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Recovery time for broken Tibia and Fibula ? (Page 3)

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August 22nd, 2011
Broken TIB and FIB and COMPARMENT SYNDROME
Hey Fellow leg breakers. It is my first broken bone, Broke my TIB and FIB about 4 inches above my ankle and it fractured into the ankle..I did it Downhill Mountain Biking ( awesome sport ) ..my shin was bent and my foot was swaying in the wind, I will never forget what it looked like..unreal..well I had to be lifted out of the woods, I was at a bike park so I was on a big mountain, the truck drive down hurt so bad, my leg was moving and bent, arg!! a couple hours at the ER they tranferred me to a tranfer room, My toes felt like they were going to explode! I kept complaining about it..they finally got a OS to look at me, I had COMPARTMENT SYNDROME, I needed surgery right away. Two long deep slices on both sides of my calve. wound vac, had to wait to get the main bone sergery..5 days later I had a IM ROD inserted, two screws at the top, three at my ankle, the outside slice on my leg had so much pressure it spread it 5 inches wide, Needed a skin graft...worst pain of my life after that six hour sergery..it happened on 6/18/11..its been a few days over two months. first month I had a splint. last 3 weeks I have been wearing a boot. Doc said not to put weight on it yet but my leg feels good, looks awful but feels a lot better, no pain for about 5 weeks now..And I took 90 perc's and 90 vikes the first 5 weeks..I read some of you guys talking about the bone moving and clicking, I had that even with the rod, I would raise my leg from the pillow and it would click and hurt, felt so awful..but it went away. I am wondering if anyone has a simular story and how long it took to get back to normal, the screws in my ankle prevent from moving it, tho I can move it maybe a inch. THANKS EVERYONE FOR POSTING YOUR STORIES, It helps to realize you aren't the only one, I replayed it in my head a thousand times and wished I had a time machine..had my good days and bad days, some really bad days..but it does get much better! And I am very lucky to have my Girl take great care of me. Its times like these that make you realize what is most important in life...heal up everyone. GOD BLESS
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replied August 27th, 2011
i'm 33 and got a tib/fib fracture mid left-leg motorcycle accident on 26/5/2011. had plate surgery with 9 screws. as i write this its exactly 3 months now but i cant lay down both the crutches. there was nothing done on fibula fracture. doc said it will just heal by it self. by second month xray, the fib wasnt even aligned straight. how can it be okey and heal when both tips are not even touching?
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replied September 2nd, 2011
Im 19, and got both my fibula and tibia broken off in a football match. Got a tackle to my leg with a knee, surreal to sit and hold it waiting for paramedics.

I got the fracture 19/5-11 which is about 3 months ago now. I got an IM nail inserted 24 hours after the accident, and was on Oxycontin for a week after as well. Now I can walk with a weird limp, comdination of discomfort and lack of strength. My balance on my left foot is rather amazing, and can play some football again as well.

http://www.youtube.com/watch?v=HARFCxs2bU8

Hope to be able to run by Christmas.
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replied September 6th, 2011
Recovery after cast removal
Hi,
I had my long leg cast removed after about 3 months, fractured tibia and fibia. The doctor did not place a weight-bearing cast on, said it's not necessary because the x-rays look good and i was not getting pain in the injured area. He referred me to begin physical therapy. I am still not to put weight on the foot and must keep it elevated. there is swelling like before if I keep it down too long.

It is my first full day with the cast off and while I'm not getting pain in the immediate area, I cannot bend my knee without pain or stretch out my leg without pain. I know the muscles are stiff from lack of use and I am trying to bend it little by little while I wait for my first therapy appointment. Are there special exercises that I can do in the interim?

Also, I can't bend my ankle it seems to be stuck in one position, can't bend it backward or forward. I don't want to do anything to jeopardise my healing.What can I do? Thanks.
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replied September 6th, 2011
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acy,

What you are feeling is quite normal. It is to be expected. The joints have not moved for three months, and they get real stiff, real fast.

Don't worry, you won't be able to do any damage to the joint, as long as you are doing active range of motion. The best thing to do is warm the joints up first. So, sit in a hot tub (bath tub) for 15 to 20 minutes, to get those tissues as pliable as possible.

