Re: broken tibia & fibula caused foot rotation and shortening of the leg

comment per post.

"spam2death" <[EMAIL PROTECTED]> wrote in message
news:[EMAIL PROTECTED]
> "adihead" <[EMAIL PROTECTED]> wrote in message
> news:[EMAIL PROTECTED]
> > i was involved in a motorcycle accident almost 3 months ago. had an
> > open fracture right below my left knee. both tibia and fibula broke.
> > tibia was pretty messed up, had to be put together with a stanley
> > steel rod which was placed down the bone's shaft and about five
> > screws, three up near the knee and two down near the ankle (to hold
> > the shaft in place. the surgeons decided not to leave the fibula as
it
> > was. fixing it would involve more cutting and more risk, which
wasn't
> > worth taking, since it is possible to function perfectly while
fibula
> > is broken.
> > the operation was apperantly successful, but my foot is externally
> > rotated about 10 degrees and my left leg has become shorter by a
> > little less than half an inch.

i had closed tib fib break.

teh first long cast gave apperance that foot rotated outward. i
mentoined, and they said not to worry. obvously i was worried. :)

while casting the second, short cast, PTB Cast Patella Tendon Bearing, i
noticed they changed teh angle aot the break. this brought my toes inot
ptroper postoin so that they were no longer angled outward.

i think my leg is slightlyl shorter. that's said ot be normal.

i walk now, but cannot let weight on or off quickly else have tendon
pain front and back at ankle. and in knee (just below cap; i think this
is hte patella tendon)

> > i have 2 questions on my mind:
> > 1. is foot rotation a common thing with these sort of insidents? or
> > does this sound like the sergeons missed slightly when they where
> > putting the pieces back together?
> > 2. from looking at the x-rays, i can see that the break in the
fibula
> > caused on part of the bone to actually overlap the other part, so
that
> > both parts are located side by side. it seems logical to me that
this
> > is what caused the shortening of my leg, since the overlapping
> > actually makes the fibula shorter, and the measurement of the
> > overlapping is the same as the amount my leg has shortened. if so,
is
> > there any way to fix this shortage? or am i stuck with one shorter
leg
> > than the other for good?

I think the tibia is the main concern. I'd expect that Tibia should be
straight and of "proper" length, as estimated during placement of rod.
Also, unless your tibia is at angle, the fibula should also be at
unbroken length.

I collected info from the web.
Some info at (Wheeless' Textbook Orthopaedics
http://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=Cast+Treatment+Tibial+fractures+Wheeless%27+Textbook+of+Orthopaedics)
included pic and
"     - more than 50% cortical comminution or displacement more than 50%
are significant risk factors for non-union;"

I interpret that statement as a minimum standard of break ends overlap,
but I haven't looked for a definition of Comminution [1]



One fibula question I still have:
I'm not sure how your (or my) fibula is expected to mend if its broken
ends aren't receiving the physical pressure that causes the (supposed)
requisite piezoelectric stimulus for bone healing. It seems the bone
fill/callus should show on x-rays. I haven't had x-rays since receiving
the PTB cast.

> > would be happy to hear if anyone has gone through something similar.
> >
> > thanks,
> > adi omry
>
>
> Wow !   Reading emails like this make me feel very fortunate. I had an
> automobile rollover in 89 that caused a severe open break of tibia and
> fibula just above my right ankle. My foot was turned completely
backward,
> multiple fractures of fibula and some splintering and splitting of
tibia.
> Also broke my right shoulder (not fixed). I was fortunate to have
surgery at
> a teaching hospital and fractures were fixed with 2 long screws in
tibia and
> about 8-9 screws plus rod in fibula. I lost much of the muscle tone in
my
> foot, but have excellent function other than arthritis and now
osteoporosis.

arthritis and osteoporosis?
Are you over 60?


> My walking stride is much shorter than before and my R leg may be a
bit
> shorter. I had constant pain in tibia near ankle until I had the 2
screws
> removed and then the ankle pain disappeared. About 4 years after the
car
> accident a giant cell tumor was discovered in my R proximal tibia and
I went
> back to the teaching hospital. Had one surgery to remove golf ball
sized
> tumor and another long surgery to replace missing bone with a large
cadaver
> allograph. I have 8 huge screws and a large rod in my upper tibia
along with
> arthritis in my knee joint, but good function other than some
sloppiness due
> to no ACL. 9 years later I am now having chronic pain in right pelvis
> socket. This pain may be caused by arthritis, osteoporosis or
avascular
> necrosis? I'm going in monday for an evaluation. Any comments?
>
> To adi omry - they shouldn't have left your fibula like that unless
you were
> about to die from the initial accident. My guess is that you will have
> significant function problems if you don't get these problems
corrected. I
> can tell you from experience that if you are only 3 months post
accident
> that you are only beginning to realize the differences and problems
this
> accident might eventually cause you. My advice is to make sure and
take your
> calcium and vitamin D

greens, milk. Multi-vitamins (type with a rational dose of component
vitamins & minerals).

and see a good surgeon at a teaching hospital for a
> second opinion on fixing your leg. The way things are now, you'll have
> trouble walking as you get older.

[1]
http://www.google.com/search?sourceid=navclient&q=%22cortical+comminution%22
gives interesting digression:
AAOS On-Line Service Academy News - Section B - CT scanning of ...
... In addition, observers significantly underestimated the amount of
dorsal cortical comminution on review of plain X-rays alone (p<0.05).
...
www.aaos.org/wordhtml/2000news/b3-17.htm - 4k -