Snowboarder vs. Healing

We just received the radiology report in the mail last night. It was short and to the point.

A comminuted fracture of the distal tibial metaphysis was noted. The fracture extended into the ankle mortise. The fractured segments were in anatomical alignment. Moderate sclerosis was seen around the fractured segments. Some bridging callus formation was noted as well. Multiple old screw tunnels were detected in this area. Moderate narrowing of the anterior and lateral margins of the ankle mortise was seen. Subchondral sclerosis and cystic degenerative changes were seen in this narrowed region of the ankle mortise.

Impression:

1. Status post comminuted fracture of the distal tibial metaphysis with evidence for post internal fixation. Anatomical alignment noted.
2. Incomplete bony union noted.
3. Moderate apparent traumatic arthritis involving the anterior and lateral margins of the ankle mortise.

What does this all mean? Time to Google it up!

Distal Tibial Metaphysis

Distal is the bottom part of the bone. Tibial is my tibia bone (the big one). And metaphysis is the wider portion of a long bone between the hollow part and the end (the epiphyse). The fracture described in the report starts around the bone graft from my pelvis and extends into the surface of the joint (the mortise).

Incomplete Bony Union

This means my ankle bones are really good at healing. And by really good, I mean terrible.

Subchondral Sclerosis and Cystic Degenerative Changes

Subchondral bone is the layer of bone just below the cartilage. With osteoarthritis, there is increased blood flow and other changes that develop in the subchondral layer -- including subchondral sclerosis, subchondral cyst formation, and increased pressure within the bone -- all of which contribute to osteoarthritis pain.

Subchondral sclerosis is defined as increased bone density or thickening in the subchondral layer. This often occurs with progressive osteoarthritis and shows up on x-rays as abnormally white (dense) bone along the joint line.

Next Steps

Now that I've got my CT scan and report, I will schedule appointments with other orthopedic surgeons in the area. I'm worried that I'm at a higher risk of a failed ankle arthodesis (fusion) because of the multiple non-unions I've already suffered. I suspect all of the non-unions were caused, in part, from the infection I had last year.

We'll keep you all updated!

Swiss Cheese Ankle

Dudes, what's happening? You're still on the Internet? Nice! My bad on not updating this blog. Turns out I wanted to act like I didn't have an ankle problem, so I stopped updating. If I'm not spending time on the computer, I'm out using the crap out of my ankle and enjoying having two working legs.

I finished physical therapy in March. While it was painful, I finished with more than 10 degrees of dorsiflexion and I could walk without a cane. While my activity level increased a little bit, the pain in my ankle has gotten worse, a little bit at a time, day by day. I rock the house cane on a daily basis. I have no dorsiflexion in my ankle. There are 78 year-olds out there that could dominate me at an Ankle-Off.

Last Wednesday, I finally decided to see Dr. Buchanan. I went into the visit with two ideas: 1) ankle arthrodesis (fusion), or 2) amputation (below the knee). The pain has been that bad, even with 800mg of Ibuprofen every 8 hours.

The X-Rays didn't reveal too much. They suggested I had bad arthritis in the ankle joint. Dr. Buchanan suggested ankle fusion with an arthroscopic procedure. He'd like to put in three screws to fuse the joint and fill the gaps with some bone and marrow from my pelvis or shin. I'd lose a few millimeters in the length of my leg, but it wouldn't be too noticeable. I'd have about a year recovery.

Dr. Buchanan was absolutely against amputation. He said 100 out of 100 orthopedic surgeons would not recommend it for me.

I plan on seeing a few other surgeons to get some other opinions.

This morning I had a CT scan. I wasn't sure what the ankle would look like. I'm no radiologist, but from my sweet Googling skills, I think I've got a case of osteochondral lesions -- possibly cystic. The CT scan videos are below. Notice the massive amount of Swiss cheese forming at the join. Those are possibly lesions or cysts.

I'm not sure how these lesions are treated. I don't know what it means for whether or not I'm a candidate for fusion.

Seriously, cut this thing off.

The Memorial

A friend of mine was visiting Breckenridge last week to go skiing with some buddies. We thought it would be awesome if he stopped by the tree I hit to deliver a special payload: some of my broken ankle hardware from my fibula.

He hand crafted a laminated memorial and found the tree using the Google map I made in one of my first posts to this blog. I was worried that the tree I had marked on the map wasn't the right one, but as soon as I saw these pictures, I recognized the beast that destroyed my right leg.

Friends, family, meet the Tree of Death.

This is one of the snowboarders on my friend's trip, reacting my accident. This is exactly how it happened.

Here's the memorial. My friend's story follows. With exception to his zings and snowboarder-hating, the story is pretty awesome.

Here's how the day went down. It was our first day of skiing in Colorado, after having arrived on Wed. night. Our plan was to hit Breck on Thurs, Vail on Friday, and Copper on Sat. (Vail, btw, was absolutely epic. We received 8 inches of fresh snow Thurs night and the Eisenhower tunnel was closed Fri morning (thus preventing visitors from Denver) and on top of that, we were joined by a Vail guide that one of us happened to be friends with ... Ok, I digress. I'll cease the bragging since you had to sit this season out).

