Broken tib & fib. Experiences & advice please!

All the best.  Can't give any advice but I've had a taste of it this year or so like never before - I've had 3 'off the bike' crashes in 15 months.  Last one was end October when I did my collarbone and tried to tear my lips off with the ground. Was hoping to be back on the bike after new year but they've told me to wait for another x-ray at the end of jan(the day before I go skiing) before I start using it for anything much.   Strava tells me last year I rode only 60% of the distance I'd done the 5 years before. 

It's tough. I've been adapting to what I could do - lots of long walks around the city, cultural stuff.

Posted by: JonEdwards

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I do have access to some private medical insurance, but the last time I used them for hospital stuff, the NHS was faster and more caring.

By your own admission they've told you to piss off as you're not injured enough, and any operation in two weeks will involve breaking the healing bone again. Call your private health provider and see if you can get an emergency appointment. You also want the "how do I get back to activity quickest" conversation, not the "how do we get you stable and out of hospital quickly" viewpoint.

Didn't know that you could pin a fibula, maybe they'll just leave it floating? I wouldn't go for the cage unless it promised a substantial benefit in healing time given the infection risk. Though you may actually be able to shower with one on which you can't with a cast.

I had a spiral fracture of my tibia in 1997 so while useful, I would expect some of my story to be out-dated by now.  The fibula was snapped as well, which the surgeon said was a good thing as they would have had to snap it to get everything aligned.

My break was lower shaft with a crack extending into the ankle.  Surgeon ruled out a nail as there was a likelihood the whole thing would split, making it worse.  Also an ex-fix was considered but rejected. So after a 24-hour "lets see what happens if we just put it in plaster" proved unsuccessful (my leg cramped or spasmed in the night and pulled the 2 bits across each other) he opted for an "in-plaster traction".  That was a 100mm calcanial pin drilled and fitted across my heel bone, my knee bent at about 20 degrees, my leg stretched out gently to align the two ends and then the whole lot encased in an old-fashioned plaster from toe to groin.

Net result - success.  Break in June '97, Surfing in Cornwall Feb 98, Windsurfing and Mountain Biking in Turkey July '98 Snowboarding Val Thorens Feb '99.  Sent my surgeon a postcard from Val Thorens to say thank you!  I'll add more in a bit.

@BigJohn, that sounds very very similar to what I’ve done, just a lot earlier. Thanks for sharing a positive outcome - it helps!

My partner had a similar if more displaced injury. She he also had to wait nearly five days for surgery as other emergencies took priority. Her first surgery was plating with screws of the tibia and the fibula left to heal. Long story short, she really struggled with pain and eventually it was declared a non union, she had revision surgery 18 months later with removal of the failed metal plates and a tibial nail( titanium not steel) which healed much more quickly and could weight bear much sooner so lost less muscle tone

TLDR: of the two options you have been given, her experience would suggest tibial nail might be more likely to succeed and recovery is much quicker as you will be weight bearing sooner 

Happy to help!
Here’s part 2. I didn’t want to write it all in one go because I find with long posts they can sometimes disappear the moment I press send. Anyway, here goes.
Some tips:

Build a good relationship with your surgeon/consultant. They’re like mirrors, the more you want it, the more they want to get you there.

When set targets, make sure you achieve them, but not more than 110%. If it hurts, say so but don’t moan. Say “I don’t mind the pain but tell me how to stop before I cause damage”.

Keep the leg raised or you’ll get a DVT. Guess how I know. Find out the symptoms and shout if you get a dull pain at the back of the knee.

So, my experience.
I was in a big clunky plaster but hobbling around on crutches the next day. I went to work about 4 days after (office job) and had to navigate a tight narrow steep staircase. That was fine, sharpened me up for the trip to Marconi Chelmsford a week later where they have the last remaining Paternoster Lift. Those ones that don’t stop – you have to hop in and hop out, and don’t take too long about it!
The first plaster was on for six weeks. The pin stayed in as there was quite a gap between the two bits of bone (even though the leg stayed the original length and the foot was almost perfectly aligned so much as to make no difference). You have to wait for the new material to fill in and for it to go “gluey” as the surgeon called it. Absolutely NO weightbearing at this stage. Showering is no problem with a big rubble sack and some microporous tape. I used to put a strap around both knees in bed as it is easy to get a groin strain if they go off in different directions.

