Friday, September 3, 2010

External Fixators Anonymous

I got this comment on the blog yesterday from a fellow boarder with a bad break.
"Hey man I shattered my ankle april 14th riding in Vail. I had 2 surgeries, an Ex-Fix installed as well as a plate and 10 screws. I thought my break was the worst ever but apparently you got me beat. I was just wondering what your recovery time has been like. its been almost 5 months for me total and 3 months or so since I got the ex-fix out. I still can't bend my ankle past 90 degrees and my toes wont fully out stretch. im kinda getting concerned im goona be a 26 year old pirate myself. I've been doing the PT and all but I just cant get this damn thing to allow my foot to bend up (it goes down and side to side fairly well, although not as well as before). so my question to you is how long did it take yours to start bending naturally? and how was your overall recovery/how functional is your ankle compared to how it used to be. Please answer and be honest even if it only took your ankle a couple weeks or something. Im kinda freaking out. thanks alot man any info you could give me would be much appreciated... and yes I plan to shred again also, even if it has to be at half speed and with weak style."
First of all -- I feel your pain. Going from being active to sitting on your butt all the time is awful. It's good that you're starting physical therapy, because at least you can start doing work and celebrating minor results.

Second -- don't panic. It can be extremely difficult to see past your recovery. Keep your eye on the prize: returning to the slopes.

My recovery has basically restarted since I'm back in an external fixator. I'm not back to normal yet. Here is how it's gone up until now.
  • February 13th - Initial injury. ORIF of fibula with external fixator. One plate with eight screws. Not bearing weight. No PT.
  • March 1st - Second surgery to remove external fixator and ORIF of tibia. Second plate with 11 screws. Not bearing weight. No PT.
  • April 2nd - First physical therapy session. Therapist says, "I can't work with this ankle in the condition it's in, see me in a month."
  • April 15th - Infection discovered. Not bearing weight. No PT.
  • May 5th - Wound vacuum installed to heal the wound from the infection. Bearing 25% weight. No PT.
  • May 19th - Skin graft. Bearing 25% weight. No PT.
  • June 11th - Start Physical Therapy. Bearing 100% weight. Driving!
  • July 18th - Ankle really starts to bother me.
  • July 28th - Ankle and plates are broken. Time for more surgeries! Not bearing weight. No PT.
  • August 16th - Third surgery. Hardware removed. Second external fixator installed. Not bearing weight. No PT.

On my first visit to PT on April 2nd, I got a giant list of exercises. Check those out and make sure you're doing those. I was able to work on these until we found the infection.

It took a very long time to get the strength back in my foot. At first, it felt like a lead weight hanging from the end of my leg. I couldn't move it, and when I tried, it hurt really bad. That feeling went away after doing those exercises every day for about two weeks. I was already getting a little flexibility back, but nothing past 90.

While I was in PT from June 11th to July 28th, I was seeing small but steady results. I was constantly working at it, even when I wasn't in PT. My biggest concern, like you, was dorsiflexion.

I was eventually able to get about 10 to 11 degrees past 90 with my dorsiflexion. This was sometime around the end of July. However, my fracture never healed, and some of that could have been contributed to some bending at the fracture site. Physical therapy hurt -- bad. But again, the fracture never healed so all of that pain was due to a broken ankle.

Ask your physical therapist about a Dynasplint. I only wore mine for about a week since we discovered my ankle never healed. But I think these things work.

You might also want to look into orthopedic shoes or Skechers Shape Ups. While your flexibility is bad, these shoes will help you walk.

Finally, I'd recommend you start taking videos of your flexibility every month so you can compare the small changes.

As far as my toes go, my great toe was really my only concern. On April 2nd, I couldn't move my toes at all. There are several exercises in that list that address toe movement. I highly recommend them, because I had some movement in both directions by the time I started PT up again in June.

My physical therapist said getting the great toe to bend up is the key goal, while bending your toes down isn't as big of a deal. Right now they're starting to get stiff again, so I'm working on my great toe every day while I'm in the external fixator.

If you're fighting any swelling or edema, it's absolutely critical that you work every day on it to get rid of it.

Above all else, don't panic. This injury has been a true test of my patience. Keep working at it. As long as I can walk, bike, and put my foot into a snowboarding boot, then I consider my recovery a success.


  1. Thanks for posting this it was helpful for me as well. I didn't break my ankle snowboarding, I had a bad ankle joint from birth that has slowly become worse over time. I had to stop snowboarding about five years ago due to pain and because my ankle/foot were turning inward (pronating). I had ankle fusion surgery on June 17 this year and had the T2 Styker system nail/rod with five screws installed; an internal fixation devise. Long story short I ended up with an Enterobacter infection that showed up about two weeks after surgery. I had a wound on my heel that would not close up on it's own and ended up with a wound vacuum as well. I had that for five weeks. I had a second surgery on July 20 to clean out the deep infection in my ankle and heel and to culture. I had a PICC line installed then too. Then after seven weeks of the infection not getting any better and two abcesses on my shin over the top of one of my screws (similar to your pic with tendons and nasty stuff showing) my Dr decided to take my hardware out. So last Tuesday night I had the hardware out and then Saturday morning I had another surgery to install a bone cement rod with antibotic packages. I will have a fifth (and hopefully final) surgery in five weeks to have the bone cement rod taken out and a second bone graft added to the rod area for stability. Ugh, I don't know how you have done it for as long as you have without losing your mind :) I feel like I am on the verge everyday. I just wanted to add a few things I found helpful: knee scooters are awesome for below the knee injurys, it allows me a lot more freedom (think carrying things) than the crutches. If you need roller bottom shoes try MBT's they are expensive but so worth it if you loose flexability of movement in your ankle. If you ever decide to break down and join Facebook we have an excellent support group for Ankle injuries and ankle fusion a great group of 100 people. Thanks for your blog you are bringing laughter to a situation that is truely tough and that is a unique ability. Good luck I will continue to check in to see how you are doing. I think after reading this that if you put your mind to riding again you are just the kind of person that will.

  2. THANK YOU!!! For posting this My name is Marlene I live in Chicago. Im only 23 years old and I also have been in a External fixtature, While reading your post and reading everything you have been thrue, I literally have tears in my eyes. Its been a Journey for me, the pain and the desperation of getting better and going back to work is unbelievable. April 20th I fractured my Tibia and fibular on my left leg, I fell down wearing heals ... yes heals something so fashionable and all of us young ladies believe we can wear with ease it's actually very dangerous!! So ladies please stay off stilettos and high Wedge heals .. My story has been crazy this happened to me with just heals my doctor literally said my break was as if I fell of a two storie window, or a almost deadly car crash. Now lets not talk about all the pain medicine you have to take and after time it doesn't do much for me. But I keep my head up high and stay positive. I just truly do not wish this upon anyone. To whoever read this and is in about the same situation I say to you don't give up the good part of all this is that if the Surgery was well done you can and will walk again. I know that I will. God bless you all and be safe :')