A Fixator to Fix a Problem---The Final Step

After two years, I finally went through the last process in the reconstruction of my right tibia, the removal of the titanium rod that went in on April 28, 2009. After five procedures, I am finally done. In addition, my leg is better than it had been since the entire process began.

After battling pain, fighting with new orthotics every six months, and purchasing new shoes every three months, I finally found a doctor who was brave enough to help change my situation. I started the reconstruction process of my right tibia in April of 2008. I began a journey that changed my entire life, from the type of work I could perform, to changing my actual height, to buying new shoes. A journey that was supposed to take only six months, but instead lasted five weeks over two years.

In a hiking accident in 1972, I fell while crossing a rushing stream. It was not very wide, but the rushing water in May covered the rocks that lined either side of the rapidly flowing stream. When I jumped, I landed on one of those rocks. My right foot slipped in to the crevice between it and another larger rock. My foot went one way and my body when another. I can still hear and feel the bones as they broke from the fall.

It was because I had gained over 30 pounds in recent months and my bones became brittle. Along with the birth of my daughter, the extra weight gain, and the lack of daily supplements, my bones became very brittle and both the right tibia and fibula broke with what was then termed, complex-complex fracture. It seemed that my right foot was hanging from my leg.

Before anyone in the party I was hiking with could do anything, I need them to splint my leg before lifting me out of the woods and into a car for the trip to the hospital emergency room. To this day, I feel that if I had not been persistent in having them split the fracture, I may have had far more permanent damage to my lower leg.

I was in surgery for two and a half hours and when I awoke, I had a cast on up to my hip. My entire leg was enveloped in plaster. When the doctor came to see me the next day, he asked me what I had been doing to create such a mess in my leg. I remained in the hospital for two weeks. I remained in the cast for six months. When it finally came off, my right leg was 2 centimeters shorter than my left, and my knee was turned somewhat to the outside. I had no calf and my lower right leg was skinner than my left calf. This was how I remained until the surgery on April 10, 2008.

Over the next 36 years, because I worked in tropical greenhouses on concrete floors, raised Siberian Huskies, and held a very active life style, my right knee and ankle began wearing down slowly. I decided to go back in to a healthier life style as soon as I was able to function regularly again. I began exercising daily, running two miles a day for many years (I ran two miles a day until I was six months pregnant with my son ten years after the birth of my daughter). I lost the weight, regained my strength, and dealt with the pain in my leg as best as I could--usually by ignoring it.

The years of activity took its toll, and by 2007, I was in extreme pain. My right knee was inflamed and swollen to four times its size for almost 15 years and my right ankle to two times its size. I was always turning that right ankle severely, and on several occasions had to use crutches to stay off the foot for days at a time. I was at my wits end to try to get help. I had gone to many doctors through the years, all ending with, "I'm sorry, I just can't help you any more."

Finally, in May of 2007, my primary physician (bless her heart) recommended me to two new doctors who had just opened a practice in my town. They were young and eager spots doctors. I made an appointment with one, and after meeting with him, he then told me there was nothing he could do the help my situation. I was devastated. I asked to have an M.R.I. done of my right knee and had the results sent to the doctor. When I went to the next appointment, he told me that his partner had seen the results and would like to meet with me. I went the next again on the next day, and this doctor said he could help me! He explained the procedure. I was overwhelmed but very excited. Then on April 10, 2008, I went in to the hospital to change my life.

The process involved cutting both the tibia and fibula and inserting an external fixator in to the top and bottom of the tibia to hold them apart by a distance of 2 centimeters, and cutting the fibula to remove the overlapped growth and left apart. The fixator also turned the tibia to its neutral position, which put my knee back in to place and took the pressure off my ankle. I wore the thing for almost a full year (one week shy, to be precise). I went to this doctor on a regular basis to take x-rays to see how the process of bone growth was going. They were not very illuminating. In January of 2009, because he could not see any discernable new growth, this doctor turned my case over to another orthopedic surgeon, who would finish with me.

He removed the fixator two days after my first visit. That surgery was a breeze.

To wake up with no more rods protruding in my leg was almost blissful. I stayed in the hospital over night and went home with a PICC line inserted in to my upper left arm. (See Another Step in the Reconstruction Process.) I had to give myself one hour of IV drip antibiotics twice daily for one month to prevent infection in the bone before we could move on to the nest step.

