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Dr Mark - Tib Fib Spiral Fracture - Delayed union ?

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I had a bad get off on June 16th. I dropped my Africa Twin on my foot whilst jumping off the bike as it careered off the track I was on. It took me 4 days to evacuate for an X-ray as it happened on a remote island in Indonesia..Fortunately I carry Oxicodin in my first aid kit. 

 

The x-ray showed a non displaced spiral fracture to the tibia and a broken fibula. The Indonesian orthopedic surgeon here in Bali wanted to operate but after living here for 20 years I've heard enough horror stories for me to want to avoid surgery here at all costs, if at all possible.

 

The hospital has a "consultant" OS from Germany (Western Doctors are not allowed to practice here)  who reviewed my x rays and told me the fracture in the tibia looked pretty stable, so if I was careful I could avoid an operation. This was a relief as otherwise my only option would have been to travel to Singapore for an operation there.

 

I spent 8 weeks in a below the knee fibre cast, bouncing off the walls at home. When the cast was removed my ankle was pretty frozen and when I put weight on it, the whole foot felt as if it had been run over by a truck.

 

I booked myself into PT and the physio told me the ankle had been set at the wrong angle and my achilles tendon had shortened.The mind boggles what the surgeon could have got wrong if operating on my tibia !

 

I was unable to put any weight on the foot without massive pain shooting all over my foot. It was far more painful than the area of the break and there was no way I could put any more than 25% weight on it. 

 

3 weeks ago I finally started doing more weight bearing as the achilles, tendons and ligaments starting easing up with the PT. I've been swimming and doing daily sessions on a stationary bike. I also had some massage therapy and acupuncture. The dorsiflex is still compromised by some swelling at the front of the ankle but the ankle is much freer than it was, and the pain in the foot has gone for the most part.

 

Last week I had another x-ray (12 / 13 weeks) which showed the tibia with no healing and is also losing bone density due to not having enough weight on it

 

The Indonesian surgeon told me to come back in 3 months. (!!)  I therefore decided to get a 2nd opinion from the German who instructed me into a moon boot with full weight bearing if pain allows and to come back in 6 weeks. 

 

Heres the X-ray from last week

 

Tibia-L.jpg

 

I'm now up to 90% weight bearing in the boot and the PT continues to improve the soft tissue issues I think. The area of the break is still pretty tender obviously

.

Dr Mark - I understand that tibia fractures can take a long time to get union, but how long will this take to heal ? It still looks like a pretty major fracture to me !

 

I'm 47, in fairly good shape, non smoker and eat a healthy diet. I drink beer or wine a few times a week. 

 

Your opinion and any recommendations you might have concerning my injury would be really appreciated. 

 

 

 

 

 

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I would get on with it and have if fixed by a competent person, all ready.  The bones are showing NO signs of healing.

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I would repair that wiith an a medially placed plate and screws, and immediate active motion.

Edited by DrMark

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