Then work as hard as you want in trying to move them with your muscles. This is active range of motion. Sit on the floor with your legs out if front of you. Try to contract your quad muscles and get the back of your knee to touch the floor. Hold for count of 10. Then try to pick your foot up off the floor, with the knee as straight as you can (straight leg raise).

Next, try to slide your heel up towards your buttocks, bending the knee. Go only as far as you can. Then straighten the knee out using the quads. Slide the heel back up again, and just keep doing this as much as you can. A firm, smooth floor is best.


For ankle motion, the best thing to do is to try to write the alphabet in the air with your toes. That will put the ankle through all possible ranges of motion. You may have to start with just up and down, but the side to side and circles will come.

Passive range of motion, is where someone else is pushing on the joints to get them to move. That is going to be necessary, but, you may want to wait till after your first therapy session, so the therapist can show you how to do it.

If someone gets a little too zealous with the pressure, you could get hurt. So, like stated, you might want to get an idea of how much pressure is okay before letting someone crank on your joints.


Your muscles have atrophied, so they are going to be weak. The joints haven't moved, and just like mechanical joints that haven't moved for a while, they are "rusted" tight. Like the old cliches "use it or lose it" and "motion is lotion", you will get moving again, it is just going to take some time.


Also, your skin is going to be very sensitive, do not scratch! Put on a bunch of lotion. The bottom of your foot is going to feel funny and may even be touchy. Sitting on a chair, put the bottom of your foot down on different surfaces: soft, firm, knobby, sandy, pebbles, marbles, etc, etc to get the sensation going again.

When you sleep, if you sleep on your side, you may want to put a pillow between your knees at first.


Glad that your fracture has healed and that you are out of the cast. Work hard of your rehab. Good luck.
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replied September 30th, 2011
Sorry did not complete my last post. I am having freer movement in my knee and can bend the leg a lot more since physiotherapy. However I am concerned about my ankle. Apparently when my leg was in the cast my foot was not fixed in a 90 degree angle and so when the cast was removed it remained in that kind of 45 degree angle. I don't know the degree i am just approximating.

As a result I am having major difficulty in getting the heal to sit flat. In therapy my foot will only slide along the floor at a particular point and if i try sliding it further back, this is done by sitting in a chair, the foot begins to lift up at the toes with my heel in the air. It is very difficult to get it down.

Will it ever be the same again? When I stand and try putting the foot flat, it only remains flat it I step it out in front of the other foot. If I try to stand with it together with the left foot my body bends forward. I can force it down which is painful, but the ankle is not bending at ALL. Will I forever have to walk on my toes or the balls of my feet?
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replied September 30th, 2011
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acy,

Most likely, it is just going to take some time and effort. When a joint is immobilized, the ligaments and other soft tissues become very stiff and thickened, in the position that they are immobilized in. That is why it is important to try to get the foot plantargrade (90 degrees), if possible. Sometimes, the reduction maneuver required to reduce the fracture, and then the position in the cast needed to hold the reduction do not allow for that to occur.

But, we always try to gradually bring the foot up out of equinous, as the fracture heals, so that when the patient comes out of the immobilization completely and begins to weightbear, the foot will be flat on the floor.

But, with time and motion, those soft tissues that have socked in around the joint like concrete, will start to loosen and stretch. Just keep working on getting more dorsiflexion. Try to warm up the tissues before stretching, with a hot bath/shower or hot packs, because warm tissues are more pliable. If you can get in a pool or large hot tub, water therapy is great. You can use swim fins on that ankle and the resistance of the water helps with stretching and strengthening.

Long static stretches are the best, try to avoid bouncing, or ballistic, stretching. If the PT doesn't quite do the job, on rare occasions, patients require a special type of brace, called a turn-buckle brace, which puts constant stretch on a joint for long periods of time. But, again, most patients can get their motion back with PT and don't need to do that.


Have you gone back to teaching this year? Hope you are doing well otherwise. Good luck.
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replied September 30th, 2011
Thanks so much. This is very encouraging. I am willing to put in the kind of work necessary to get as much motion as I can. I will definitely be doing the warm soaks. Thanks again. Was feeling a little down but feels better now. No I have not been back to school the doctor does not think it's safe yet.
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replied October 8th, 2011
I have been hearing about the benefits of using a walking boot or fracture boot for ankle injuries. With my particular injury should I try it? My physiotherapist seems reluctant, but I find that when I wrap the ankle when I am getting pain after exercise it helps.

