Tibial Plateau Surgery - Titanium Man

March 17

This afternoon I had an appointment with Dr. Allan Maples of The Orthopaedic Center here in Huntsville.  They took another round of x-rays, and then we discussed.  He showed us the three pieces of the upper tibia that had broken from the main part of the bone.  Basically, there is one piece on each side and the third piece is down the middle.  The middle piece has been pounded down by the impact.  The top of the tibia plateau has an indentation that looks like a ball mark on a soft putting green.  So, the surgery will raise the middle section and then screw everything together.

Dr. Maples estimated I will be non-weight bearing for 8-12 weeks, but I will be able to bend my knee.  So, I am hopeful that I will be able to drive the automatic sedan we have very soon.  Our other vehicle is a Ford Bronco with a manual transmission.  Fortunately, Martha can drive that easily even though I usually drive it.

March 19

Surgery went well today.  The first surgery to install the external fixation took all of 20 minutes.  This surgery was much longer at more than an hour and a half.  According to Dr. Maples PA, Mason, it all came together as well as it could.  Mason was optimistic on getting weight on the leg in 6-8 weeks.  However, it really matters on how well things heal over the next several weeks.  I have an appointment back with Dr. Maples on April 9 when the stitches should come out.

No glue or extra bone material required

As best as I can tell at this point, two plates were used and a total of 16 screws—one less than Lindsey Vonn needed. 

March 20

I got released from the hospital this afternoon.  This morning before breakfast, I worked with Sara, the PT.  She had me crutch up and down the hallway once.  She also opened up the splint, and she bent the knee a little bit, maybe 10-15 degrees.

My industrial brace

March 22

Nathan and his two oldest boys came to visit this weekend.  Nathan is going to deploy on the USS H.W. Bush any day now.  It was great to see them even though we had just seen them for Seb’s birthday three weeks ago.  They left this morning, and I put in my first self PT session.

My leg is in a brace that can be locked straight or unlocked.  I worked all variations of straight leg raises on the floor—on my back, side, and belly.  I also added in some crunches.  Then I unlocked the brace and worked the range of motion for 10 minutes or so.  At this point, I can bend the knee about 25 degrees.

Never stop running (unless you have a broken leg or a knee replacement),

Darin

Fracture of the Tibial Plateau in my Left Leg

 March 9

14 years ago on this day, I experienced the most significant injury to my running career.  I tore the ACL in my right knee doing large ski jumps.  On this day, I wasn’t doing large jumps; rather I was cruising quickly down a groomed, but icy double blue run in Big Sky.  As I neared the bottom of the run, carrying around 46 mph, I came upon other skiers and began to scrub some speed.  I am not sure what went wrong, but I lost control and crashed hard.  My right ski came off, but not the left one.  Immediately, I felt pretty intense pain in my left knee.  Oh no, have I torn my left ACL?  Painfully, I disconnect my left ski and another skier asks if I want him to get ski patrol.  Initially, I say, “give me a minute.”  Then while I am still lying on the ground in significant pain, he says, “I will go get ski patrol.  At worst, you will be up by the time they get here.”  I respond okay and wait for the pain to lessen.  The pain doesn’t lessen, and ski patrol is to me in less than two minutes.  Erich hiked up to me and immediately began to assess the situation.  How old are you?  What hurts?  Did you hit your head?  What is your pain level?  My answers:  57, left knee, no, 8-9 and by the way, I am an ultrarunner, so I understand pain.

The last thing I want on a ski slope is to be carted off on a sled.  Erich calls in the sled, and they immobilize my left leg as best as possible with a leg splint.  They put two wedges behind the knee to keep it slightly bent.  Then they strap me into the sled and down the hill I slide.  Off to the side of the ski lift, the sled is transferred from a human to a snowmobile.  The snowmobile drags the sled and me to a waiting a Suburban.  (It was offered to call in an ambulance, but I declined.)  I get loaded from the sled into the Suburban.  Every movement of the left leg brings intense pain.  The Suburban takes me to the slope side medical clinic.

Erich and another ski patrol person strapping me into the sled
Credit:  Stefano Coraluppi

Martha is waiting for me at the clinic.  They put me in a wheelchair, elevating the left leg.  Martha notes that I am in more pain than I was 14 years ago with my right ACL.  Perhaps I did more damage than my ACL?  The clinic staff takes off my right ski boot and attempts to remove the left one.  That is not happening as flexing the foot and pulling on the leg creates the most pain I have felt in my lower body.  Okay, they decide they can take the X-Ray with my boot and ski clothes on me.

In the Big Sky Medical Clinic

In the X-Ray room, I ask for some drugs.  Let’s start with 800mg of ibuprofen.  They bring me the vitamin-I, and I am then able to get on the X-Ray table.  I am still laying on the X-Ray table when Martha comes in and tells me I broke something.  She shows me the X-Ray, and my first thought is that might be quicker to recover from than a torn ACL.  Erich stops by and says he didn’t think my pain symptoms were lining up with an ACL, and he feared it was a tibial plateau fracture.  He wishes me a speedy recovery, and I sincerely thank him for his most expert first aid care.  The clinical staff determines that I need to go to the hospital in Bozeman as surgery is likely necessary.

This tibia fracture doesn't look as bad as Lindsey Vonn's

So, Martha gets the car, they load me in the back seat, and off we go for the hour drive down to Bozeman.  Before leaving the clinic they give me 1000mg of Tylenol.  Martha pulls up to the Emergency Room entrance, and a nurse comes out with a wheelchair that doesn’t have a leg extension capability.  I tell her that isn’t going to work, and so she goes and gets a gurney.  With a little assist, I hop on the gurney and they roll me inside.  The doctor on call for trauma cases is Dr. Jon Robinson.  He will be in shortly, but he wants everything off of my legs before he gets there for the first surgery.  Wait, did he say first surgery?  Yes, they will likely install an external fixation, and then I can travel home for the next surgery to install hardware inside the leg.  So, a couple of nurses and at least one nurse’s aide start to get the layers off.  Of course, most of my clothing is swag from an ultrarace.  First off is the left ski boot.  With one nurse holding my leg and two more manipulating the boot, we manage to get it off without me screaming.  Next off are my ski pants then a pair of thermals.  The socks I am wearing are Darn Tough socks that were swag.  The nurse asks about Darn Tough socks, and I explain that I prefer DryMax over Darn Tough for running.  Finally, off comes the base layer—an old pair of running tights.  They let me keep my underwear on!  Then the top layers come off—Patagonia Hellgate 100k finisher shirt and a thick synthetic running shirt.  They let me keep my Twisted Branch 100k t-shirt on in addition to my underwear.

Post Surgery with the External Fixation in Place

Dr. Robinson comes in and briefs the surgery he is going to perform and soon the anesthesiologist is putting the drugs in the IV.  They whisk me off to the surgery, and it is performed in 20 minutes.  I spend almost the next 24 hours in the hospital.  The nurses check on me every hour to ensure compartment syndrome is not setting in.  I make it through the night with just some additional Tylenol.  Before getting discharged, a CT scan is performed, and we are given the DVD to take with us back to Huntsville.  I have an appointment with Dr. Maples on Tuesday to determine when and how the next surgery will be done.  Until then, I am hobbling around on crutches with the Ex-Fix and no weight on the left leg.

Back in Big Sky Resting Comfortably

Never stop running (unless you have a broken leg or a knee replacement),

Darin