Hi, this may not be the best location for this post, but I’ve always found this forum to be pretty helpful. Last April I suffered (boy, did I suffer) a comminuted open fracture to my tibia and fibula. I have a nice titanium pin running through my tibia; so it’s not all bad. Anyway, the good old NHS have discharged me but it’s still a right old mess inside; the fibula is “non-union” and the tibia still has a way to go for full calcification. I’d like a second opinion as to options going forward; could anyone recommend a suitable specialist/consultant? Cheers, Pegleg Mac.

How on earth would the NHS be discharging you if you have a non-union?? Is the tibia functionally stable, non-painful etc? If not then the NHS should have plenty of expertise to deal with it, or at least outline any further options. If it was a comminuted fracture I’m surprised that a pin alone would be a suitable way to stabilise it. External fixator would seem a more appropriate option (he says without even having seen any details or X-rays, and being a vet not a doctor…)

where are you based?

Hi, I’m based in Tooting, South London. The NHS seem to consider that the fibula is the best it’s going to get. As I’ve only broken my leg once I have no idea if the advice I’m getting from the NHS – from separate consultants each time I go in – is just the NHS fobbing me off to get rid of me, or simply the sad truth that my leg is pretty knackered. Any advice most welcome. X ray available on request.

Ok, the tibia is the main weight bearing of the two lower leg bones and you have a titanium plate assisting things there, there is bone union from what you said just not hardening (calcification) yet….this is normal and can take time.

The non fused fibula would concern me, it helps to perform the rotation of the lower leg like the ulna does in rotating the forearm….if it’s not fixed (even artificially) then you’ll not have full use of that leg.

The NHS is very good at saving life and limb but once you’re walking they tend to be disinterested in your ability to play sports etc unless your career depends on it… again nothing wrong with that, there simply isn’t the money to put all ACL tears correct on amateur footballers or sort the knees of every hobbyist cyclist!….you could try nagging your GP, they are the gate keepers to further treatment, can you afford private?….it’s what pro sportsmen and women do…could try telling your DR that it impacts normal daily activities and see if that gets things moving.

Re. The healing tibia, high protein and high calcium diet and gentle weight bearing exercises will see the bone density improve.

Thanks Deviant; the plan from the start of my recovery was for me to get back to cycling, swimming and running. Cycling is 95% and swimming is fine. Running is pretty scary; there’s all sorts of compensation going on with my gait, and it hurts. I checked and checked again re whether it was ok to try a run and was told to go for it, but slowly. What bothers me is not the slow healing of the tibia – I can see new callus on the x-ray and there is a mighty pin in there – it’s the poor state of the fibula which I’m told is non-weight bearing and will not be a problem, but there is no suggestion of any other treatment, like a bone graft, to kick start the new callus growth. Guess it’s back to the GP initially and then maybe a private consultant. Does anyone have a recommendation for a consultant? Cheers, Mac

Friend of mine had similar (I think). She pushed and pushed and finally they did a bone graft from her pelvis to assist the bone fusion. It worked, but she still hobbles somewhat.

Good luck. Keep pushing. Don’t let them discharge you.

I broke both in 1993. My tib was plated and pinned, but the fibula, which was in three pieces with a floating section was left as it was. I was never a runner, but I did walk a good deal, and to be fair the leg was so badly damaged that the fibula, which I’m told only acts as a stabilizer, didn’t make any difference to the eventual result. It tires after a long walk, but no issues that I can detect as far as cycling is concerned. With proper physio my leg was as good as it was going to get after a couple of years.

A quick google gets you
http://www.londonbridgehospital.com/LBH/consultant-services-rel/orthopaedic-surgery/
If you speak to a private consultant and work out what needs to be done to get hold of your imaging & notes you can get them to do you a consult, could even be one of the docs you have already seen in the NHS. You can still go back into the NHS stream.

I’m back in 3 weeks for my funky wrist injury, if time is short and it’s not getting explained well enough I’ll book in to see the same consultant privately and discuss options over a longer time with more questions. (australia but same can apply)

If you’re London you can see if the GP will refer to RNOH Stanmore, be prepared for a wait though….the surgeons are superb there. Tib fib fractures can be extremely difficult to manage especially in the lower 1/3 of the bones and the nail may effectively be keeping the fibula apart and contributing to the nonunion.

deleted – wrong topic!

Kinda related, I broke my radius three times (not in 3 places, 3 times!).

Between the 2nd and 3rd there was bone growth but it didn’t calcify and when they went in to repair the 3rd break the bone was apparently dead (non-vascular).

There’s a few possible reasons, ranging from bad luck, to smoking, to too much exercise to it dying in the 6 weeks between breaking it and getting into surgery. I don’t smoke so it’s not that, which leaves bad luck and exercise. I was back on the bike about 4 weeks after the break so I’m pretty sure it was my own stupid fault that it died and broke again (either that or the 6 week wait)!

What I’m saying is, if it’s not calcified, give it a while before getting back to anything that’s going to vibrate or put too much load on it. The advice is to exercise it to keep the blood (and therefore calcium and other nutrients) flowing through it to speed up healing, but that means very low impact activities.

Thanks for all your advice chaps (and any chapesses); I’ll get back to see my GP and twin track a private consultation too. I did a 2 mile run yesterday and all is not well down there. Good job running isn’t my main mojo. Good luck to anyone else with a dodgy fracture too. Cheers, Mac

Interesting article here.

Pertinent points seem to be that 50% of fibula non-unions fix themselves, although this can take several years, and this paper (and it is only one paper) recommends some type of surgical intervention. So it was probably written by a surgeon haha. I’ll keep looking, it would seem that you are doing the right thing so far, ie staying active, but don’t push it too far! 🙂
The running surprised me, but if it was cleared by the hospital folks then it should be fine I guess. What has your physio been saying?

My personal philosophy is to avoid surgery as much as possible, because it can lead to further complications (like infections etc). So giving your fibula a chance to heal on its own might not be such a bad idea, you can always push for surgery at a later date

Left Leg

Physio and NHS consultant both cleared me for running – slowly, with a full cushioned running shoe and not on the path/road. Still felt scary. I am going to try and attach a photo of the most recent x-ray for all you budding fracture experts; the tibia looks on the mend, although it’s a bit of a mess, but the fibula still has a big gap. I was told not to weight bear for 12 weeks; then told by my GP that weight bearing was essential for bone growth. Good old NHS. Maybe the fibula missed a window to promote bone growth? There is some sign of callus there, but we are now 14 months in – should I wait longer before considering other intrusive options?

I was told not to weight bear for 12 weeks; then told by my GP that weight bearing was essential for bone growth. Good old NHS

You need to stimulate it to encourage the bone to grow, but not so much that the soft callous of bone get’s killed.

Photo attempt…

Broken leg? I’ll give you a broken leg!

[url=https://flic.kr/p/dkiecA]Stu's leg 3[/url] by jimmyg352, on Flickr

Now that’s a broken leg!

Not mine BTW, my mate Stu’s.

I was told not to weight bear for 12 weeks; then told by my GP that weight bearing was essential for bone growth. Good old NHS. Maybe the fibula missed a window to promote bone growth? There is some sign of callus there, but we are now 14 months in – should I wait longer before considering other intrusive options?

NWB for 12 weeks after a nasty fracture seems reasonable. The idea may have been to stop bone segments slipping under pressure and start the sticking together process. The GP was probably basing his advice on Wolff’s law which states something along the lines of bone will adapt to the pressures that is put on it. Both correct at the relevant time.

Speak to your consultant and ask them why they are discharging you. They sometimes do an operation to roughen the bone ends up to promote growth. See if that’s an option for you.