I have been getting a strange kind of pain in by ankle a sudden sharp pain that comes and goes quickly near to the ankle joint as if something is pressing just around the joint area. I am thinking of getting the boot.
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replied October 8th, 2011
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acey,

It is not uncommon to develop some inflammatory soft tissue around the edges of a joint that has been immobilized for a while. This little bit of extra tissue can get in between the bones of the joint, and get pinched. This causes significant pain, as can be imagined. But, while it can be continuous, it is usually an off and on type of problem. Just showing up when the tissue gets into the joint and gets pinched.

Dr. Wolin was the first to described this many decades ago, and one of the soft tissue impingements in the ankle carries his name, the Wolin lesion.


You may be better served with one of the smaller ankle supports, rather than the large fracture brace (Cam-Walker for example). The larger walking braces can be very cumbersome and often make the patient uneven and off balance.

The ankle braces come in a variety of types, from the simple neoprene sleeve to the lace up types for extra support. I'm sure you can find one that provides you with the little extra support that you are seeking while you are regaining your strength and range of motion.

Therapists are often hesitant to recommend that patient use the larger supports, because many patients become dependent upon them, and slow their recovery or halt it all together.

That is why it may be better to use the smaller support. It will probably provide you with the comfort and stability you are seeking, but will still not be enough to slow down your rehabilitation.

Usually, the impingement symptoms go away as rehab progresses, as you regain your more normal range of motion. In rare cases, the patient ends up having to have an arthroscopic surgery in the ankle to clean out that inflammatory tissue. But, again, this is quite rare.


Hope you are doing well otherwise. Hope that you can get back to your teaching. If you are like most teachers, it is something that you love and miss when not participating in it.

Good luck.
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replied October 9th, 2011
Thanks for the prompt response, really appreciate it. Another patient had recommended the ankle brace since she used it when she had fractured her ankle. She said it made a big difference. I'll keep you updated.

Yeah I miss school, really hope I am not out too long.

What you are doing is truly wonderful, in helping people. May God continue to bless you with ideas and resources that will allow you to do what you are doing for a long time.
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replied October 9th, 2011
Especially eHealthy
Thanks for the kind comments.

Again, keeping working hard in PT.
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replied September 10th, 2011
Thanks. I have been trying to do what you recommended and yes it is hard and painful but I'm plugging on. I see some swelling in the knee and I'm a little concerned about that. I have my first therapy session on Wednesday 14th September. Looking forward to it (I think).
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replied September 13th, 2011
Non displaced tibial plateau fracture
I'm a 42 yr old male with a non displaced fracture in my left tibia. The fracture runs diagonal from the top middle and stops before separating the bone in two. I was placed in a brace and told it would heal without surgery. After 2 weeks the fixed brace was adjusted to allow for 30 degrees of bend at the knee. This was much better. Two weeks later it was adjusted to 60 degrees. I returned to work with 60 degree of flex. This week I started driving myself, but still need alot of help around the house getting up and down the stairs, getting in and out of the shower, can't get around the kitchen enough to make my own lunch or help with diners. Doctor says next week, the brace will be moved out to 90 degrees, 2 weeks later I should be able to get rid of the brace completely, but will continue using the crutches. Can't wait, although I'm grateful I'm not in a cast, the brace causes more discomfort than the broken leg. I have had no weight on that leg for 5 weeks now. I can stand, I can extend my leg fully and bend it 60 degrees. It's more difficult to keep it extended than bent. My current goal is to be walking by Halloween. It will be 12 weeks at that point. By my doctors guide, I should be walking and putting weight back on the leg with crutch help 2 week prior to this. I'm concerned because I have a trip already planned and really don't want to have to try to reschedule everything. Plus it will be nice to have a long weekend in the Caribbean to cap off this recovery. So, how possible is it to be walking unassisted after 12 weeks with my current progress? I don't see myself jumping in the waves, but would like to be able to walk the beaches.

