The update on the tib/fib fracture

Well, we meet again. Most of you, if not all of you, follow me on social media so you know what's been going on in my life. However, this update, this post, it's for me. It's about my leg.

Bare with me if you've heard this or know this information. Feel free to skip. In September, I was on a motorcycle trip on antique motorcycles. This specific trip was from Sault Ste Marie Michigan (so pretty much Canada) all the way to the east coast and then down to South Padre Islands, TX. Anyway, I didn't get far and I was in an accident. If you want to read all about it and my reaction to the whole accident here is the link to the other blog that I wrote it in. Blog about accident

It was a small town and it was traffic-y. I was driving behind a U-Haul; the light was green. I wasn't going fast, and I wasn't following behind the truck closely by any means. However, apparently the light turned yellow (per the driver of the U-Haul) and they slammed on their brakes. I slammed on mine, I wasn't able to make it in time, I tried to avoid it by swerving to the right, but still hit the U-Haul. Ended up having a left open compound fracture of the tibia and fibula and needing surgery. A rod and screws were placed.

Complications I have had since have been what to me seem significant.

My wounds had a lot of output - but for how much I was on my leg, Mike (stepdad) discussed with an orthopedic colleague, that was normal. Eventually, did get on antibiotics in case of infection due to the look of the wounds.
Numbness in my foot. I have significant numbness in my toes and the balls of my foot. However, currently I do feel like it has slightly improved. It's a very weird feeling. It feels like my foot is swollen. If I step on something it takes longer to feel it - but it's more sensitive so hurts more, once I do feel it
Pain. Now the pain goes with a lot of things. My pain and were and what type it is changes throughout the day. I was in a walking boot for a long time, having bone pain. So every time I took a step I had this achey intense 5 or 6 out of 10 pain.

In November they started me on a bone stimulator. It delivers ultrasonic or pulsed electromagnet waves into your leg to hopefully stimulate bone growth. It doesn't feel like anything. Sometimes I feel a little twinge of a muscle spasm or something. I wear it for 30 minutes a day.
I started taking bone strength vitamins.
I have also been working with physical therapy
Around December I started feeling like I was having muscle pain - which was a good thing. My muscles were starting to attach to the bone again. Had knee pain from compensating and walking on my right leg more. Got that fixed/worked out, had some half muscle pain.
Continue to have tenderness at the area of the fracture if I or someone else presses on it.

With the muscles needing to grow back and having the nerve pain - this all happens because the ends of broken bones are often sharp and can cut or tear surrounding muscle, nerves or blood vessels.

It is now (I almost said January) February and I am still having significant pain. We (my physical therapy guy) got the pain down to a 3-4/10 which beat the 4-6/10 range. I still can't "walk normal" due to pain. Whether it's ankle pain, muscle pain, knee pain or having some bone pain. My X-Rays show that my tibia is not growing together. By now it should be grown together.

My orthopedic sent me to a trauma orthopedic surgeon to take a look into my case. From my understanding it seemed like there was a possibility of removing the bottom screws by my ankle to allow the bones to come together better and grow.

Anyway, at my appointment my surgeon and had a long discussion about what should be happening and what we want to see happen. After listening to my options of what we could do to get to the end of recovery, we decided to go forward with another surgery. Somehow, this didn't even cross my mind as an option. But after listening to the surgeon, it seems like the most appropriate.

This surgery. I'm not sure what it is called to be honest, I do know what is going to happen. They will take pieces of bone graft from my iliac crest (in my hip) [I just had the best idea - think maybe I can convince them to takeout some fat while they are at it?!?!?] and put it in the part of my tibia that is not growing together. Essentially, it will stimulate my body to think my bone is broken again, to make it grow more bone and fix my fracture. They will put a plate over this area as well. While in there, they are going to look at my bottom screws (in my ankle), it appears that the screws at possibly going into the fibula which would be causing some stiffness in my ankle.

So -- me being me, I started researching the surgery, but I found more information on the initial fracture and such. Naturally, I am going to give you this information.

Up to 60% of high energy open tibial fractures will fail to heal by 20 weeks

Bone graft: supposed to "jump start" the healing process. Provides a scaffold on which new bone may grow. Provides fresh bone cells and the naturally occurring chemicals the body needs for the bone healing. https://orthoinfo.aaos.org/en/diseases--conditions/nonunions/

Open fractures treated with external fixations - delayed union is so common that some almost always plan early elective bone grafting at 2-3 weeks post injury. ( I had internal fixation)

As soon was soft tissue envelope is closed and non-infected, bone grafting may be considered

Some recommend bone grafting 5-7 days after debridement, but others argue that early bone grafting may result in resorption of the graft and/or increase in the rate of infection

A study was done with 30 patients that had a high-energy fracture and had bone grafting done. 19 out of 30 of the fractures were treated with bone grafts within six months of the initial injury and 11 out of 30 were grafted after established nonunion . 29 out of 30 obtained union which is 97%! Unfortunatey graft healing ranged from 3-12 months (https://pubmed.ncbi.nlm.nih.gov/2295176/)

So really, what is a nonunion fracture and why did this happen to me?

Nonunions -- when a broken bone fails to heal

Risk factors : (for me)

possibly anti-inflammatory meds (ibuprofen) that I was taking for pain
A complicated break that is open or compound
bones need blood supply to heal. Tibia bones have a moderate blood supply, but an injury can disrupt it. The example the website used: a high-energy injury can damage the skin and muscle over the bone and destroy the external blood supply. It can also destroy the internal blood supply found in the marrow at the center of the bone

Resources: But I'm not doing it the right way - sorry not sorry

https://orthoinfo.aaos.org/en/diseases--conditions/nonunions/

https://www.frontiersin.org/articles/10.3389/fsurg.2021.754150/full#T2'

I get asked a lot

Something that I get asked, people wonder and talk to me about is how have I not totally lost it?

This month it will be 5 months since my accident and surgery. When I talk about my recovery it usually is something along the lines of "well, it's getting there". Truthfully, I expected to be up and moving no problem by now.

I go into my appointments and I think other people see my frustration more than I notice it. I don't typically allow myself to think about how long it's been, or to dwell on it because I know it causes anger, discouragement, and frustration. Honestly, what can I really do about it? I'm still plugging away at physical therapy and doing my bone stimulator daily.

When I do think about it, I get a mix of emotions. I get sad, angry, frustrated, discouraged, anxious, uncertain, unmotivated, upset, and powerless. Thats a lot of feelings to be feeling.

I'm over feeling pain every time I take a step. I'm over being restricted on my activities. I'm over being tired from my body fighting to fix itself. I'm over the feeling of I'm getting somewhere and see a light, and having it taken back because I then have more pain. The ups and downs is exhausting. Sometimes I feel good - my leg feels good - and sometimes I can barely put weight on it. It goes back and forth so frequently it's extremely unsettling. Is there an end to this pain and discomfort? I can handle my pain pretty well - I've had to be told multiple times that "Brianna, this was a traumatic break".

When I think about it having been 5 months of this, that exhausts me - hence why I try not to. Now looking forward and knowing I will have 6-8 weeks of recovery after this next surgery - not the biggest fan of that. Will I be at square one? Was all this hard work worthless?

I'll get through it - I always do. But today was a little tougher than the rest.