The second plaster was also toe to groin, but this time straighter and it was time to start putting weight on it. Bones don’t heal unless they’re made to work, but a spiral fracture will slip if it’s worked too hard. I went to the fracture clinic each 1 or 2 weeks (NHS, Stafford Hospital – yes the one with the “scandal”) and saw the same surgeon each time. We got on really well and he set targets – importantly how much weight to put through it. it might be 5kg today, 10kg in 1 week, 15kg in 2 weeks. (made up numbers, I can’t remember the actual ones). I used a bathroom scale. Bloody hell – I do remember how painful and scary the first one was. I also remember the initial feelings of all the blood rushing down to my foot every time I went from raised to standing.

In October the plaster came off. By then I’d been without crutches for a couple of weeks and was stomping around on it all the time. Where I worked was half a mile down the road and my Physio was about 500 metres from home. So I was walking most places.
My physio was mates with the surgeon. And that meant when he saw me out of his window when I went for my first tentative bike ride he phoned the surgeon and I got a call from him saying stop that at once till I tell you.

The main issue I had (apart from the DVT, which means that I still wear a knee length surgical stocking some days – but it is improving, 28 years on!) was that my ankle was fused solid through calcification. I had a lot of physio and did exercises every day to free it up. It still has less movement than the other one making calf stretches more difficult to do properly but it’s fine.

There’s a lot of nerve damage when that rogue blade of bone goes mashing about – think of prepping a leg of lamb with a paring knife – so expect your balance to be a bit compromised at first. A balance board is useful. My balance is a bit odd. On a bike I’m fine, pretty good in fact, same with windsurfing and I’m pretty nifty on the dancefloor, which makes my wingfoiling friends incredulous when I can’t stand up on a paddleboard. It doesn’t matter how flat the water is, how much like an aircraft carrier the board is, I just wobble a bit then walk off till it tips me in. Seemingly the reflexes take a long time to get to where they should be going. But this might not be all about the ankle. I’ve got a dodgy eye and had a pretty nasty spinal injury so don’t worry too much.

Anything else, just ask.

My wife did the same about 15 years ago. We got my work’s health insurance co (Aviva I think) involved immediately. Once the NHS hospital started playing silly buggers, which included leaving a snapped drill-bit in her leg, we let the ins co take over. The best of luck.

Good info, thank y'all - especially @BigJohn (again).

I'm of the type to push things, but understanding what's too far is definitely important and things like spiral fractures slipping if they're worked too hard is good knowledge. I've had that blood rushing to the foot thing a good few times already!

I WFH and our house is cellar + 3 floors, so I'm going to get very good at hopping up and down stairs. (typing this from the office PC on top floor).

Thinks like ankle calcification I need to build in to recovery plans - already well aware my quad/hipflexor are getting battered as I crutch around holding the heavy leg a bit up in front of me so the toes don't catch on the floor. Glute isn't getting worked and that will pull my dodgy back out that i normally counter with loads of stretching and gym, none of which i can currently do...

I'm told NGH in Sheffield are very good with bones, and if the staff in fractures are as "outdoors understanding" as the A&E guys and gals were (mostly runners), then hopefully it'll work out OK.

Been here. Had a Taylor cage fitted for ~4 months. It sucks. Keep on the strongest painkillers you can tolerate to start with (Tramadol in my case). After a month or so I was only taking them to sleep. Best way to sleep is two stacks of pillows with the frame in-between. Shower with a bin bag over the leg taped up. Managed to go without infections, but thats the most common complication. Usually easily sorted with antibiotics. Swimming at the sanitised hospital pool was the highlight of my weeks. 

In my case, weight bearing was good and was able to put weight on it the same day after surgery (whilst on a morphine drip). Crutches for about 2 weeks. Towards the end i was doing 6 mile walks in the frame. Can't drive obviously due to the bulk/insurance issues. Keep up with the physio. I lost alot of muscle and gained weight. 

From breaking my leg, i was able to ride my road bike 5 months afterwards. Went to Morzine 7 months after breaking it. Had on/off pain in the pin sites for about a year after, and took a long time to return to running. Despite the above, would 100% recommend a frame if given the choice as there's less cutting into you (nerve damage risk), and no rods to go loose over time. 

Painkillers:  my surgeon was adamant that anti-inflammatories slowed bone healing so shouldn't be taken.  

I also dosed up on calcium supplements although there was no evidence that it was useful.

I was 44 when it broke, so no spring chicken.

 I’m staying well off the ibuprofen - aware of that issue. Paracetamol during the day, coedeine at night. 51 here so definitely not in my youth, but until 48 hours ago as fit and as strong as I’d ever been. 

@enigmas do you mean the rod in the bone can come loose?? Another new fear unlocked!

