Thursday, May 27, 2010


Today marks seven weeks since my surgery. Next week I go to see the surgeon, hopefully to remove the brace permanently from my right arm. X-rays should show how well the bones in my leg and arm are mending and how much longer I'll be wheelchair- and walker-bound. My face is still sore over the left eye, where I cracked the orbital bone, and I still have pink patches from the abrasions, but I don't look like a car crash victim any more.

I've learned a lot about tibial plateau fractures. For example, only 1% of all broken legs are this type, considered to be a very challenging break to manage. There is a classification scheme that further subdivides these fractures in terms of how they're handled. Although I don't know my exact classification, I gather from the amount of hardware in my leg and the reactions of the orthopedic surgeons that it's one of the worse versions. I know that the bone was broken into three main pieces, with the ACL pulling one piece out of place. Now I have two plates, one on either side, and about ten screws pinning it all back together, along with bone graft material. On my list of things to do is call the hospital to get a copy of the X-rays and CT images.

Drop foot, caused in my case by surgical trauma to the peroneal nerve, has left me struggling to control the muscle that lifts the foot and toes. Without the ability to lift the foot at the ankle, walking is difficult since the toes drag while the foot moves forward. Electrical stimulation of the muscle and nerve has led to a huge improvement over the course of the past few weeks. I've become proficient at picking up marbles with my toes, which I can't do nearly as well with the left foot. The nerve damage was apparent immediately after surgery, and the surgeon told me that the nerve was sulking, but 99% likely to recover. This week I had a physical therapist in out-patient PT who worked with me as an in-patient. She gushed over the amount of movement I'm getting with the foot, so that's reassuring that the improvement is real. I've graduated to lifting my foot enough to tap my toes, which I do every time I think of it. It would seem the surgeon is correct that the nerve will repair itself. It's just extra work.

Beyond the third incision leading to a sulking nerve, it also hasn't healed properly. Somehow the sutures weren't as even as on the other two incisions. The tech who removed my sutures at two weeks was hesitant to take those out on the third incision, but the surgeon "wasn't worried." Within a day of the application of the steri-strips, I had indications that it had opened up. When the steri-strips dropped off the two well-healed incisions, this one remained open. Prescription antibiotic ointment and a lot of bandages have helped it progress, but it's still scabbed over at seven weeks. I think the hole under the scab is very deep.

In spite of the wound, the occupational therapists allowed me to go into the heated saltwater pool this week. They seal over the small scab with Tegaderm, a waterproof dressing. I'm "toe touch weight bearing" which means that I can touch the toe of the bad leg down enough for balance, although I usually just balance on the good leg. Technically, I'm allowed 20% of my weight onto the leg. The buoyancy of saltwater means that I can walk in water at chest level. So I've begun to slowly walk back and forth across the pool.

Seven weeks of avoiding pressure on the leg is long enough to retrain the brain on acceptable modes of transport. My brain now believes that hopping on the left leg is the way to go. The right leg never relaxes while standing, but always hovers in the air. Retraining the brain takes conscious thought. Reach the leg forward. Put the leg down. Push forward with the good leg. Put weight onto the bad leg. Lift the good leg, while leaving the right leg down (!!!! something I haven't done in seven weeks!). Roll forward on the right foot. Push off with the right foot. Stand up straight. In actuality, the buoyancy is so great that it's hard to get a lot of forward motion out of pressure on the foot. A one-pound ankle weight helps.

Interestingly, the amount of brain involvement in the issue becomes obvious by trying different walking directions. Walking sideways or backwards seems almost normal, because the brain has not retrained those methodologies. Treading water feels totally normal.

The standard treatment for this type of broken leg is no walking for ten to twelve weeks, so I have up to five more weeks to go until I can start partial (50%) weight bearing. Right now I'm looking forward to being able to weight bear on the right arm, which will relieve me of the platform on my walker. Regaining the right arm hopefully will make getting upstairs a possibility for me, as well. I'm wondering if the surgeon will recommend crutches as an alternative to the walker. I feel I might be a menace to myself on crutches. While my fine motor coordination has always been extremely good, the very fact of this injury lends credence to my lack of gross motor coordination.

Luckily, I'm not having much pain anymore. I totally weaned off the narcotics as soon as possible after seeing my regular doctor. Since I typically never take any painkillers, four weeks of heavy narcotics were scary. My very alternative medicine friendly doctor was obviously nervous about the oxycontin usage, even at the lowest possible dose, and recommended immediate discontinuation. I did manage to do that, with some withdrawal issues, and continued on the hydrocodone for another week or so. Now I take an occasional ibuprofen, but rarely need that. I expect pain management may become more of an issue when I can actually put weight on the leg again.

For the foreseeable future, three days per week of therapy, two hours per day, will be my lifestyle. Add in the hour round trip travel and my days are shrunken. Add in the fact that EVERYTHING, from showering to dressing to loading into the car takes at least twice as long as normal, and the days don't have enough time in them for everything I'd like to do, like writing more on this blog.

For my initial post on my injury, telling how I got into this crazy predicament, go here. For Frankenstein photos of the injury, try here. For a laugh over my garage shower, see here.