Accidents aside, my leg is still sore, but no longer feels especially broken.  In fact, like some sort of cruel joke, I feel as though it’s sort of taunting me to use it.  That’s not supposed to happen, in any capacity, for another four to six weeks sadly.  The top part of my leg aches pretty badly when my leg is in the wrong position.  I keep wondering if it’s one of the screws in my tibial plateau causing the pain.

There’s a certain irony in having pain in a limb that is, at least on the surface, incredibly numb.  It’s difficult to explain, but any time that something touches my leg, it feels as though it’s happening through a few inches of foam.  It’s a really bizarre and uncomfortable feeling.  I’ve been told that this numbness will improve over time but may never go away completely.

Following the advice of my surgeon, I’ve been wearing a compression sock on my leg for almost two weeks now.  While it’s not especially comfortable or stylish it has markedly improved the swelling in my leg and foot.  I put the sock on in the morning before work and generally take it off after dinner at some point.  When the sock comes off my leg and ankle are much closer to the size they ought to be.  My only real complaint about the sock thus far, aside looking like a one legged LeBron James, is that it’s a bit of a struggle to get the sock on and off.

Completely not following the advice of my surgeon I started driving my car again.  Luckily I drive an automatic so not having the use of my left leg isn’t much of a detriment.  Getting in and out of the car with crutches is somewhat awkward, but having a little bit of freedom and normalcy back is well worth any amount of discomfort or hassle!

Medically speaking, week four of my recovery hasn’t been particularly eventful.  I had the remainder of my stitches removed this week and swapped out for steri-strips.  The steri-strips that I had put in place of  the stitches that I had removed last week are starting to peel off with a bit of encouragement on my part.  As they come off, they reveal what I assume will become permanent scars from all of the sutures in my leg.  I don’t feel like the swelling in my leg, foot or ankle have changed much this week.  I think my surgeon must agree as he suggested getting some compression socks to help with the swelling.  On the positive side of things my surgeon also mentioned that he was impressed with the range of motion in my knee given where I am in the recovery timeline.  Although I haven’t had it officially measured, it’s definitely somewhere beyond 90 degrees.  All of the time I spend trying to push my knee to the edge of pain and back must be paying off.

Unsurprisingly I suppose, my leg still hurts.  While the pain isn’t excruciating, it’s definitely uncomfortable and persistent.  There are still seemingly random moments of considerable pain which materialize and then disappear just as quickly.  All of this is probably exacerbated by the fact that I’ve stopped taking pain medications.  As I’m supposed to be off of pain meds within the next two weeks anyway and it’s difficult to concentrate at work while medicated, it seems silly to delay the inevitable.

Although I’m still depressed and grumpy, I am happy to officially be a third of the way through the first half of my projected recovery.  I’ve heard that physical therapy and beginning to walk again can be a painful experience.  Even if it’s twice as bad as I imagine, I still wish that I could fast forward eight weeks and begin the second half of my recovery, however painful.

After reading many stories of other people’s recoveries, it seems as if other people with IM rods are often able to start bearing weight on their legs much earlier than 12 weeks, so I was curious why my timeline was seemed a bit longer than some.  At my first post operative checkup  this week I was able to pose this very question to the man handing down my sentence.

In addition to reiterating the fact that the damage to my leg was more radical that the average break, my surgeon explained that a lot of work went into reconstructing my tibial plateau and that there was a real risk of compromising that repair by putting weight on my leg prematurely.  The difference between a good repair and a bad repair he said was probably the difference between having bad arthritis in my knee in the future or not.  I can’t say that I feel any better about being immobile for what amounts to 3 months, but at least I now understand the reasoning behind it.

On the brighter side of things of my incisions have been healing nicely and I was able to have most of the 103 stitches in my leg removed this week.  They were replaced with steri-strips affixed via some sort of smelly medical adhesive.  I can’t say that this had made my leg look or feel any better, but it’s a milestone of sorts and one that brings with it the prospect of not having to have my wife wrap my leg in a trash bag when taking a shower.

Physically speaking I feel a little bit better this week.  The swelling in my leg, ankle and foot continues to decrease very slowly, but it’s enough that I can’t tell the difference between this week and last.  I’m still experiencing pain, but it’s tolerable even though I’ve backed off of my pain medication substantially.  I’m doing daily exercises to improve the range of motion in both my ankle and knee.  Both joints have had a very substantial loss in flexibility unfortunately.  I’ve also been moving around on crutches more this week which has been challenging and provided a bit of exercise to boot.  Baby steps as they say…

My lower leg, ankle and foot are still quite swollen and bruised.  The leg itself is definitely very sore and now aches, particularly in the places where my tibia was broken.  While pain medication is definitely necessary to maintain comfort at this point, I have managed to reduce the amount that I’ve been taking by a third or so in the last week.  Overall my many incisions look clean and dry which I’m pleased about.  Some of the stitches have even started to itch a little bit, which while extremely annoying, is generally a good sign that my incision sites are starting to heal.

