In the spirit of procrastination I've been trying to figure out what happened to my legs. I have an impact injury (about 5 years ago now) and screws and plates and so on and so forth.

I think I've figured that I have a talus/calcaneous fusion of my right foot like this:



And... I think I had ALL my midfoot bones dislocated so that either they (or my metatarsals) were angled off (severely) to the left. So... Even though my ankle was forced straight with the fusion my foot looked like it was angled off to the left.

Though maybe the dislocation was between the talus and the midbones (so back one joint more towards my heel).. Maybe it was there and from that joint on my whole foot was angled off to the left. That fits the location of my bump better (it is still there). Apparently they couldn't pop it in properly because they were more worried about disrupting the calcaneous (which shattered into at least 4 pieces).

Had an ex fix on the foot to try and hold the calcaneous straight with the leg bones.

My left leg got fixed like this:



They aren't my x-rays - but the closest I could find online (that match the scars and bumps I can feel from screws).

Does anyone have injuries like this?

They told me to expect traumatic arthritus (like degenerative arthritus) and plan for a wheelchair later in life. I'm not sure how much I should be careful with them (e.g., not play tennis, not go out jumping around dancing) incase I'm hurting / stressing the bones. Or how much I should do that to harden them by impact and also to strengthen the muscles / ligaments / tendons.

I'm also not sure how much I'm limited by the screws and plates (only one screw has been taken out - the long angled one in the last pic - 'cause I kept shaving over the bump in the skin making it bleed). So I physically CAN'T move my feet in certain ways (e.g., because of the fusion) and how much I could do if I strengthened the muscles etc.

They said they wouldn't take the plates / screws out because it would risk complication if the bones got infected so they would just leave them in. But... They shouldn't do that - should they? If they take the screw out that is fusing the calcaneous / talar then I'll regain some side to side movement in my right foot - won't I?

Sorry... I know this is a mental health forum... Please can someone help?

I'm sorry I'm not so clear...

Here is some foot anatomy:



so... my talus is fused to my calcaneus (right foot)
and there as a major dislocation... not sure where. maybe the navicular and cuboid were dislocated off to the left of the talus... or maybe the cunieforms were dislocated... or maybe the metatarsals...

With my left foot...

The surgical cut extends quite low... extends from fairly high up the leg to along the calcanus and cuboid... i'm not sure that the plate extends all that way... but maybe there is some fusion there too...

:-(

Has anyone heard of them leaving in screws and plates for strength? I mean... They told me I'd never walk without crutches and I can... But can I only walk in virtue of the strength provided by the fusion screws and plates etc? Or... If they remove the screws and plates (they said they wouldn't because of possible risk of infection) then will I regain movement from my (currently) fused bones???

I mean.. My right foot won't move side to side because of the talus calcaneus fusion. And my left foot won't really move up and down because of the fibula (and / or tibia) talus fusion, I guess. And... If the fibula / tibia / calcanus is fused to the cuboid too then it isn't any wonder I can hardly move my ankles :-(

[okiedokie]

Hi Alex,
Unfortunately, you will get different answers depending on the specialist you ask.

Normally, we always want to go in and remove the hardware at some point. A risk of infection is always present when the skin is opened, so don't know why you got told that as a reason to NOT remove the hardware. Additionally, most ortho surgeries require a preop, during and postop administration of prophylactic antibiotics. Perhaps they didn't want to keep an active young woman from weight-bearing for any length of time to allow proper healing? I don't know.

I recommend that you get more than one opinion. Take your x-rays and your operative reports with you to your appts.
Good luck hon,
Okie

[Perna]

Don't know if these address your concerns about leaving in/taking out hardware?

http://orthopedics.about.com/od/cast.../f/removal.htm

http://www.mybrokenleg.com/faq/detail.html?id=39

Hey. Sorry I kept editing my posts while you were posting yours. I was just trying to be as clear as possible and I've only just learned how to imbed pictures

> Normally, we always want to go in and remove the hardware at some point.

How come? Is it because people regain some lost movement... Or is it because the person can reject the foreign items... or...

> A risk of infection is always present when the skin is opened

Yes. And since the screws are embedded right into the bones there would be a risk of deep infection in the bones, too. They said that was why they wouldn't remove them.

I actually asked them... Whether I was hitting up upon the limitations of the public health service (LONG waiting lists for all but emergency surgeries) or whether that was medically the best thing to do. They seemed pissed that I asked that question and didn't answer. I was like 'I'm sorry - I just mean if I'm earning money one day and / or manage to get some fabulous health insurance coverage then... Would it be worth my finding out whether they could do anything more?' They seemed... Pissed that I asked still so I left it alone.

Apparently... Everyone thought the surgeon did a remarkable job. The training doctors... Thought that my legs were (quote) '%#@&#!' and went a little pale (thought they were goign to have to amputate). I think... I was meant to be exceptionally grateful for what they did do (and i truely am). I'm just... Seeing if I can do anything more though, yeah. Also... My injuries were self inflicted (jumped). And... The docs seemed rather disgusted with me on a personal level. Kinda like... I didn't deserve their concern :-(

I also asked... See, the underside of my right heel is bumpy. Feels like I have a whole chunk taken out of the part of it that is closest to my toes. That results in what feels like a bony ridge around the back of my heel. All the pressure goes there and it hurts. Walking on hard surfaces (e.g., wooden floors) with no shoes (which is the culturally expected thing to do in NZ). They mentioned orthotic insoles and I asked them whether they could fix the bone so the surface was flat. Got a strange look there too.

Maybe they thought I'd heard of these and was wondering why I didn't get one...

