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DrMark,

I wanted to get your opinion since you ride and are a doctor. I broke my tibia and fibula about 4” above my ankle almost six weeks ago. They put a plate on the tib (bone was broke in 3 pieces and was dislocated) The fib was left to mend on its own.

I go on Friday and hope I will be somewhat weight bearing. I hope. Anyway I still have a pretty swollen ankle and over the fib break. I’m in a boot since they removed sutures after 10 days but I’m only ttwb. My question is about the plate. It has 9 screws with about half of them down near the ankle. Should I worry about overall bone strength if I leave the plate in the rest of my life? I’m 43 and in average shape but do enjoy jumping/wheelies etc but I’m not a hardcore Mx guy more like a trail guy that likes to get air sometimes. Is the plate a concern for kickstarting a bike or kicking a football etc? I figure this recovery will have me off of any bike for 6+ months but I get mixed answers to this. 
I would love to hear your thoughts/opinions. I realize you can’t give me actual medical advice but would like to know your thoughts on what you have seen in the past etc

 

Thanks

Jerry

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DrMark,
I wanted to get your opinion since you ride and are a doctor. I broke my tibia and fibula about 4” above my ankle almost six weeks ago. They put a plate on the tib (bone was broke in 3 pieces and was dislocated) The fib was left to mend on its own.
I go on Friday and hope I will be somewhat weight bearing. I hope. Anyway I still have a pretty swollen ankle and over the fib break. I’m in a boot since they removed sutures after 10 days but I’m only ttwb. My question is about the plate. It has 9 screws with about half of them down near the ankle. Should I worry about overall bone strength if I leave the plate in the rest of my life? I’m 43 and in average shape but do enjoy jumping/wheelies etc but I’m not a hardcore Mx guy more like a trail guy that likes to get air sometimes. Is the plate a concern for kickstarting a bike or kicking a football etc? I figure this recovery will have me off of any bike for 6+ months but I get mixed answers to this. 
I would love to hear your thoughts/opinions. I realize you can’t give me actual medical advice but would like to know your thoughts on what you have seen in the past etc
 
Thanks
Jerry



Can you post the x-ray?

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not a doctor, didn't sleep at a holiday inn, but i suspect you will want to get the plate removed eventually if it has hardware near the ankle. I have a plate in my femur that is buried under alot of muscle and tissue, so it's not a problem, but I had to have the one in my collarbone (which dr mark installed back in 2008) removed because the plate and screws being so close to the skin proved to be uncomfortable. Also mrs llama had to have the hardware out of her ankle for the same reason.

 

I don't think you will have any issues with bone strength, but you  probably will have issues with tenderness, especially when wearing moto boots, ski boots, or similar.

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13 hours ago, llamaface said:

not a doctor, didn't sleep at a holiday inn, but i suspect you will want to get the plate removed eventually if it has hardware near the ankle. I have a plate in my femur that is buried under alot of muscle and tissue, so it's not a problem, but I had to have the one in my collarbone (which dr mark installed back in 2008) removed because the plate and screws being so close to the skin proved to be uncomfortable. Also mrs llama had to have the hardware out of her ankle for the same reason.

 

I don't think you will have any issues with bone strength, but you  probably will have issues with tenderness, especially when wearing moto boots, ski boots, or similar.

I certainly appreciate the info. I’m so torn because of the rehab time if the hardware is removed down the road but I worry about the sensitivity and strength if left in. When I broke it I was sort of glad it needed surgery only because I could not handle a full cast! It’s like a claustrophobia thing I guess...having a body part trapped in something. My wife thinks I’m crazy and she’s probably right. LOL

Edited by 01DRZRIDER

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On 10/15/2019 at 8:28 PM, 01DRZRIDER said:

DrMark,

I wanted to get your opinion since you ride and are a doctor. I broke my tibia and fibula about 4” above my ankle almost six weeks ago. They put a plate on the tib (bone was broke in 3 pieces and was dislocated) The fib was left to mend on its own.

I go on Friday and hope I will be somewhat weight bearing. I hope. Anyway I still have a pretty swollen ankle and over the fib break. I’m in a boot since they removed sutures after 10 days but I’m only ttwb. My question is about the plate. It has 9 screws with about half of them down near the ankle. Should I worry about overall bone strength if I leave the plate in the rest of my life? I’m 43 and in average shape but do enjoy jumping/wheelies etc but I’m not a hardcore Mx guy more like a trail guy that likes to get air sometimes. Is the plate a concern for kickstarting a bike or kicking a football etc? I figure this recovery will have me off of any bike for 6+ months but I get mixed answers to this. 
I would love to hear your thoughts/opinions. I realize you can’t give me actual medical advice but would like to know your thoughts on what you have seen in the past etc

 

Thanks

Jerry

Check out a clinical psychiatrist for the amont of adrenalin you require. If not Im wondering if you can feel the rain come before it does. Thats alot of metal in you and you still ride. 

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2 minutes ago, Aaron Larson said:

Check out a clinical psychiatrist for the amont of adrenalin you require. If not Im wondering if you can feel the rain come before it does. Thats alot of metal in you and you still ride. 

Not an adrenaline junky. Just a mid 40 year old trying to keep up with my son!  My wife thinks I’m crazy for worrying about the plate, not for riding. Only happened almost 6 weeks ago so too early to tell if weather etc will bother me. I still have some swelling and some numbness on the top of two of my toes but it seems to be coming back. Been riding since I was 4 yrs old so basically 40 years of riding with a little down time in my thirties and this is the first time I’ve ever been hurt enough to go to a doctor. Guess the luck ran out!

