Orthopedist evaluation

[Selden]

I now have a shiny blue shorty cast on my left arm. No pain with the switch from splint to cast, and my fingers now have much more movement than before, so I'm more or less back to 10-finger typing.

 

The navicular bone (3) in my foot is broken, but can be screwed together fairly easily. However, the medial cuneiform (4) is shattered, and will need to be reconstructed with some bone grafts, screws and a plate, then fused to the bones in front of, and behind it. Surgery on April 8 (general anaesthesia hooray), then probably 8 weeks in a cast, by which point my lower body will probably be really flabby. If the arm cast comes off at the end of April, I'll at least be able to start doing some upper body exercises (other than pushing a wheelchair).

 

 

Moral of this story: wear sturdy boots. I'm reasonably sure that had I bee wearing my Aerostich boots, I would be riding in a few weeks.

[roughwaterjohn]

Looks like you lost a little skin also, are they going to fix that in surgery?

[Selden]

Looks like you lost a little skin also, are they going to fix that in surgery?

Subtle, very subtle.

[drzep]

Sorry to hear about your injury, perhaps even more sorry that now you may be second guessing your footwear selection. We don't always 'do the right thing' at the moment, but those actions can bring some unpredictableness and spice to life!

 

On the bright side, most of the tarsal bones can be fused with little drama and the result is usually quite good, with appropriate stability postoperatively. Always some loss of eversion and inversion if it involves the talus / calcaneous, and in your case a little probably a slight reduction in plantar flexion (toes rolled down and under). Should not change your dorsal flexion (toes up). The cuneiform bones and navicular really just bridge the talus/calcaneous with the metatarsals and it is the metatarsals are responsible for much of the plantar and dorsiflexion of the feet.

 

I wish you the best of luck and encourage you to post up your progress at regular intervals. I'm always interested to follow fellow cyclist's injuries.

 

Heal well.

 

 

[Skywagon]

Selden...best of luck with your recovery. I think I understand what DrZ said, but let me see if I have it right.

 

Apparently from not having a proper boot installation, you found wobble in your wheel while shaking it from 10 and 4. Replacing the crown bearing with new hardware and using proper shims should cure the problem. However post repair you should consider keeping the fluids changed with regular intervals and recognize you might still wobble at 10, but the 4 wobble will be limited.

 

 

[Paul Mihalka]

Selden...best of luck with your recovery. I think I understand what DrZ said, but let me see if I have it right.

 

Apparently from not having a proper boot installation, you found wobble in your wheel while shaking it from 10 and 4. Replacing the crown bearing with new hardware and using proper shims should cure the problem. However post repair you should consider keeping the fluids changed with regular intervals and recognize you might still wobble at 10, but the 4 wobble will be limited.

 

And you probably will have to investigate what tire fits best your repaired wheel

I hope you don't mind the joking about your misstep and may be puts a smile on your face. Heal well and fast!

 

[Selden]

Selden...best of luck with your recovery. I think I understand what DrZ said, but let me see if I have it right.

 

Apparently from not having a proper boot installation, you found wobble in your wheel while shaking it from 10 and 4. Replacing the crown bearing with new hardware and using proper shims should cure the problem. However post repair you should consider keeping the fluids changed with regular intervals and recognize you might still wobble at 10, but the 4 wobble will be limited.

Exactly the response I would expect from this much of gearheads. My doctor said essentially the same thing as Dr Z -- very good outcome is likely, as long as I'm a good boy and keep weight off my right foot during recovery.

 

Re second guessing -- not much. Time flows in one direction. But from now on, I'm wearing the Combat Touring Lites -- maybe even around the house, where I have still broken more bones than while riding.

[Lets_Play_Two]

"the medial cuneiform (4) is shattered, and will need to be reconstructed with some bone grafts, screws and a plate, then fused to the bones in front of, and behind it. "

 

I shattered that same bone 6 years ago and the surgeon suggested not doing anything with it unless it caused problems. Reason being, blood flow to that area is limited, limiting recovery ability. Surgery might not fix it, etc. I left it alone and have had zero problems. Please realize this is simply my experience and not a recommendation of any sort. I was wearing riding boots! Crack in heel and shattered bone. I wore a walking cast for 6 weeks.

[yabadabapal]

Best wishes to you buster. Might be good to take it easy for a few weeks. Enjoy the rest. Its good for you in the long run.

 

[Selden]

I shattered that same bone 6 years ago and the surgeon suggested not doing anything with it unless it caused problems. Reason being, blood flow to that area is limited, limiting recovery ability. Surgery might not fix it, etc. I left it alone and have had zero problems. Please realize this is simply my experience and not a recommendation of any sort. I was wearing riding boots! Crack in heel and shattered bone. I wore a walking cast for 6 weeks.

We discussed options yesterday; just letting it heal is one, but he felt there was significant risk of the arch collapsing at a future date, leading to worse problems down the road.

 

When I asked if the plate would be permanent, he said it could be removed at a later date, if I wanted. Are you out of your frickin mind? That would involve cutting everything open again -- no thank you.

 

Each case is different, even if there were an orthopedic surgeon in this forum he wouldn't be able to see the X-rays or CAT scan. I'm not thrilled with the prospect of surgery, but I'm also not concerned enough to seek out a second opinion. Even in the age of the internet, there are limits to how self-informed patients can be; at some point, I have to accept the recommendation of someone who has much more expertise than I do. I have known for a couple of years that my bone density is marginal, so I'm more comfortable with having a titanium plate down there stabilizing things.

[Lets_Play_Two]

I don't blame you, I wasn't offering a 2nd opinion, simply my own experience. You will really drive those TSA guys nuts with titanium in your foot!!!