For diagnosis, I had x-rays at the ER the day after the accident. I had x-rays at my ortho 4 days after and 18 days after. I also had an MRI 6 days after the accident. He says I will not need x-rays at the next exam. I am going every 2 weeks. The MRI didn't show any tissue damage, but the x-ray does show what appears to be a chip above the bone and below the knee where the tendon attaches. Doctor says it may not affect me at all or it could require knee reconstruction, no way of knowing until the bone heals and I try to walk.
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replied September 21st, 2011
Update. I saw the dr today. No new xrays, don't need to use the brace any more, starting physical therapy once a week and still non weight bearing until next apt in 3 weeks. Not in much if any pain and things seem to be going great.
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replied October 14th, 2011
Update. Things are progressive very well. I started weight bearing a few days before I was given the go ahead from my doctor. Started putting weight on it while using 2 crutches, then went half day using 1. Now after 9-1/2 weeks the doctor gave me the go ahead to weight bear as I'm comfortable. My xrays show a lot of bright white areas of new bone growth and the fracture is pretty faint. That was 3 days ago.

I was my PT this morning and got new exercises and feel pretty comfortable getting around on one crutch. So much better to have an arm free to carry stuff, hold doors... I can manage stairs fairly well now too. For short distances, I can manage to get around without any support. I picked up a cane and hope to move to just using it over the next week and would like to be on my own in the next 10-12 days. I don't have a lot of pain, mostly pressure and soreness that accumulates during the day.

Overall, I am looking at the whole process taking 12 weeks, seems like forever, but reading other stories I am progressive relatively quickly and right on track for our trip to Cancun.
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replied October 11th, 2011
I am 24 years old good health don't smoke.I broke my Tibia and Fibula on the 22nd of september. I slipped on wet tiles.I broke my tibia in 3 places and my fibula in one I had emergnecy surgery on the saturday was in hospital for 3 days. I was wondering how long it is before I will be able to walk normally again?and will I have a limp for ages after this?I have a pin and 5 screws which are never to come out I have a cast not allowed to put any weight on it for 6 weeks I have another 4 to go doctor said I might need to be put in another cast in 4 weeks and have to wait longer before I can put any weight on it any information would be helpful..!
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replied October 11th, 2011
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clare1234,

A couple of things puzzle me a little on your posting. You state that you have "a pin and 5 screws". Usually, tib-fib shaft fractures are treated with an intramedullary (IM) nail (also called a rod) and interlocking screws placed through the proximal and distal ends of the nail.

Occasionally, in a shaft fracture a plate and screws will be used instead of the IM nail.

If the fracture is at the very distal end of the tibia, just above the ankle (called the tibial plafond), then it is usually fixed with just screws and sometimes K-wires. (In some tibial plafond fractures a special clover leaf plate can be used along with the screws.) The K-wires are sometimes called pins, since they are smooth, without threads.

So, I'm not absolutely sure how your fracture was treated, since you say a pin and 5 screws. Was it actually an IM nail? This just helps to get an idea of what the fracture pattern is, based on how it was fixed. This helps in determining the usual course of fracture healing.

But, anyways...

There is a known time frame for the healing of tibial shaft fractures. This is in general, as every fracture is different.

When you say, when will I be "normal", that is really difficult to determine. Again, every patient is different, because what you would consider "normal", is not necessarily what someone else would feel is "normal". What is normal for a young athlete is different from that of an 80 year old gentleman.

Some things that you also have to keep in mind, during your healing and rehabilitation, is that not just the bones were injured. When a patient fractures the tibia and fibula, the periosteum around the bone is ripped apart, the muscles are torn off the bone, the tendons and fascia are stretched and twisted, and the nerves and blood vessel are also be injured. All of this soft tissues damage also has to heal and then undergo rehabilitation.

These soft tissues heal with scar tissue, which does not stretch and contract like normal tissue. These tissues also undergo atrophy after an injury from disuse. All of this has to be overcome during rehab.

It can often take a year to 18 months for someone to get back to the activities they were doing before the fracture. That does not mean that you will be unable to do anything for that long, just that it is going to be quite a long road, with many ups and downs along the way. There will also be some plateaus along the way, which can be discouraging. But, the time and effort you put into your rehab, will be rewarded in the end.