Get as much physio as you can after.  Mine was brilliant at mobilising muscles that hadn't moved for 6 weeks.  My leg looked like a chicken leg.

I got down the pool every day with a float between legs, doggy paddle style.  In the end I was beating swimmers just pushing out with legs.

On crutches at first 100m, after a month I was flying.  Really built up my arms and chest.

To prevent dvt I took anticoagulant injections.  I did them myself in the thigh.

Like you, soon as I was allowed home I just wanted to get back to normal.  Wrote down everything physio said, lay with leg elevated, lots of upper body mobility.

Good luck, I was soooo bored.

No help at all but I broke mine when I was 9 on a school skiing trip (second day).  Can't remember the details as it was a very long time ago I had a full length plaster on for something like 3 months and missed 2 months of school resulting in my failing to get up to the 'big' school.

As I said, no help, but I hope you recover well.

I haven't dpone the tib and fib as a pair but from many, too many, previous accidents I would very strongly talk to the private health surgeon. They may offer you options that the NHS won't even mention*. They may be willing to do longer and more complex surgery that will give better long term results. Even if you go with the NHS, finding out the full set of options will only cost the insurance excess and may bring big benefits in terms of procedures performed and possibly time to operations. It will probably be the same team doing the operation but you are more liklely to be operated on by the top guy rather than one of his juniors.

*My wife and neighbour had almost identical shoulder injuries at about the same time.

The only option my neibour was given was to cut a tendon in the shoulder which removed the pain but means she will never lift her arm above her shoulder again. She uses a ladder to hang out her washing.

We went private because of the delay in getting an NHS operation and thank goodness we did. We saw the same surgeon as my neighbour and he suggested an operation that relocated the tendon and basically pinned a bit of pipe in place so the tendon stayed where it should. Fully recovered in a couple of months. When asked informally and off the record why there was a different operations, and after much "each case is individual" he basically said that relocating the tendon is not available through the NHS because it is timeconsuiming and expensive compared to just cutting the tendon.

I had a tib fib compound fracture many years ago when I was 14 or 15.

External fixator which the cranked apart every few weeks to lengthen my leg to make up for bits they cut to get back to clean. 

Went in a couple of days before Christmas and the consultant unscrewed it in his office at a check up before Easter. Biggest advantage is that you can still walk around on it pretty normally (after about a month for me) at which point I only used crutches in case of being bumped around in school corridors. Could do a few miles walking with the frame in. Really helped reduce muscle wastage and keep other joints moving normally. 

Downsides would be the continuous cleaning of the pins, catching the frame on stuff and having to go back for your crutches when you forgot and left then behind.

Once out I ride my bike the next day and did Ten Tors walking challenge a month later. Did take a while before I could run a turn, straight lines only.

no experience with your injury or the cage thing, but plenty of experience of getting over major surgery.

and i think the key to this is a good mental attitude and keep positive all the time.

i had a ankle fusion which meant 12 weeks no load bearing on the joint so was on crutches all the time.

started slow, but was soon doing stairs on them and longer walks on them up to a couple of miles. and with being a big bloke this was a hell of a workout.

i was back on the bike with a aircast boot after 12 weeks, using 2 fold up walking sticks in my saddlebag for time off the bike.

had a hip replacement, and i was back on the turbo trainer after 10 days. used it in the garden to make it feel like i was proper riding outside.   it kept my mind good which is number one in aiding recover.

got over being in AF and open heart surgery by being strict with my rehab and physio and moving my goalposts at bit. cant ride fast now, but can ride far, and regular.

you just have to keep your head strong and keep on going forward.   bad times seem terrible, but they pass quickly with a mental attitude.

and i reckon a bloke who rides alot, and does a lot like you seem to do, you will get over this no problem.

good luck mate.

I broke my tib+fib+something on my ankle in late 2012 I think. Foot slipped from pedal, got stuck on a root but bike and rider continued on. Ouch!

The surgery was done on next day, doctor told me that 3rd attempt was successful and the end result is just about OK. Not something I wanted to hear but these days the ankle works well enough and I have about similar movement range in both ankles. 

Posts above already have loads of info and tips but I’ll add some other things I found out. The swelling was quite bad and lasted way longer than the estimated 6weeks. My injury apparently required quite a bit of hardware on both sides of ankle - I could walk, ski and ride pretty well afterwards but wearing any boots with ankle support (XC skiing skate boots and hiking boots) was way too painful. All the hardware was removed after couple of years, there was handful of plates and screws and getting rid of those helped getting the ankle feel normal again.

Best of luck with your recovery.