Fractures of the tibia, in the lower leg, are the most common long bone fracture in the human body. They usually occur from falls, athletic injuries and motor vehicle accidents. Due to the thinness of the skin over the shin bone, the fractures tend to break the skin leading to open fracture referred to as a compound fracture. It is also common for the fibula bone to break along with the tibia due to the close proximity. Significant complications such as nonunion, infection, neurovascular damage and compartment syndrome can occur and become a threat to both life and limb.
Those of you who follow sports most likely heard about the injury of NFL quarterback Alex Smith and his impressive recovery and return to play. He sustained a compound tib-fib (tibia-fibula)fracture during a 2018 football game which became infected and ultimately required 17 surgeries to save his leg and his life. Despite this, he was able to return to the NFL field just one month shy of the two year anniversary of his injury.
By now, most of the world has now heard of the most recent athlete with a tib-fib fracture. This time, not from sport but from a motor vehicle accident. Tiger Woods sustained at least two compound fractures of his tibia and fibula which required immediate surgery to stabilize the lower leg with an intramedullary nail, screws and pins as well as a fasciotomy in order to prevent compartment syndrome (a limb threatening complication that is caused by the build up of fluid within compartments of the lower leg and leads to a compressing of nerves and arteries). There is still much speculation as to the full extent of his injuries which makes it hard to say what his recovery will look like. At this point, he and his doctors are more concerned about preventing complications so that he does not end up in a struggle for his life or limb similar to Alex Smith. I would never presume the thoughts or feelings of either of these two men or compare my "simple" fracture to their significant injuries, but I thought it might be helpful to others to pass along the knowledge I acquired during my tib-fib fracture recovery.
This is what I learned. Your brain is an amazing pain blocker, when it wants to be. I knew the exact moment when my leg broke. Not only that, I could show you the exact location of the fracture and as I told everyone in earshot, it was "through and through". Despite this, I had only minimal pain. I'm sure if I tried to stand on my leg it would have probably been excruciating but as long as I protected it I was fine. I could even laugh and make jokes. Of course, I knew that was temporary so I had no problem accepting whatever pain pill the ER doctor handed me within minutes of my arrival to the hospital on Thanksgiving Day 2016.
Having had a bad experience with opioids from a previous surgery, I knew I did not want to be on them for long. I was able to switch to Tylenol about a week after my surgery to fixate my tibia with an intramedullary nail and stabilize my fibula with a plate and screws. Unfortunately, it was still long enough to suffer hallucinations and constipation that are common (but certainly not fun) side effects of opioid use. Opioids are useful and effective but definitely not something you want to take longterm if you can help it. I found that light exercise and active mindfulness activities such as crocheting were a good distraction during my stay in the hospital and throughout recovery. I would also utilize breathing and meditation techniques at night in an attempt to shift my focus from the pain when everything else in the world was quiet but the ache in my lower leg.
Even harder to deal with than the post surgical pain was the incapacitation. I had just spent the previous year fighting for my life against breast cancer with multiple surgeries, chemotherapy and radiation but none of that prepared me for the challenge of dealing with the inability to move freely. It is difficult to understand the frustration, indignity and anger that accompanies the sudden loss of mobility until you experience it yourself. A class assignment during my physical therapy education attempted to give us some insight into this experience by having us use a wheelchair for half a day with a partner. Nice try, but that assignment did not even come close to replicating the sense of loss, shame and helplessness that comes with losing your ability to walk. Even now, I know that what I experienced during my eight weeks of limited mobility is nothing compared to the struggle that those who develop long term or lifetime disabilities must go through.
You never appreciate it until it’s gone. The freedom to move. The freedom to walk. The freedom to run. The ease of getting up to go to the bathroom whenever you want and with little effort. Bringing groceries in from the car. Driving. Slipping onto an elevator at the last moment so you don’t have to wait. Opening a door. Carrying your drink and meal to the table. Reaching over the counter of your favorite takeout restaurant to grab some napkins. Perusing the cute boutique shop on the corner. Nimbly (or not so nimbly) avoiding the crack in the sidewalk in need of repair. Easily navigating the boards and ramps put in place as a temporary path for a sidewalk under construction. These are just a few of the things that we take for granted every day that can be lost in an instant…or slowly, against our will.
We tend to forget the mental health aspect of injury in the face of the obvious physical consequences. Injuries, big and small, leave behind emotional memories that affect our health, ability to heal, manage pain and avoid future injury. They are left there to protect us but can become problematic if we do not recognize them and learn to manage their influence. I broke my leg because I was looking at my phone walking down stairs and missed a step. It would be understandable if I avoided stairs for a while but developing a fear of stairs is not helpful. Instead of eliminating stairs from my life, I took what I needed from that emotional memory and make sure I never look at my phone while on the stairs. Just like my physical scars, my emotional scars are not inherently bad, they are just memories of something that happened. What I do with that memory is up to me.
As I said before, my injury pails in comparison to Alex Smith’s and Tiger Woods’ injuries but struggles with things such as pain, loss and fear are universal after trauma. Whether Tiger decides to return to professional golf or not, he has a long road of mental and physical recovery ahead of him. My advice…patience and a great physical therapist.
Virtual Reality and Pain
I once had a burn patient that required debridement (removal of dead skin) along the length of his leg. It was excruciating and would take upwards to an hour to complete. I would plead with him to take pain medicine before arriving but, for many reasons, he refused. Imagine if I had a virtual reality headset that I could have given him to temporarily transport his mind. Any amount of pain reduction that it could have achieved would have sped up the process and allowed both of us a little peace of mind. Virtual reality is an exciting new avenue for pain research that is already eliciting positive results. The following article is an interesting review of concepts of virtual reality in acute and chronic pain management as well as direction for more substantive research for the future.
According to the Center for Disease Control, every twenty minutes an older adult dies from a fall. More than 95% of hip fractures are caused by a fall and falls are the leading cause of traumatic brain injury. There are many conditions that contribute to the risk of falls including vitamin D deficiency, certain medicines, weakness, poor footwear, fall hazards (such as rugs and uneven steps), vision problems and balance problems. A relatively simple thing to check at home and begin working on is your balance. It's important to begin balance training early before you become at increased risk for falls. Take a look at the form below and see how you stand...
Balance exercises to perform at home