So, the following is information taken from the Wheeless Textbook of Orthopedics, from Duke University:

TIBIAL SHAFT FRACTURES

Time to union;
- low energy fractures: 10-13 weeks;
- high energy fractures: 13-20 weeks;
- open fractures: 16-26 weeks
- type 3B & 3C open fractures requires 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 the report by Anne Skoog et al., 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
> References: "One-Year Outcome After Tibial Shaft Fractures: Results
of a Prospective Fracture Registry" Skoog A, et al. J Orthop Trauma
15(3):210-215, March/April, 2001.



You have to remember that the above time frames are for the time till the bone unites, not the time to final recovery. That time period is too wide to be able to determine for any one patient. Again, every fracture and patient is different.


So, Clare, you are still basically in the immediate post-op period, as you are not even three weeks out from injury yet.

The best thing you can do is follow your surgeon's and therapist's instructions. Try to keep the swelling under control with elevation of the foot above the heart. Move your toes at least every hour while you are awake. This will help to pump venous blood and edema back into the core. It will also keep the tendons from scarring down around the ankle.

As soon as you are allowed to weight bear, try to do so. By placing stress across the fracture site, the body will actually lay down more callus around the fracture and make the bone stronger. This is Wolff's Law: bone will respond to the stresses applied to it. That is why bone and muscles get stronger when you exercise and lift weights and will get weaker when the muscles and bones are not used.

Since you do not smoke, that helps a lot. You should also not consume alcohol to excess. Eat a good balanced diet, with a little extra protein. The body needs the extra protein to heal the bones and soft tissues. Most patients get enough calcium and vitamin D in their diet, but if you want to eat a little extra milk and cheese that would be fine. In terms of vitamin D, a lot of foods are vitamin D fortified nowadays. Also, it only takes 20 minutes of sunlight on your face, to get the daily recommended amount of vitamin D. If you want to take extra vitamins thats okay, but you really don't need to spend your money on them. It would probably be better to use the money to buy a good steak and milkshake every once in a while.

As to whether or not you will have a limp, depends upon so many factors. The bone has to heal, you have to rehabilitate the limb, everything has to go according to plan, there can't be any problems, etc, etc, etc. Basically, all you can do is the best you can and see what happens.


If at any time you are concerned about things, be sure to ask your surgeon. He/she knows what the bones looked like and how well the fixation was placed. Don't be afraid to ask questions.


Hope all of this did not overload you too much. Hang in there, follow your doctor's instruction, work hard in rehab, eat a good diet, get out of the house once in a while, and it will get better day by day.

Good luck.
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replied October 12th, 2011
Thanks very much for the information. My injury was just above the ankle I think. It wasn't treated with an IM nail the doctor said I have a pin and 5 screws in it so maybe it's a K wire as you said.I'll just work hard on my phisio when it comes to that.
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replied October 12th, 2011
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Clare,

It makes a lot more sense to me now, why you have to be in a cast and nonweight bearing. It sounds like you had a very distal tibia fracture, that did not involve the ankle joint, but was so far down that an IM nail could not be placed. And, in the lower part of the leg, there is not a lot of soft tissue overlaying the bone, so the usual plate that is put on shaft fractures was probably not feasible. Thus, the fracture was reduced (put back together) and the pieces were held in place with some K-wires and lag screws.

This construct would not be as stable as an IM nail or plate, so the cast had to be employed. And since it is not a strong construct, weight bearing would not be allowed until there is callus formation and the bone has started to unite. You don't want to displace the pieces after just having put them back together.


Unfortunately, as you can see from the time frames on how long it takes for tibia fractures to unite, the distal fracture location has a tendency to not heal as well as the midshaft location. This is due to the paucity of soft tissues and thus a poor blood supply.


So, eat a good diet, wriggle your toes, and elevate the foot. Hopefully, at your next appointment the x-rays will show callus formation around the fracture and you will be able to get into a walking cast real soon.

Good luck. Hang in there.
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replied October 15th, 2011
tibea and fibula fracture 2 inches above ankle
i broke my tibea and fibula right above the ankle. the bone isnt displaced and would no like surgery. if i was to get a cast as i have a splint right now would the bone recover normally and would i have the same amount of strength in my leg as i did before i broke it? i am very freaked out about this since this is the first bone i broke. if somebody could please help that would be greatly appreciate it since i am 16 and have alot of life in me
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replied October 16th, 2011
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dirtrider,

As long as everything goes according to the treatment plan, then yes, the bone should heal without any problems. After the bone is healed, you will then have to spend some time in therapy, getting your joint motion and strength back again. So, getting the bone to unite, is just the first step.

