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Broken Tibia/Fibula, Details not picked up in OR

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Hello, I am new to this and need some advice on my current situation. May be a bit lengthy but please bare with me. On Friday Jan. 4, I broke my tibia and fibula due to sliding on a sheet of ice. When my right foot came in contact with the pavement I pretty much did a faceplant into the ground due to the initial pain. I was taken to the ER and given an Xray, which they determined I broke my tibia in two places and my fibula near the knee. I was released in a support cast and with some pain medication and referred to an orthopedic.
Dealing with the pain all weekend, I was finally able to visit my orthopedic on monday Jan. 7. After reviewing my xrays I was admitted back to the hospital. I had to wait 2 days for some swelling to go down and then on the 3rd day my doctor insisted on doing a closed reduction followed by a fiberglass cast. I was then released on the 10th and scheduled to be seen by my Orthopedic in 2 weeks.
On Jan. 24th, I visited my OP and was shown that my tibia was not only broke in 2 places but 4.
How did you not catch that when I was in the OR??? It was soo clear on the Xray. Unbelievable! My swelling at this point went down significantly leaving me with a loose cast, which I noted, but was sent home without any concern from the doctor. Now Im no genius but I dont believe my cast should be this loose 2 weeks out of the hospital. How was the bone, well I mean bones, supposed to magically grow together straight with a loose cast??
On Feb. 7th I had an Xray done and was back visiting my OP. Now when I was in the Xray room I had asked to view the prints, and let me tell you if my leg heals the way it is going, it will only take one rolled ankle to break it again. Now I was waiting for my OP to tell me that I need to possibly have it reset and add a little hardware but I was wrong. “ Oh yea its healing great, there is some callus forming already and you are healing quick, good thing your 27 and have great bones!” Now my tibia is fractured in 4 places. Two hairline fractures right below my knee and two above my ankle. Now the break that causes the most concern is one that is 4.5” long angled from ankle up the tibia. Now to me there is a significant offset which is clearly visible on the xrays. I can also feel the crack which is about a 1/4” thick, but like he said its healing great. I also have this loose cast still which has developed a large crack in the back behind the calf. I informed my dr. but still nothing is done, not only is the cast loose but now I have this crack that enables the cast to fold in the center. At this point I am told that I will be good to go in 3 months total for my injury.
Two days later my fiberglass cast breaks in half. Hahaha, seriously? Now this is on Saturday and I have to wait until Monday to get this taken care of. So on Monday I call and they tell me to come in ASAP. At this visit my doctor dont even visit me and they cut the cast off and give me a boot, which fortunately is below the knee so I can start to get some strenth back. Once again though I am sent home just wondering what news is to come my next visit in 2 weeks.
Today, Feb, 26th was the best act of incompetence by my OP yet, but am I surprised? No , I saw it coming. I went in to have an Xray once again, and reviewed the once again also before I went to see my doctor. Now he ordered me to have the xray taken with my boot on which only the top of my leg is visible. The side view, which is the one where it looks the worse, is masked by the metal strip on the side of my boot. Ummm, what is the point of that? Now the top view looks worse than before as it appears the top of my main tibial fracture is sliding off the lower part. I already know though what my OP will say before I even go to his office. “ Oh my, this is healing just great huh??” Now I am pretty pissed off and am not leaving until I put in my 2 sense. I ask him again, “ so your telling me this is healing great with the two bones offset the way they are?” He replies that it is healing just the way it should be. I also asked why I didnt have any hardware put it to stable and align it better and was told that it would have been overkill to do so given they only do that when the bone is separated “too far apart.” So my wife asks him, “Well wasnt his completely separated at that area?” And one of the dumbest replies he has had yet was “ No, it was broken all over.” Already in my head I think I need a second opinion. I cannot work due to this injury as I am a carpenter and I have a family to support as a lot of people do. Bills are just piling up and I am helpless on doing anything. There is no help for those who have a broken leg and cant work so I am in bad shape until I can do so. Now to add my condition at this point is NWB, which I expected as everytime I try to take a step on my broken leg the pain isnt necessarily in my tibia but in my ankle and foot. It hurts soo bad it feels like all the bones in my foot are brittle and about to fall apart. Knee pain I feel is normal. And now instead of 3 months healing time I am looking at 6 months instead. Wow, thats a big jump from a couple weeks ago when you were positive it would be 3. Whats next, 9 months...a year? Is there something he aint telling me or am I just over exaggerating? Well I have to wait a month until my next appointment but I dont think that I am going to see him anymore.
I know this is a long post, I should have started one from the beginning, but if anybody does take the time to read it, please respond with some feedback. It would be greatly appreciated. Thank you.
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replied February 26th, 2013
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DerrickC,

Sorry about your injury and situation.