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9 minutes ago, 01DRZRIDER said:

Not an adrenaline junky. Just a mid 40 year old trying to keep up with my son!  My wife thinks I’m crazy for worrying about the plate, not for riding. Only happened almost 6 weeks ago so too early to tell if weather etc will bother me. I still have some swelling and some numbness on the top of two of my toes but it seems to be coming back. Been riding since I was 4 yrs old so basically 40 years of riding with a little down time in my thirties and this is the first time I’ve ever been hurt enough to go to a doctor. Guess the luck ran out!

The left over sweeling is fine if its been getting better. More hope for the feeling to come back when pressure drops . If its took this long and still with the tramua you must be on it. Neg - ions  form on the ground before lighting storm and irritation might be barly noticeable in your toes or calf might tense up. 

 

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The tibial repair is good.  I think the ankle is unstable because of the fibula is displaced, and likely all the ligaments connecting the tibia to the fibula are torn.  In these cases I fix both and stabilize the two bones together. If you want to consult Dr. Google, look up syndesmosis.

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1 hour ago, DrMark said:

The tibial repair is good.  I think the ankle is unstable because of the fibula is displaced, and likely all the ligaments connecting the tibia to the fibula are torn.  In these cases I fix both and stabilize the two bones together. If you want to consult Dr. Google, look up syndesmosis.

Thank you DrMark. So would you leave the metal in long term? I just worry about all the screws and holes causing a weak spot during exercise, sports etc. Am I worrying too much?

i wish the fib would have been fixed too but my doc swears by fibs healing themselves which I trust him but I hope it’s healing okay. You’re probably right about torn tissue etc,,.......when it broke my foot was 90 degrees rotated to the right and I straightened it thinking I had dislocated my ankle. Thank God for adrenaline! I almost puked when I realized it was broke and not dislocated!

I should also note that these x-rays were taken right after surgery. I will have 6 week x-rays done tomorrow.
Jerry

Edited by 01DRZRIDER

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Thank you DrMark. So would you leave the metal in long term? I just worry about all the screws and holes causing a weak spot during exercise, sports etc. Am I worrying too much?
i wish the fib would have been fixed too but my doc swears by fibs healing themselves which I trust him but I hope it’s healing okay. You’re probably right about torn tissue etc,,.......when it broke my foot was 90 degrees rotated to the right and I straightened it thinking I had dislocated my ankle. Thank God for adrenaline! I almost puked when I realized it was broke and not dislocated!
I should also note that these x-rays were taken right after surgery. I will have 6 week x-rays done tomorrow.
Jerry



The fibula fracture always heals. That’s the traditional view. But by it healing crooked in a critical area the ankle instability is aggravated. And the ankle instability ALWAYS leads to arthritis and an ankle fusion. The tibial hardware is not an issue.

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10 hours ago, 01DRZRIDER said:

I certainly appreciate the info. I’m so torn because of the rehab time if the hardware is removed down the road but I worry about the sensitivity and strength if left in. 

rehab time from hardware removal is a month or so off the bike and away from sports like hockey, but you can do other normal stuff (cycling, gym) pretty much immediately.

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35 minutes ago, llamaface said:

rehab time from hardware removal is a month or so off the bike and away from sports like hockey, but you can do other normal stuff (cycling, gym) pretty much immediately.

Thanks. I figure I’ll see how I feel in 6 months to a year. I’ll talk to my doc tomorrow and explain I would prefer to be metal free at some point but we’ll see.

Jerry

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Just realized I never followed up after my dr appointment. So he okayed 50% wb for 7 days minimum and then 75% for another 7 days leading up to 100% while wearing the boot. This Friday if I was on the 7 day schedule I should be 100% wb.   I don’t think I’ll be there. I feel a fair amount of discomfort in my ankle at 75% but I think it’s mostly from the swelling and stiffness.  I go in again for PT Friday so I guess I’ll get their thoughts on this. Sure is nice to at least stand on it though!

Jerry 

Edited by 01DRZRIDER

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That's quite a gap on the Fibula break and will take some time to mend. I wonder if there might be some long term problematic type concerns with that?

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I am sure I am older than all you guys and can state accurately that arthritis is a real concern. Many don't seem to take it seriously but it does cause issues later in life. IMO it it very very important to seek out a Dr who takes Dr Marks approach. As I have said before, it is important to find out which Drs do things the right way BEFORE you need them.

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On 11/3/2019 at 12:57 PM, Piney Woods said:

I am sure I am older than all you guys and can state accurately that arthritis is a real concern. Many don't seem to take it seriously but it does cause issues later in life. IMO it it very very important to seek out a Dr who takes Dr Marks approach. As I have said before, it is important to find out which Drs do things the right way BEFORE you need them.

Thanks guys. Yeah I do worry about the gap but it looked a lot better at 6 weeks. Arthritis is a concern for me but it is what it is at this point. I started using just a cane today with the boot. Ankle joint feels like hell right now but after resting 10 minutes it’s okay. Range of motion is coming back but still not great. More PT tomorrow. I only go once a week due to my wife can only take me on Fridays but I do all the stuff they want me to do at home too.

I feel LUCKY though. A friend I work with just had back surgery this week. He fell from 20’ from a tree stand and broke his back in 3 places. He’s going to be okay but I can’t imagine that.

Jerry

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Good luck to you snd your friend. Phy therapy can be a great thing and also a terrible thing. Many PTs are just plain incompetent and cause more harm as good. Kinda hard for the layman to know though. Personally I would ask Dr Mark for some ideas concerning treatment. My wife is getting treatment for her back and her Dr recently had a rotator cuff/shoulder injury repaired. His Dr gave him three movements to do on his own and did not want him to even see a PT. Be careful!

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