Most nondisplaced fractures in the distal tibia are treated with a long leg cast for a few weeks, then that is followed by a PTB (patellar tendon bearing) cast until the fracture is healed. The PTB cast is a weight bearing cast, so the patient can begin to ambulate and work on knee motion.

Is some cases, if the surgeon feels the fracture is very stable, the long leg cast can be skipped. But, that is up to the treating surgeon.


Again, once the casting is finished, then the hard work begins. The ankle will be very stiff from being immobilized. The calf muscles will have atrophied (become weak) and will need to be strengthened. It will usually take several weeks to a few months to get all of the range of motion and strength back, to where the patient can return to activities such as athletics and heavy manual labor.


You have youth on your side, as the bone still has a thick periosteum around it. This will hold the fracture together better and provide a good blood supply to the healing bone. You will also bounce back in terms of rehabilitation a lot faster than an older patient.

If you use tobacco products, stop. These slow the healing of bone dramatically. Eat a good diet, with a little extra protein, for bone healing. You will get enough calcium and vitamin D in your diet, but if you want, you can also eat extra milk and cheese. Taking supplements is just a waste of money. It would be better to spend the money on a good steak and milkshake, in terms of bone healing.


So, again, if nothing goes wrong, you will heal the fracture well. It is then up to your to rehabilitate your leg. If you don't do your therapy, then you may not get back to "normal". And, it will take some time. Patients are usually advised that they will not know the complete final result, until about one year after the injury.

Good luck. Follow your surgeon's instructions. Don't smoke. Eat a good diet. Work hard in PT. And you should get back to "normal".
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replied October 27th, 2011
Spiral fracture
I broke my tibia and fibula first four months ago. I had to have two plates and 19 screws to reduce this spiral fracture. The doctor ( am in th uk) told me the tibia had shattered above the ankle. My bones still have not healed. I had so many. X-rays taken over the last few months. Last was last week. I am trying to do a bit of walking and putting slight weight on it using the walking boots but it gets too painfull. My ankle on left side of my left leg is still swollen and very tender to touch. My left foot looks purple compared to the foot on my intact leg. Am concerned. The dr said it was an extensive fracture and it will take time to heal. However, he indicated that I might be fit for work to my employer which means going back to work. Although an completely bored at home and would more than love to go back to my normal life, I am very concerned of doing this when I've been told that my bones haven't healed!
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replied October 28th, 2011
I Broke My tibia and fibula in one place on 29/8/2011 .. Been In above knee Cast For 1 Week ... Then I was Told I need Surgery .. I had (IM) nail and 4 screws on 6/9/2011 ... My Doctor Told Me not to put on the ground for 2 weeks then start touching the ground but not putting weight after my fifth week i was told to put weight and walk with crutches for about 4 weeks now i am in my 8th week it will end next thursday .. i am desperate to leave my crutches since my surgeon said i don't need PT . i treid walking without crutches once i wasn't actually walking it was like i was jumping my right leg with my broken left leg just touching the ground my mind is not actually letting me put all my weight on my broken leg ... i want to know what are the best exercises to get my leg on walking again .. as i really want to go to my doctor next week walking without crutches and say in your face Smile my question is Can I walk now without crutches it is almost 8 weeks ?? and what are the exercises to get back walking ? thx
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replied October 28th, 2011
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MasterBroken,

First, you should follow your surgeons instructions. He/she is the one who knows what type of construct the fracture has and if it is stable enough to place a significant amount of weight across it. Though IM nails are stout they are not strong enough to hold up under excessive stress of weight bearing. They can be placed as a load shielding construct or as a load sharing construct, depending upon what the fracture needs.

Not all tibia fractures are the same, of course. Though two patient may have fractured the tibia in exactly the same place, the one with a transverse fracture can weight bear immediately, but one with an oblique or comminuted (fractured into more than two pieces) fracture pattern would have to wait till there was sufficient healing of the bone.

So, again, follow your surgeons instructions.