[image]http://www.osteosynthesis.stryker.com/physicians/usa/sps_calcaneal.php[/image]

I wonder why I didn't get one...

But that isn't going to make the underside surface regularly shaped I guess :-(

> Perhaps they didn't want to keep an active young woman from weight-bearing for any length of time to allow proper healing?

When I got the screw removed they just told me to go easy for a couple days. I was on crutches at that point, actually. I think they told me to try not to put weight on it for a couple days and try to keep it elevated. That was hard for me at the time (because my right leg couldn't hardly take any weight - let alone all of it). I'd cope much better with doing that now - if they could do it one leg at a time...

They wouldn't give me the x-rays. Said they were the property of the hospital and they needed to keep them incase I ended up back in hospital. That most patients tended to lose them.

Is it worth my trying to get them when I go back to NZ (going back for a few weeks). Because I've left the country now and I'd like to have them for my future medical care.

One issue is that... If the joints are not smooth with cartialidge between them anymore... Then I've heard that fusion can be the answer to traumatic arthritic pain. It might be that if they weren't fused the pain would be too much for me to be able to walk. So the increased movement... Would actually be a bad thing. I don't know...

Thanks OkieDokie.

oh... its because the front of the heel was crushed so they had no place to insert the screws :-(

yeah. the screws probably are providing structural support. and preventing arthritic pain.

Thanks Perna

i guess it is worth finding out about one day. debridement etc. they even have ankle replacement surgeries now...

it is hard standing, i guess. feel like i'm walking through water (the amount of effort it takes to move forwards).

i'm just... starting to grieve for this now, i guess. instead of grieving that i lived through it i'm starting to grieve for the limitations on my life.

[okiedokie]

Aw honey, it shouldn't matter one whit to a doctor how you ended up in his/her operating room.

I'm sorry you felt like they judged you. I certainly don't. I am sorry that you got hurt like you did.

This is a great time to request your records/x-rays precisely because you are leaving the country. They don't know if you are returning or not. Let them know that you plan to pursue "next steps" regarding your function and range of motion and the options available to you. That's all. No more, no less.

Usually, hardware is removed because it tends to want to wiggle it's way out anyway and cause protrusions much like what you experienced when shaving caused bleeding.

You are at high risk for developing arthritis down the road. But you are young, and if you plan to have additional surgery, now would probably be the best time to do it.

In the US our medical records belong to us. Only you know what the laws are in your land.
Best,
Okie

Hey. I've actually left the country already, but I'm visiting for a time near the end of this year. I think I will try and get my records, though. I can tell them I've been out of the country for a couple of years and I don't think I'm going to be returning. And that I want my records to pass on to the doctors who are now involved in my healthcare, yeah.

> Usually, hardware is removed because it tends to want to wiggle it's way out anyway and cause protrusions much like what you experienced when shaving caused bleeding.

Yeah. I think that was because that screw was angled and so not hard up against the bone. I do think... That the main trouble with my injuries was that things didn't just fracture they literally shattered or disintegrated. As such, there wasn't really anything they could do aside from what they did. I was in a wheelchair for 3 months completely non weight bearing (with elevated legs, too).

Unfortunately... I don't have good health insurance yet. Have to pay 20% of specialist visits and stuff... Though... I will certainly check it out when I'm earning (and I'm certainly careful to keep health insurance). Trouble is 'pre-existing condition' clauses... Health insurance isn't as standard in Australasia as it is in the US... Maybe because the public system is better... Just different ways of distributing the health care is all... It does mean that I'd have more chance of getting this sorted if I had private health insurance in the US, though.

> In the US our medical records belong to us. Only you know what the laws are in your land.

Yeah. I don't know what the laws are on that in NZ. All I know is I asked for my records and they showed them to me (though didn't explain any of it to me), but wouldn't give them to me on discharge. When I'm there I'll put in a request for them... Trouble is that clinical notes can surely be copied / duplicated okay. Don't know what happens with CAT / x-ray / MRI imagine etc, though. Not sure they can be duplicated...

[heyjoe]

absolutely they can be duplicated. osteomyelitis is bad news, i dont think that i would mess with it unless you have problem with the hardware, the risk of osteomyelitis is real.

Thanks. I didn't know they could be duplicated. I do think it is important that I have them to show to my doctors wherever I end up.

Yeah... Ostemomyelitis would suck... I guess there are likely to be costs and benefits... It might be the case that the high impact stuff I do (dancing which consists mostly of jumping) is just the thing to rebuild bone density in the areas that were shattered. It might be that the dislocation can be fixed now that the shattered areas are harder etc. There might be... Some things that can be done :-)

I can't afford to look into it just now... But I have been thinking of being a bit intensive with the physio exercises (I had stopped doing them thinking that I'd be making them degenerate further the more I used them). But I'll do what I can to strengthen the ligaments etc... Picking up marbles and screwing up towels with my feet and standing on my tippy toes etc... And maybe one day... With a little health insurance... Something like a joint replacement could give me more mobility back :-) I'd really like to be able to play tennis (for fun) whereas at the moment I can't run... I don't mean super competitive... But just being able to run around the court a little more (at a fairly relaxed pace) would be awesome :-)

[heyjoe]

weight bearing is what builds bone, not high impact. It s the opposite of what you might think, the more you weight bear the stronger the bone gets. They get porous when they are not used. I have seen a teaspoon of calcium carbonate powder, not pill, taken everyday for a few months do some wonderful things for people and horses, with non union fractures, and growing bone. Good Luck, just watch that high impact stuff for a while.