[Marty Hill]

Doubt it, my shoulder has never rung the bell. Titanium been in there since before 9/11.

[Selden]

If I have any choice, flying has been at the bottom of my list of travel options since 2001. Paul says his wrist plate causes no problems with metal detectors -- too soon to tell.

[ESokoloff]

OUCH!!!!!

 

Mend well & fast Selden.

[SageRider]

Heal well!

[Bologna]

Good Luck Selden!

 

[CarrotNC]

Be a patient patient, and don't rush things -- doc and physical therapist will help guide your recovery. But at same time, push yourself. It'll be a long recovery.

 

Couple years ago I had a lisfranc fracture & midfoot dislocation (#9 bone in your picture), and snapped the cap off my ankle. One plate and 8 screws later my foot is strong as ever -- but I'll never run full speed again. Have only set off a metal detector once since then.

 

Doc said the metal parts may eventually become bothersome and if so, can be removed. During flights or strong weather fronts, my foot will ache for a bit, but not enough to warrant surgery! However, twice now I've had the foot "lock up" like someone put a locking pin into the ankle -- traction will free it, just have to pull until it pops. Like you I'm just not ready to have that area sliced open again.

[Selden]

Thanks for all the expressions of support. I think everyone on a forum like this realizes "There, but for the grace of god..."

[Selden]

I'm free! After hanging around the VA Medical Center for the past year, I really wasn't prepared for the pampering at the Emory Orthopedic and Spine Hospital. Instead of patient checkin, they have a "Guest Services" desk. And, instead of whatever we choose to serve crappy hospital food, they handed me a full menu. I can hardly wait to see the bill.

 

The surgery lasted for 3 hours, including one hour to reconstruct the cuneiform bone, which the surgeon described as a jigsaw puzzle. The outer part of the bone is attached to a tendon from the heel, which had retracted and flipped it 180 degrees, and the tendon also needed repairs. The bases of two metatarsals were cracked, but not displaced, so no problems there. Two plates holding everything together. He said he was very pleased with the outcome, but right now, it just hurts, although not as badly as the first 72 hours after the accident. Unfortunately, no more morphine now that I'm back home.

 

Two weeks in a splint, then post-surgical evaluation and a cast for 6-8 weeks, then 6-8 weeks more before I can put 100% weight on the foot. In the meantime, I'm getting a knee walker to get around with fewer collisions with the walls and woodwork of the house, which is going to need a thorough repainting when this is over.

[yabadabapal]

Selden, Im just catching up on your news here as Im getting ready to take off. Congratulations on seeing this through with a good attitude and a volume of valuable information you used to make the right decisions and choices. Heal well and keep going.

 

Best wishes to you.

[decorbin]

I had an accident in 1998 that pretty much crushed my right leg below the knee. Two days after the first surgery, I feel in a hallway and couldn't go down with the crutches so I tore both rotator cuffs. That put me in a wheelchair for the better part of a year with all the surgeries on the leg and both shoulders. I saw a lady with one of those knee walkers today. I guess they hadn't thought of them then, because I did not like the chair.

 

Good luck with the recovery. Sounds like your've got the right attitude.

[Bologna]

Glad to hear that the surgery went well, maybe we can swap x-rays of our metal plates

[Haynes]

....no more morphine now that I'm back home.

 

That's a major tragedy.

 

Look after yourself and heal quickly.

[Mike05]

Selden,

 

Glad you're into the recovery process; heal well & completely.

[Chris K]

Glad you surgery went well, Seldon. I hope your bones mend fast and straight.

[Marty Hill]

Heal fast and well!

[Lets_Play_Two]

If I have any choice, flying has been at the bottom of my list of travel options since 2001. Paul says his wrist plate causes no problems with metal detectors -- too soon to tell.

 

Guess I just have more titanium than the rest of you!! My hip sets the bells off every time.

[Selden]

I had an accident in 1998 that pretty much crushed my right leg below the knee. Two days after the first surgery, I feel in a hallway and couldn't go down with the crutches so I tore both rotator cuffs. That put me in a wheelchair for the better part of a year with all the surgeries on the leg and both shoulders. I saw a lady with one of those knee walkers today. I guess they hadn't thought of them then, because I did not like the chair.

 

Good luck with the recovery. Sounds like you've got the right attitude.

There is always someone with a worse story for consolation. I tried crutches a few times, but with my left arm in a cast, they just felt too risky. We went out to a restaurant last Saturday night, and I just stood at the curb for a couple of minutes while my wife parked the car -- I was having visions of tipping while trying to jump the 4" curb. I'm doing fine with the wheelchair, but our house dates from the mid 60's, with a fairly long hall and narrow doorways, so I'm tearing up the woodwork and the walls. I was planning to repaint this year anyway.

 

The biggest reassurance is hearing from the number of people here who have had similar or worse injuries who have made complete recoveries. I was never a runner, so no great loss there; we'll see how hiking goes. When I feel up to it, I plan to get on one of my wife's 250's first, then the Hawk, and finally the R1100RT -- but not until I feel I can use a centerstand safely.

[Nice n Easy Rider]

Wishing you a speedy recovery Selden.

[CarrotNC]

Something to keep in mind is that the physical therapy equipment they'll have you using can be bought for home use. Best device I picked up was a pair of "fitball balance disks", although I also tried the "cando foam roller". Even with shipping it was under $60 USD.

 

The therapist has a wide array of devices available, and will find what works best for you -- follow their lead and then I'd recommend buying the devices you like best. Working with them at home a few minutes throughout the day can shorten the rehab time and lessen the tired/sore feelings that can come from only using those muscles/joints at their office. When finished, the devices can be donated.