not the body will fill in the gap. The device they want to use is probably a bone stimulator. The results on the use of a stimulator are mixed. Some studies show good results, while others so very poor results.
The bone graft that the surgeons want to take from your “hip”, is the usual way to get this fracture to heal. The bone is actually taken from the anterior spine of the iliac crest (the pelvic brim). What the surgeon does is make a small trap door in the top of the the pelvic brim, then he/she takes a currette (which looks like a tiny ice cream scoop) and removes the cancellous bone from the inside of the pelvic bone (the ilium). Once he/she has gotten as much cancellous bone as he/she wants, the trap door is closed, the periosteum is closed over the trap door, and the soft tissues are closed in layers.
The cancellous bone is the spongy bone, which is filled with red blood cells and other cells. Remember, the blood cells are formed in the bone marrow. The bone marrow is in the cancellous bone.
Then, the fracture site is approached. The ends of the bones are “freshened up” by cleaning off the fibrous tissue, back to raw bleeding bone. Then the cancellous bone is packed into the defect. The cancellous bone will provide a scaffolding for the new bone to grow on. It also brings osteoprogenitor cells into the area, so that they can jumpstart the healing process.
Yes, it is another operation, but if it works, it should be the last one. As to having the bone heal naturally, this way is still a natural process. The fracture is just being helped along a little. No different than putting on the external fixator or fixing the soft tissues.
Is there any way to share my x-ray pictures with you. Yes it is ultrasound bone stimulator. And as for my skin grafting its a tiny area which has as well sealed my open wound nicely. I would like to share injury pictures and x-ray pictures with you for tbe best suggestions. I do not know if you believe in homeopathic treatment but there are so good medicines for bone healing as well.. although its difficult to find its practitioners in London. Its just I do not like to disturb the way my body is naturally 3 operations and then one more to go that too taking out bone piece from a place its naturally fit and disturbing body where I have no injury seems scary... I am on my own here so just scared a bit for another operation.
There is a way to upload pictures to this site, it is usually done through an outside site, such a photobucket. Sorry, I do not know how, I am not much of a computer "geek".
If you believe in homopathic methods, I am all for them, as long as they do not disturb the healing that is already going on.
It is sometimes possible to get the bone to heal with the circular fixator (also called an Ilizarov), if the bone ends are touching, and the bone stimulator actually works. But, that is a big gap to fill in. Most of the time the bone just cannot do it on its on.
The bone grafting operation is usually the only way to get the gap filled in.
You need to have the tibia healed in a width that is going to be able to support your body weight and the stresses you apply to it when walking and running/jumping. Just getting the two bones to connect may not be wide enough to support your weight.
I understand it is hard when you are by yourself. But, the bone grafting procedure should not make your situation any worse than it is now. But, speak with your surgeons about it.
I do not know if you have any idea how much an external fixator hurts you every second with every slightest movement you make or even if you stay still for longer period of time I.e. maximum 5-10min.. you can't sleep or do anything. . Your body gives up strenght every now and then. .. you feel helpless.. you can not do you own things and when you are on your own you need to do things even if it hurts..even going to bathroom or fetching wather for yourself seems a big task.. I am too not a geek kind but when I saw my x-ray I find that butterfly fragment as a puzzle piece which for me can be placed back with no gap or slight gap. Is it possible? Or just my mind acting wierd
If your external fixator is that painful, you should contact your surgeons. Usually, patients are very comfortable in their fixator. It holds the fracture still, so it allows the bone and soft tissue to heal.
If it is causing pain with every motion, it might be loose or some other problem. It should not be that painful.
Of couse, it is a "pain" to be in a fixator, there may be periods of being uncomfortable, but it should not be painful all of the time. There is something wrong with the fixator.
As to the butterfly fragment, if it is torn away from all of its soft tissue attachments in the accident, it is a dead peice of bone. This commonly occurs in open fractures.
In closed fracture, the butterfly fragment can usually just be left in place, and it will incorporate back into the bone.
Again, if the butterfly fragment has soft tissue attachments (which bring blood in to the fragment), the surgeon can usually "key" the fragment back into the fracture, and if necessary, hold it there with some pins or screws. Then the fragment will incorporate back into the bone.
But, if it has been removed, because it had no blood supply, it cannot be placed back into the hole, since it is dead.
So, in that case, the defect has to be replaces with cancellous bone graft. The reason that this bone graft can be places back in without a blood supply, is due to the fact that it is cancellous bone. The butterfly fragment was cortical bone.
Again, if your fixator is causing that much pain, contact your surgeon. Patients in fixators should be very comfortable. There is something going on with your fixator.
I have seen patients with Ilizarov circular fixators walk with them on. Get up and move around without any pain. I have seen patients with the bar type of fixators, grab the fixator and move the leg, without any pain. Again, patients with fixators on should be comfortable. Contact your surgeon.
They have not removed the bone piece its there hanging in without any pin on it thats what I want to consult and as its not placed on exact place "as per me" as what I see is just a single and exact puzzle like piece coming out which has been pkaces low causing too much of space. Thats what I wish to show you. Even for frame I did tell mydoctor but I not know why he doesn't take me seriously may be coz I behave in understanding manner or always smile. Although my pin sides are healing but keep realising yellow discharge forming hard stuff around my pins and not letting it heal due to which my skin around pins remain red. I do keep cleaning but just can pluck it off as it may coz infection. I have 6 poles connecting both the circles out of which I find two loose. I did informed junior doctor who was examing me but he told me its ok. if you can guide me it will be great as I am not able to talk firmly with them about my treatment as I am no medical person and you need to trust your doctor but I have seen my main doctor not taking my queries and problems seriously when his juniors still reply there level best.