If he/she has allowed you to go to full weight bearing as tolerated, then the best way is to actually walk with your crutches. You can then put only as much weight as you want on the injured leg, but you can get back into the proper gait mechanics. Once you have minimal pain with the crutches, go to a cane in the opposite hand (the hand opposite the injured limb). Using a cane (rather than one crutch) provides the same amount of weight alleviation, but allows for more normal walking patterns and gait mechanics.

To be able to walk normally, you have to have a minimum of 63 degrees of knee flexion. That is the minimum ROM needed to clear your toes in the swing through phase of gait. But, of course, you want to get as much ROM as you can in the knee.

It is best to do stretching and ROM exercises with tissues that are warm. So, a hot bath or shower, hot tub, or hot packs before the therapy is very helpful. Warm tissues are more pliable. Water exercises in a warm swimming pool are also excellent. The water takes the weight off the lower extremities, the water warms up the tissues, and the water can provide resistance (like when using fins).

Static stretching is advised over ballistic stretching. You can put the knee in flexion by lying on you back, flex the hip so the foot is pointing at the ceiling. Then gradually allow the knee to flex (bend), using gravity as an assist. Go as far as you can, allow gravity to pull on the leg (keep the hip at 90 degrees). You can also reach up, place your hands on the upper shin and gently pull down, again go as far as you can. You should feel stretching in the quads (thigh) and maybe also in the knee joint itself. Hold for a count of 10. While holding, move the ankle up and down. Repeat the exercise 10 times. You should do this 3 or 4 times a day.

If you have an assistant, you can lie on your stomach. Keeping the front of your thigh on the floor, bend the knee. The assistant can place one hand on the back of the thigh, near the knee, and the other under the shin. Then the assistant can bend the knee till you say stop. Hold in that position for a count of 10, moving the ankle while holding. Repeat 10 times, 3 or 4 times a day.

If you use an assistant, it is called passive ROM. You have to be careful though, the assistant must stop when you say, so that you are not injured from overzealous pushing on stiff joints and muscles.


Range of motion of the ankle is obtained by doing ROM. One good exercise is to write the alphabet in the air with your toes. This will put the ankle through the full component of motions that the ankle and foot can do.

You need to stretch the Achilles tendon, which you can do with wall leans. You need to stretch the Achilles complex with and without the knee bent. With the knee bent you emphasize the Soleus muscle and with the knee straight, the Gastrocnmius muscles is emphasized.

Use of a TheraBand, which is basically a strip of elastic, which comes in different strengths can also be used for strengthening of the muscles around the ankle. Strengthening and stretching can also be done with toe rises. This can be done on the edge of a step (if you are really stable) or on a small board placed on the floor. Again, this should only be done when you are allowed to, and can, bear significant weight on the injured limb.


One thing that most patients do not work on, in rehabing a lower extremity injury, is that of proprioception. This is a very important part, and is often the reason patients have trouble getting back to anything above just walking of flat ground. Proprioception is the ability to know where your limbs are in space and what they are doing, without having to consciously think about it. It's the ability to chew gum and walk at the same time.

Getting proprioception back, in a physical therapy department, is done with special half ball platforms that allow the ankle to move in all directions while weight bearing. But, if you do not have access to something like that, there is an alternative that can be done at home, with minimal equipment.

Get a large bath towel and fold it into about a one foot square. Place it on a firm surface, such as at the kitchen table. While holding onto the table for stability with one hand, place the injured foot on the towel. (Of course, this exercise is for when full weight bearing is allowed and can be tolerated.) Then, pick the good foot up off the floor, so you are in a single limb stance. If you are rock solid, try closing your eyes while maintaining your balance. Once this become very easy, increase it to two towels. The softness of the towels makes the balancing much harder. Hang on to the table though, you don't want to twist your ankle now. Again, try closing your eyes. You can go up to about 4 towels, depending upon their size and plushness. This is a very good substitute for the expensive physical therapy equipment.


Once you can walk about a mile without discomfort and the strength of the injured limb is at least 90% of the uninjured side, then you can go to sport specific training. The ability to do such things as sprinting, jumping, cutting, kicking, dribbling a soccer ball, etc will all also take some time to regain. But, these activities cannot be done till you have basically regained the ability to walk "normally".