So Thursday at Breck it was myself, two other skiers, and a boarder (I know, I thought the same thing: snowboarding... weak, right?). I had briefed them on your situation and each of them had spent an hour or so catching up on your blog. I let them know that I had some authentic ankle hardware from the accident and they were pumped to memorialize the murder tree along with me. Starting from the Peak 7 gondola, we headed over to Peak 8 where we proceeded to dominate the summit from the Imperial Express Chair -- thousands of feet above the tree line. The visibility was pretty terrible so we headed over to Peak 9, which you may better recognize as "Pain Peak".

At this time you and I were corresponding via email while I was on the lift. Your recollection was that the incident occurred somewhere near the Mercury Superchair near Lower American... a GREEN CIRCLE, as you may recall ... SA-WEET! (Ok in your defense, you can really carry a head of steam bombing down from the upper runs: American, Columbia, or Bonanza).

The first run down we scoped out potential incident locations. While many of the tree clusters looked quite menacing on this nearly flat run (zing!), most of them had trail markings or other signage near them, which you had not mentioned. Our next run down we focused in on just a few likely candidates. My friend turned on his GPS and fired up the Google Map from your blog. This allowed us to see our location in real time as we honed in on your suspect.

We found a sinister looking tree nearly directly where you had identified on your map. To both its left and its right stood dense tree clusters, but this angry bastard stood alone. It coincided almost perfectly with your marker on the map. It was time for vengeance (or, at the very least, some public shaming of the tree).

Before I left for Colorado, I printed out a pic of one of your xrays, to which I attached the ankle hardware. I did my best to protect it with some "lamination", although as you can see in the pics, attaching tiny hardware to a luggage-crumpled piece of paper in the back of a minivan winding through slippery mountain roads is not nearly as easy as it sounds. I managed to drive a couple nails through it into the tree and bent them over to secure the notice, like a staple. An off duty ski patrol dude happened to come by, curious as to what we were doing. We gave him the abbreviated version of the story and explanation of the sign. He nodded his approval and skied off with the standard ski-bum farewell: "Gnarly!" (Seriously, I can't make this stuff up -- people really still say that out there).

Below are a few pics of the memorial. I tweaked the name of the tree to be "Tree of Pain" instead of "Death" since, well, people actually do die running into trees and I didn't want to come back to the tree and find it adorned with wreaths and candles. We also took the time to shoot a brief re-enactment of the event (too soon?). There on the Tree of Pain shall the memorial stand for all eternity -- or until the next tree-hugging hippie or stiff breeze comes along and rips it off.

One Beer Anniversary

The anniversary of the accident is coming up in a few days, and our awesome friends Eric and Mandy Marshall sent us a sweet package. Eric, as I've mentioned on this blog before, has every man's dream job: running a brewery. His company, Marshall Brewing Co., makes some delicious beer, and they were kind enough to send us a ton of it for the one year accident anniversary. It even came with a Belgian-style IPA he did with another Oklahoma brewery, Choc Beer Co.

What did I get? From left to right:

• No label -- must be a secret beer.
• Sundown Wheat
• Atlas Indian Pale Ale
• Old Pavilion Pilsner
• McNellie's Pub Ale (only served at McNellie's in Oklahoma)
• Sundown Wheat
• Old Pavilion Pilsner
• El CuCuy Indian-Style Black Ale
• Big Jamoke Porter
• El CuCuy Indian-Style Black Ale
• Wild Brew Belgian-Style IPA (collaboration between Marshall and Choc)

This is exactly what I needed to celebrate. Thanks, Eric and Mandy!

Ankle X-Rays

My last set of X-Rays were taken on January 19th. The ankle doesn't look too different from the last set of images.

I leaned a bit forward for this X-Ray to see what the joint looked like with a bit of dorsiflexion. There isn't a whole bunch of room in there.

That giant crevasse in my tibia is gnarly, but surprisingly I have no pain there.

It Happens

It happens to everyone with a blog -- you eventually stop doing it.

I've had several people complain about the lack of updates. I've been working, doing physical therapy, and going to the gym quite a bit. My bad.

My ankle progress has been absolutely awesome. I just got back from physical therapy. We took a measurement of my dorsiflexion -- I'm at 11 degrees! My goal was 10, now I think 15 is in reach. It's great to see this progress. When we started, my physical therapist didn't think we'd get to 5 degrees. My big toe still needs some work to help reduce my limp.

I've been walking quite a bit. I don't use a cane that often. I'm still having pain issues and edema, but I can manage it with rest, ice packs and Aleve.

My last doctor's appointment is next Wednesday. It'll be a bittersweet end. We love the people there, but I think both Brooke and I are done with doctor's visits.

I'll continue doing physical therapy as long as I have more gains to make. I need to make a video of my ankle to compare the motion now to what it was 6 weeks ago.

New X-Rays

Yesterday we saw Dr. Buchanan for our four week check-up. The x-rays looked great!

This is the first time I've seen my ankle without the bones covered with screws, metal plates, or an external fixator. You can see that the fibula has healed hilariously, and I have tons of large cracks in the tibia.

Notice the "C" formation of bone on the fibula?

There's a relatively large crack in the back of the tibia, but it's all fused together -- finally!

Physical therapy is going well. I started out with no dorsiflexion four weeks ago. Now, I have about 5 degrees of dorsiflexion. I'll need about 5 to 10 more degrees to walk without a limp. I plan on getting that back.

I'm taking a prescription anti-inflammatory to help with the stress on my foot joints. Most of my pain is coming from the foot. The ankle is holding up very nicely.

All in all, things are going great!