I wasn't on drugs in this picture. And by "wasn't," I mean "was."
On February 13th, 2010, I was on my fourth and last day of snowboarding in beautiful Breckenridge, Colorado. On my second solo run of the morning, just as it started to snow, I hit a tree at about 40 MPH. While rocking a pretty amazing mustache.
In our sudden but fierce match, the tree won. Handily. Tree, 1. Snowboarder, 0. Little did my wife and I know that this accident would change our lives forever.
How To Snowboard Into A Tree, Expertly
The accident was entirely my fault. I had dedicated the day to practicing my switch stance. I've been snowboarding for over 15 years. And up until this accident, I considered myself an expert. How many expert snowboarders do you know that have nailed an unmoving and plainly visible tree? Yeah, me neither.
So how did I manage to snowboard into a tree? I was avoiding a collision with another skier. She had taken a line to my right but unexpectedly darted left in front of me only a few feet away. I quickly cut to my left. I had spotted the tree earlier and knew I had enough room to maneuver around it to the left.
But there were two problems.
The first problem: I was riding switch. Because I was riding backwards, my control was off. I couldn't make tight and sudden turns -- especially to my left. And I had just made a split second decision to cut left.
My cut wasn't cutting. My momentum continued to carry me toward the tree. That was my second problem. I was still fire-balling it down hill. With the tree at about 25 feet away, impact seemed likely.
In another split second and possibly life-saving decision, I immediately sat on my butt to greet the tree with the bottom of my board. Even with a helmet, I wasn't going to survive a direct hit standing up. Also, I need to protect my rugged yet beautiful face.
I went from a bullet to a complete stop using only the bottom of my right foot. I was covered in a cloud of tree bark. And now my foot, still in my boot, dangled from my leg. Autopilot engaged. No more split second decisions. Just instincts.
My brain pumped my lungs full of air. I started belting out enormously cries for help. I remember how it took me by surprise. It sounded really loud and fearful.
Amazingly, a skier behind me, who happened to be a doctor, came to my aide. He'd seen the entire event unfold.
Autopilot disengaged. I asked for a scarf. My foot and ankle felt wet. Because I couldn't see into the boot, I feared I was bleeding and wanted to place a tourniquet on my leg. Then I asked for a cell phone so I could call my wife. Unfortunately, I couldn't reach her because we were too high up on the mountain.
Soon, Ski Patrol showed up. I was in the emergency room at the base of the mountain about 30 minutes after hitting the tree.
But there were two problems.
The first problem: I was riding switch. Because I was riding backwards, my control was off. I couldn't make tight and sudden turns -- especially to my left. And I had just made a split second decision to cut left.
Google Map of the Accident.
In another split second and possibly life-saving decision, I immediately sat on my butt to greet the tree with the bottom of my board. Even with a helmet, I wasn't going to survive a direct hit standing up. Also, I need to protect my rugged yet beautiful face.
I went from a bullet to a complete stop using only the bottom of my right foot. I was covered in a cloud of tree bark. And now my foot, still in my boot, dangled from my leg. Autopilot engaged. No more split second decisions. Just instincts.
My brain pumped my lungs full of air. I started belting out enormously cries for help. I remember how it took me by surprise. It sounded really loud and fearful.
Amazingly, a skier behind me, who happened to be a doctor, came to my aide. He'd seen the entire event unfold.
Autopilot disengaged. I asked for a scarf. My foot and ankle felt wet. Because I couldn't see into the boot, I feared I was bleeding and wanted to place a tourniquet on my leg. Then I asked for a cell phone so I could call my wife. Unfortunately, I couldn't reach her because we were too high up on the mountain.
Soon, Ski Patrol showed up. I was in the emergency room at the base of the mountain about 30 minutes after hitting the tree.
The Injury
The accident resulted in what is referred to as a pilon fracture. The impact instantly snapped my fibula in half and turned my tibia, the weight bearing bone in your leg, into a million pieces at the surface of my ankle joint. My foot was compressed two inches up into my leg. Since it was a complete break, I also hit the the tree with the top of my shin, just below the knee.
Fibula.
Tibia.
I suffered severe nerve damage which resulted in the loss of feeling in most of my foot and toes. This is why it felt wet and bloody so suddenly.
Gross.
Here's a picture taken just after my first surgery. The giant red blister on the ankle is a fracture blister. You'll also notice the pen mark on the top of my foot. This is was the only spot where a pulse could be found.
Let's Salvage The Ankle
We spent the first three years trying to salvage my ankle. My first surgery took place a few hours after my accident. I had an open reduction and internal fixation (ORIF) of the fibula. An external fixator was put on my leg to stabilize the tibia fracture until I returned to Washington, D.C.