The tibia was still not fussed. The gap between the top and bottom had new bone. This was not visible in the x-ray while the fixator was in place. Because the first doctor had not set the precise parameters for the fixator to place it in the exact location of its neutral position, it moved the tibia four degrees too far to the left and three degrees to the front. The next step, one month later on April 28, 2009, was to insert a titanium rod in to the tibia and secure it with four steel screws. This would help straighten the tibia and move it to the right a few millimeters and back the same amount. That procedure was a nightmare. I woke with sever pain in my throat and upper chest. The procedure went well, but it seemed the anesthesiologist had difficult intubating me (placing the breathing tube in my throat to insure the air passage remains open) and inserted it into my esophagus the first time. That caused sever pain that lasted sever days. I remained in the hospital for two nights.

Going home with a cast from my foot to my upper thigh took a bit of getting used to. I did not leave the house for two weeks, until my next appointment. That cast came off and one to just below my knee went on. First, it was green. Six weeks later after x-rays, it was blue, and then six weeks later, it was purple. I wore a cast for three months total after the removal of the fixator. When the cast came off for good on July 25, 2009, I could walk very well with only one crutch. A few weeks after that, I went to a cane, and soon I was walking with no assistance. My bone was filled in with two centimeters of new growth and completely fussed together. What seemed most impossible to me before beginning the procedure, actually happened even though it took a bit longer than first expected.

I began to become more active all through the procedure, beginning with the fixator. I began walking on crutches daily along my road, to build up strength while the fixator was on my leg. After ever surgery, I would start exercising as soon as the pain would subside enough to allow me movement. I had a lot of pain in my foot and ankle while the rod and screw were in the leg. I was in pain constantly unless I was sitting with my leg elevated. That did not stop me from moving and doing some of the things I loved to so. My outside perennial beds were neglected for two summers, and now I could attack them with a vengeance. I began walking my Huskies, one dog at a time, almost every day, and did my exercise routine without failure. This included the foot exercises designed to get back its flexibility. I went to physical therapy three times a week, then twice a week, then once a week until March of this year. The vigorous stretching and flexing of the foot every day helped to get back regular movement. I had the four screws removed as an outpatient procedure in January of 2010. This alleviated the pain in my toes and upper foot while I walked. That was exciting.

Once the cast came off for the last time, I needed to have an orthotic made that would help to put my ankle and foot in the neutral position. The first doctor's measurements were off a bit and the bone healed to the inside by four degrees and to the front by three degrees. This is not very much, but it makes the ankle and foot look out of balance. Thus, the orthotic help to make everything work together in a much smoother motion.

In March of 2010, I began noticing that when I had my slippers on with no insert, I had less pain in my foot while I walked. When I studied my leg in the mirror and as I took a step forward, I noticed my foot was working normally with no pain at all. I made a small insert to place beneath my heel to help turn my ankle to the outside, but after a while, my foot and ankle would begin to hurt. I removed the insert and began walking with out insert in my shoe, and my foot felt the bestit had in 37 years. It seems that the tibia turned my ankle and foot back into the neutral position over time. I know no longer wear any kind of an insert other than those that come in the shoe.

On April 27, 2010, I went in to the hospital for the final procedure of the removal of the titanium rod. This was an outpatient surgery that took 30 minutes. I awoke with no pain in my foot or ankle--just a very sore kneecap where the incision was for the removal of the rod. By 11:30 A.M., I was at home in my bed sleeping off the anesthetic.

It has been one week since the surgery and my knee is becoming more and more flexible. I can walk more comfortably in a natural stride. I still have a lot of pain at night and take pain medication so I can sleep. I awake with little pain, ready for a full day of activity. I am avoiding weeding and working in the perennial beds until the stitches come out on May 11. I have gone too far to allow infection to set in by doing something not totally necessary.

This has been a life-changing experience for me, and because the angle of the lower leg is off, I am considered disabled because the range of motion in my foot is limited and I am not able to work on my feet as I once did. I do not mind as I now have a new career doing transcriptions of audio files in my home. I finally have the sit-down, air-conditioned job I have been dreaming about for the past five years!

This article is how I over came some demanding odds that would change my life for the better. Even though they were not necessarily life threatening, the procedure demanded my full attention and a lot of hard, painful work. With the help of my spouse, a great team of doctors, and a fantastic physical therapist (who never once yelled at me!) I was able to get back on my feet. With a lot of persistence, dedication, and support, I did it!