The most disconcerting part of my injury so far is the continual numbness that I have on both the top of my foot and my toes.  I am also completely unable to move my big toe in an upward direction.  Both of these issues were present in the hospital, but don’t seem to have improved much if at all over the last week.  In the hospital these problems were attributed to the swelling in my leg messing with the nerves that run to my feet.  As my swelling seems to have decreased over the last week I had been hoping to see some sort of inverse parallel where the numbness was concerned.

I’ve got an appointment with my surgeon in a few days.  It will be interesting to get a professional take on where I stand in the recovery process.

Jake McMillan’s 21st Century Boy provides a well written and humorous seven part series on his adventure with a broken tibia and fibula.

I also found Stephanie Abegg’s Recovery Trip Report to be an interesting read. She gives an almost day by day account of her battle to recover from a compound tibfib fracture and a nasty MRSA infection.

As, or if, I find other interesting sites I will certainly amend this entry.  If you should stumble across this site and have another worthwhile site to contribute, please don’t hesitate to leave a comment.

UPDATE: I found another site with a lengthy thread containing comments from many people suffering similar injuries.  Perhaps it’s my current state of mind, but overall I find the discussion on the site more depressing than uplifting where rehabilitation is concerned.  Having stated that, you can check it out at: Sports Injury Info.

Officially speaking I fractured both my tibia and fibula. Two bones for the price of one! Call it naivety or inexperience, but I have always held this romantic notion that you when you show up at the hospital with a broken limb you get an x-ray to see what’s going on, there’s a particularly painful moment where a doctor reduces your fracture and then you get a cast of some sort or another and are sent on your way with some ibuprofen. So much for that notion!

The lower leg is divided into four separate compartments. Significant enough trauma to the leg can cause bleeding, swelling and that type of thing. Unfortunately that blood and swelling can in turn raise the pressure inside of these aforementioned compartments, reducing the ability of lymphatic vessels in those compartments to drain and the blood vessels within to adequately move fresh blood to and fro. The result? Irreversible tissue damage. Muscle death. Nerve death. This nasty cocktail of symptoms is known as compartment syndrome and it became rapidly apparent that I was suffering from it.

Something about the possibility that my foot or leg were in legitimate danger of needing to be amputated makes a broken bone or two seem like a pretty minor deal in retrospect. Treatment for compartment syndrome involves having a procedure called a fasciotomy. No doubt there’s more to it, but in short a surgeon slices your limb open where needed in order to relieve the building pressure. That slice is left open to facilitate drainage.

Fast forward to my surgery. If anything positive came out of Nazi Germany, it would have to be the invention of the intramedullary rod, or so called “Küntscher nail”, which now runs the length of my tibia. My surgeon opened up a space above my knee, drilled down and then pounded that bad boy in. There are incisions both mid shin and near my ankle where they added screws that are affixed to said rod. This setup holds my broken bones in place, creates stability and provides a kind of scaffold for healing. In order to deal with the compartment syndrome, my surgeon performed a fasciotomy on either side of my lower leg running more or less from ankle to knee. These were left open and attached to a wound vacuum. Everything was wrapped in gauze and my left leg inserted into a leg brace.

My first surgery lasted about four and a half hours I’m told, and I’ll just have to take everyone’s word for it as I only regained mental faculty some nine hours after being wheeled into the operating room. Apparently I don’t wake gracefully from anesthesia! This is a fact that I would be reminded of two more times in the next seven days as I had subsequent surgeries to close the fasciotomy openings on either side of my leg.

Naturally I could write at length about my hospital experience. There are the tired topics of hospital food, uncomfortable beds and the always entertaining pain med stories. I’m not going to head down that road. All in all, I am very happy with the staff and service at the University of Utah. Literally everyone… Emergency room doctors and nurses, orthopedic trauma surgeons and residents, anasthesiologists, nurses, housekeeping staff, physical therapists and nutritionists were all top notch. Was the food world class? No. Was my hospital bed comfortable? Of course not. Did every shot or IV line feel great? Nope. Having said that, I still have my left leg and the prognosis is that I’ll be able to use it as per normal in about six months time. That’s incredible and what truly matters.

My thanks to all of the staff at the University of Utah for fixing me up. Many thanks to my friends and coworkers for their support both inside and outside of the hospital. A gigantic thanks to my family and especially my wonderful wife for keeping my spirits up, taking care of me and managing to deal with me during a difficult time.