My surgeon in Frisco, Colorado was Dr. Peter Janes. He also happens to be an avid snowboarder. Dr. Janes referred us to Dr. Matthew Buchanan at the Orthopedic Foot and Ankle Center in Arlington, VA.
Dr. Janes and The Expert Snowboarder
My surgeon in Frisco, Colorado was Dr. Peter Janes. He also happens to be an avid snowboarder. Dr. Janes referred us to Dr. Matthew Buchanan at the Orthopedic Foot and Ankle Center in Arlington, VA.
Where'd that sweet attitude go?
Surgery number two was on March 1st, 2010. We had to wait several weeks for the swelling to quite down. We removed the external fixator and had another ORIF of my tibia. As you can see from my the look on my mug, the second surgery hurt.
After surgery #2.
This is the result of two surgeries to fixate both fractures. I ended up with two plates and nineteen screws.
Infected!
Unfortunately, several weeks after my surgery, we discovered a large hole in my second incision. It burrowed about 2cm into my ankle, dangerously close to the newly installed hardware. We ran cultures and discovered I had an infection.
Wound vacuum.
After several weeks of treating the wound, we decided it would not heal on its own. My doctors decided I needed a wound vacuum to help the wound close up. I wore the wound vacuum for about three weeks. At this point I'm still not bearing weight on my ankle.
New skin.
Once the wound vacuum treatment was over, we had a skin transplant to close up the remaining wound. This transplant was called an Apligraf. It's grown in a petri dish from donated cells. Where did the cells come from? A baby's penis foreskin.
Yep.
After the wound healed, I was permitted to bear 100% of my weight and begin physical therapy. Six weeks later, I had a follow-up appointment with Dr. Buchanan to see how things were going. As it turned out, not very well.
Recovery Failure.
Here are two X-Rays that show a nonunion of both my fibula and tibia fractures. My ankle alignment was totally messed up. The fibula plate broke in half and three or four of the screws in my tibia plate broke in half.
We regret to inform you that your attempt at a full recovery has been denied. Please try again.
I had my third surgery on August 16th, 2010 with Dr. Buchanan. The plan was to remove as much of the hardware from my ankle as possible, take bone from my iliac crest and implant it into my tibia fracture, and install a second external fixator to hold everything in place.
Here's one of the pictures of my new external fixator. The third surgery went well. I was in the hospital for three days to make sure cultures from my bone biopsies were negative.
Nice bruise.
The iliac crest bone removal ended up bleeding massively, giving me this wonderful bruise that covered my entire left side. An extremely large piece of bone was removed from my pelvis and inserted into my ankle.
For those of you keeping track at home, that's one penis and one pelvis in the ankle.
For those of you keeping track at home, that's one penis and one pelvis in the ankle.
The removed hardware.
Here are a few pictures of the hardware removed from my ankle and smuggled out of the hospital. Several broken screw ends were left behind since they couldn't be extracted without taking more bone out. A friend of mine stapled the hardware to the tree.
I hung out with the second external fixator until November 2010. Originally, the plan was to go under general anesthetic to remove it, but I thought it would make for a sweet video if we removed it while I was awake.
After removing the fixator, I went through several months of physical therapy. Things seemed to be getting better.
Unfortunately, around April 2011, my ankle started to get worse. Day by day, the pain increased. I started using a cane. The pain got bad enough that I went back to see my surgeon in June 2011. I got a CT scan and discovered that I had an incomplete bony union of the fractures, severe arthritis, and degenerative cysts and sclerosis of the bones.
Suuuweeet.
My swiss cheese tibia and talus (both were full of arthritic cysts).
So we decided to perform an ankle distraction arthroplasty on my ankle to see if we could get any improvements in my severe ankle arthritis. The third external fixator pulled the joint apart to relieve the pressure and promote cartilage growth.
My ankle distraction treatment.
For another three months (the standard ex-fix timeline), I was able to walk on my third ex-fix and unlock it to move my ankle.
Almost no cartilage is left in my ankle.
The third ex-fix was removed on November 3rd, 2011. Immediately my pain was alleviated. I no longer walked around on a bone-grinding joint. But over time, as before, the arthritis returned. I started walking with a cane more frequently.
Amputation
By January 2013, I was done. Each day was a challenge. I had severe bouts of back pain because my gait was asymmetrical It was time to abandon any attempt to salvage the leg. What good is a salvaged leg if it doesn't let me do anything?
My single goal is to return to the sport I love. Both my wife and I believe our best option is to electively amputate my right leg below the knee. I want to be able to run, walk, and stand without being bed ridden the following day.
So that covers the last three years of the recovery. I'm really excited about the future. I'll be updating the blog regularly as we recover from the June 14th amputation.