Hopefully, I have a picture of your fractures. At first, it sounded like you had a Maisonneuve Fracture, which is where the medial malleolus (the distal tibia) fractures, with the fracture stress then going up through the syndesmosis ligament and out through the proximal fibula (up by the knee). This is actually a fracture that should be treated surgically. Mainly because the syndesmosis ligament is torn, which allows the tibia and fibula to separate from each other, thus allowing the ankle mortise joint to widen. Usually, with a Maisonneuve Fracture, the distal tibia (the medial malleolus) is fixed with screws and then syndesmosis screws are placed from the fibula into the tibia to hold the two bones together.

But, then you stated that you also had some fractures up in the proximal tibia, up by the knee. So, then it came to mind that you may have had a proximal tib-fib fracture, with another fracture in the distal tibial shaft (rather than a medial malleolus fracture). So, that would be treated differently, since the ankle joint and the syndesmosis ligament would not have been injured.


So, it is difficult to make specific recommendations, without seeing the x-rays, to know exactly what fractures you have.


But, since you no longer have any confidence in your current orthopedic surgeon, it is probably best to just get a second opinion. It is kind of strange to not change your cast when it become loose, and especially when the cast is broken. If the patient is going to be treated with cast immobilization (which actually takes more work and diligence than managing a post-op patient), then there has to be close observation of the cast and x-rays. The cast has to be well fitting and comfortable. If not, the fracture can displace and the patient can develop pressure or cast sores.

You do have to understand that surgery does not make fractures heal any faster. But, if a facture needs better alignment for proper healing or if the fracture involves a joint, then internal fixation may be necessary. But, again, it does not speed up healing. Also, internal fixation cannot replace bone for bearing the stresses placed on the bone during weight bearing. It is just placed to hold the bones in place, until they unite. Orthopedic hardware is not strong enough to withstand repeated stresses of weight bearing. Some tibia fractures can have weight bearing from the time of injury, if the fracture line is transverse in nature. These are inherently stable. But, if the fracture line is oblique or spiral, or if there is comminution of the fracture, then there cannot be any weight bearing until there is healing of the fracture.

Some types of internal fixation, such as the intramedullary nail (IM nail), can share the stress of weight bearing. But even with IM nailing, if the fracture is oblique/spiral/comminuted, weight bearing has to be delayed.

It is also a fact that it is a race, when hardware is placed, to see what happens first: the bone healing or the fixation failing. Internal fixation, when repeatedly stressed, will fail. It is like a paper clip, which is bent over and over, will break. So, having hardware placed does not mean that the patient is going to be able to bear weight and get back to physical activity any faster than a patient who is treated with immobilization.


The main things with tibia fractures, is that the overall alignment is okay. It is often fine if there is a little offset of the bones at the fracture site, as long as the overall alignment of the bone is okay. The body will remodel fractures to some degree, but cannot correct significant angulation or rotation. Also, if the fractures involve the joint surfaces (ankle or knee), then it must be confirmed that the joint surface is congruent (as smooth as possible). When fractures involve joints, usually surgery is needed to make sure that the joint is reconstituted as anatomically as possible. This reduces the incidence of traumatic arthritis.

So, there is no one way to treat fractures. It is the up to the judgment of the treating surgeon to determine if the risks of surgery are justified. If the fracture will heal adequately with immobilization, then that is the way to treat it. But, if not, then surgical intervention is warranted.


But, again, it sounds like it would be best if you got a second opinion. When you do not trust your surgeon, it is not a good situation. So, see if you are get in to see another surgeon for an evaluation. Also, see if you can obtain your x-rays from the beginning. The second surgeon you see will need the x-rays.

Good luck.
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