Spiral Fracture to Tib/Fib

[kimberleyone]

I am a 48 year old female insulin dependant diabetic. Experienced silent MI on 20 July this year. In process of this, fell out of car door, and broke leg. Spiral tib/Fib at lower end. Had temporary cast for 17 days while stent inserted then MUA and full leg cast. Full leg cast for 10 weeks. Removed today. Xray shows very little unification, although consultant says it is "sticky". Lower leg cast now in situ. No prognosis for removal. Problem is, my knee is very painfull. Can achieve 70 degrees before pain. Can someone advise exercise to improve ROM and relieve pain. Not getting much movement as cardiac stent failing and have angina on exercise. Also can anyone comment on healing times? I came away feeling very disappointed today. The fracture is stilll moving, although there is no pain from the site at all. If this doesnt heal, what happens next? Thanks in anticipation

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[physiobob]

Don't worry Kimberley, you seems to have a few issues health wise however the spiral fracture issue and knee pain post removal of a full length cast is par for the course. You actually lucky to have 70 degrees flexion.

I imagine that someone has you in for some outpatient physio? Maybe they have over-looked it as you are still in a lower leg cast. If that's so maybe ask the consultant for a referral. For now give it a few days for the body to work out that it is in fact OK to move the knee. In the beginning you fractured and were put in a full length cast. The brain by now thinks that having a fixed knee is therefore impt to allow the injury to heal. It will work out in a few days that actually bending it is OK.

Keep us updated as you have a way to go.

p.s. Fractures do require weight bearing and therefore load to heal and begin ossifying so in the beginning we only see callous formation on x-ray. Some slight slowness on this at this time is not uncommon and so this is why you still have a lower limb cast on. Eat well and stay positive

[kimberleyone]

Hi
Thought i would leave update on my situation.
Firstlymy knee has now sorted itself out and apart from a little pain when flexing my knee, i now have full range of movement.
Thats the good news. My stent has reblocked meaning a repeat angioplasty in Jan 08. In the meantime, no healing is apparent on my fractured tibia. X ray stated that if she didnt know differently, she would have said that the xray was of a new fracture, not one that was 16 weeks old. I discussed with the consultant the possibility of IM nailing, but since the angiogram has ruled out surgery before the angioplasty(due to anaesthetic risks of a blocked cardiac artery) and for some 6 months post surgery (due to anti platelet therapy) I was wondering if anyone could give me advice on what may happen next? I am not sure that I can cope with a further 6 months just sitting here with nothing happening. I have read articles about ultrasound tretment but not sure if available onthe NHS as private treatment is out of the question as my sick pay finishes in 2 weeks . Any advice re my next discussion with the consultant would be very welcome. Another problem is a developing rotation of my foot, this was noticed at the fracture clinic when the replacement of the long leg cast was mentioned, but moved away from when he saw the look on my face!! Please, anyone out there that can give me some cheer?!!!!!!!!

[kimberleyone]

Hi
Got another update. Got phone call from Registrar to say that they had taken advice from cardiologist and anaethetist and decided to go ahead with surgery in leg so to come in to hospital the next day!!. Had pin and plate fitted with bone graft from iliac crest 4 days ago. Donor site is very painful on movement and leg is as you would expect. Only confusion now is that reg says 2 weeks plaster then begin weight bearing at 6 weeks, consultant says plaster for 6 weeks and weight bearing at 12 weeks. Not a lot of difference there then!!!