All of this rehabilitation can take quite a while. It often takes longer to get the soft tissues back in shape, than it does to get the bone to unite. But, if you work hard and are persistent you should be able to get back to the activities that you wish to do.


One more time, follow your surgeon's instructions. If you are allowed to put 50% weight on the limb, then do not go above that. But, if you have been cleared to put full weight on the limb, as tolerated, then go for it.

Let pain be your guide. If you have sharp, intense pain, right at the fracture site, you need to back off a little. The body will tell you if you are exceeding the stress limit of the tissues. However, work-out type pain that you get with stretching and muscle usage is okay, and necessary. Just watch for the sharp pain at the fracture site.


Good luck. Hope you are walking in a very short time.
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replied October 28th, 2011
Thx For The advices for the exercises i hope it become helpfull one day to me since my surgeon recomended only two exercises one for my knee and the other is to lift my leg up while stretched .. i actually can pay for PT and all but my surgeon says i don't need them at all i don't know why till now .. but i guess in one or two weeks i will know since the 9 months he told me that i was supposed to leave crutches after .. .. now i don't feel any pain in my leg at all even when walking with crutches .. so i guess that means i am healing right or sth .. so i tried to walk without them i didn't feel any pain in my broken leg .. but it was a little jump with my other leg rather than walking it felt god though ... so as for stretching and knee exercises i do this daily from after 2 weeks from surgery .. never done the lie on stomach part though .. i can actually bend my 2 knees like each other not notcing any diffrence . the thing i want to know is what the normal time of being able to walk without crutches even with a limp i don't mind for a while but just being able to walk ?
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replied October 28th, 2011
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MasterBroken,

It sounds like you are doing very well. Having full knee ROM is a great start and the fact that you do not have any pain at the fracture site means it is probably well healed.

From the dates you gave in your original post, you are just two months out from your injury (29-08-11). So, you are actually going great.

If there is no pain, then limping is usually due to weakness or loss of range of motion at the ankle. And getting back to walking is just a matter of retraining your muscles to work like they are supposed to, rebuilding strength and flexibility.

It sounds like you are doing fine on your own. Most patients who get their ROM back quickly and are motivated, really don't need the formal physical therapy. We usually reserve the expense of PT for patients who are timid, not wanting to move at all, don't get their ROM quickly, and are at risk of getting frozen joints. Most of the PT that you would be doing would be self guided, basically regaining strength. If you need to pay some one to tell you to exercise, then it may help. But, it sounds like you are well motivated, so you probably don't need to pay out the money.

Patients are usually advised that it takes about 9 to 12 months to get over a major orthopedic injury and surgery. That is the time it usually takes the average person to get back to full activity. But, the patients are usually walking long before the 9 month mark.


Glad that you are doing so well. Work hard on your therapy and you should be back to walking in no time. Good luck.
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replied October 30th, 2011
Recovery time?
I was side swapped by a car while riding my motorcycle.
My tibia and fibula were fractured as well as two small bones in my foot.
I had a 3 hour surgery the next day to insert 2 plates and 17 screws.
I'm getting my cast removed after 6 weeks tomorrow morning.
I don't know what to expect... Haven't found anyone with the same type of injuries and so I'm a bit worried about the outcome. I'm a 23 years old female.
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replied October 31st, 2011
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Lateagain,

When you get your cast off expect for your ankle to be very stiff. Your calf muscles will be smaller than the other side from disuse atrophy. Your skin will be very sensitive and soft, so don't scratch.

Usually, most surgeons will go from a cast to a splint/brace/boot so the patient can transion from full immobilization to completely free.


You do not say if you have been weight bearing or not in the cast. If not, then you are going to have to get both range of motion and weight bearing back. Usually, it is recommended to do range of motion out of any immobilization, but to start weight bearing with the splint/boot/brace on.

You will need to do complete ankle rehabiliatation. This includes range of motion, flexibility, strengthening, and proprioception.

It often takes longer to do the soft tissue rehab than it takes to get the bone to unite. Bone healing is just the first step in the long process. We usually advise the patients, that after a significant lower extremity injury, that it can take as long as 12 to 18 months before the final results are known.


But, you really need to speak with your surgeon as to how he/she wants you to rehabilitate the limb. Every injury is different and your surgeon knows your case the best. Make sure you understand all of his/her instructions.

Good luck.
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