non union of commutued lower distal fractured tibia

[jerome]

hi everyone sorry to bother you but i need some advice i will try to keep it brief but want you to have all the facts so here goes in march 2011 i was assulted resulting in multiple fractures of the tibia and fibula of my right leg i was treated with internal fixation requiring two plates and 17 screws. Unfortunately i am a 39yr old male with insulin dependent diabetes and also take statins and medication for high blood pressure. It has now been nearly a year on and although my fibula has healed apparently my tibia hasnt and i have non union. Added to this is the fact that origionally i was in a cast for what i consider to be an excessive amont of time(around 16-18wks) and my right leg was incorrectly set ( about a 5% bias to the outside) i now find that my ankle which had previously sustained no damage has a dramatically reduced dorsi flex resulting in my redundancy from my occupation as a stonemason.
Obviously i am unhappy about this and most of the problem is with massive stiffness around the front of the ankle rather than the achilles tendon.
Now heres the kicker i have been referred to a specialist orthopedic hospital and having had various scans and xrays they have confirmed the non union however there was bridging and callous formed on the opposite of the bone to the plate. I had a consultation on wednesday and the professor was of the opinion that he needed to remove the bone in that area around 20-25mm and do a transport using a illazarovs cage he reckoned i would have to wear this device for 12mnths. So now my concern is as follows firstly its taking another year of my life secondly i will get atrophy of the limb and also this device will not allow as much movement so will i face further problems with my foot and leg function/movement, thirdly the current metal work will have to be removed so further intrusive surgery pressumbly resulting in greater damage to soft tissue and tendons? and finally i will have a constant battle against infection at pin sites and will be on a wild array of drugs.
So heres the thing i thought there could be a possibilty of a bone graft but maybe im clutching at straws the prof seemed to think that there was maybe only 50% chance of success but why wouldnt we try that? Afterall the fibula healed no one has identified why i have non union or if there is a problem with my bones pressumbly this procedure would involve a smallish incision at the site of the nonunion roughing up the bones and application of graft and marrow as i already have a plate i am guessing i wouldnt need to be in a cast again so could start weight bearing quickly and work with wolfes law thinking that if successful i could possibly be ok within 3mnths. Also should this procedure fail then its on the area that they would remove anyway for the transport and cage kinda like using a puncture repair kit before splashing out on a new innertube right?
So im not sure why the seem so keen to try the transport method over the graft? surely if theres a chance it would work and i could be back to normal quicker its worth the risk?

well there it is excuse the spelling and grammar and i appreciate your patience and response many thanks jerome

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[violablue]

Hi Jerome,

I think if you have a well-recommended specialist, you can often be confident in his/her recommendation. If you have a not-well-recommended therapist, then you may want to look for a second opinion or options. It can be difficult to figure this out as a patient. So if you know other people who have been to this specialist, ask them how things went. Ask around. People really do like to share information if things went well or didn't.

Hope things go well with you!!! I completely understand the issue with injury and not being able to work. Especially when your job relies on your physical ability, so I hope you heal well and quickly.

[Crystal R. Westergard]

I agree largely with Viola's advice. It would be good if the surgeon saw fit to sit down with you and discuss the WHY behind his decision.
He has recommeded something that will have a high likelyhood of working, but is expensive to the healthcare system and to you.
Has anyone looked at why you couldn't have an intermedullary rod put in? This is done in these cases often in Canada.
However, there may be a reason that won't work, due to the 5% bias perhaps.
I had a patient who had the cage, in fact I've had a few, but they were all placed right away after injury. Perhaps then, he plans to
"injur" you by rebreaking the leg and straightening it. I think, to be fair, it would be best if you knew that ahead of time. Unfortunately, this calls
for a surgeon who is caring and has bedside manner. This is a very rare thing. In the USA they do have such. If you were looking at the cost
of a whole years wages, perhaps it would be worth it to fly to the US and meet with a consulting orthopedic surgeon for 20 minutes. You might
get a different perspective, and you wouldn't be so frustrated. Being stressed and frustrated DOES NOT help bone healing.
Crystal

[jerome]

thanks for your responses i guess alot of it boils down to the fact that although we understand more about biology and body chemistry every person is different and therefor the medical professionals are loathed to speak in absolutes. Having meet with some of the care team i still have some unresolved questions they are potentially planning to put me in a 4 ring fixator for upto 12 mnths the have said my leg will be pretty scarred by all the operations which whilst isnt ideal is ok as i dont intend to make a career from model hoisery but i am concerned about the amount of atrophy to the limb whether there will be stiffness to knee hip and ankle joints what degree of permance this will and what levels of function can i expect whilst in the frame i live alone on the 1st floor so steep staircase to tackle everytime going in or out also will i be able to use the gym and weight train? thanks for any advice jerome