Category Archives: tibial plateau fracture

A Recovery Asymptote

In math, an asymptote is a value that is approached infinitely closely, but never quite reached. Think of a curve that approaches a straight line, but eventually runs almost parallel to it, getting closer but never touching even out at infinity.  That’s what recovery from my accident feels like.

I’m still making progress, but the increments are getting smaller as I get closer to normal.

On cursory inspection, strangers probably don’t notice my limp, although I still feel that my stride is a bit constricted. I’m starting to feel a bit sheepish about using my handicap parking placard. I do still need it, because I get tired quickly and the limp increases. I’m ever so grateful to come out of a store and find my car right there. The permit expires at the end of October, which will probably be just about right.

I was discharged from physical and occupational therapy at the end of August. It was a strange feeling to say goodbye to people I had worked with thrice-weekly for almost five months and have them tell me they hoped to never see me again, at least at their workplace. Although technically I was functional, being able to walk a short distance without assistance, I still felt far from normal. The burden of returning to my former state, however, shifted from the insurance company’s pocketbook to mine.

I followed instructions to explore gym memberships and finally decided that I would hire a personal trainer for a period of time to help me approach those intimidating machines. After three weeks of work, I’m certain that was the best choice. My teenage son may find the image of Mom lying on a bench pressing 12-pound dumbbells funny, but he didn’t have the broken arm. Now I have a clue how to use all those machines, and how much weight I can use. My trainer has a master’s degree in sports medicine, so I’m confident that he knows what I should and shouldn’t do, and how to get me better in the most efficient manner possible. Having a knowledgeable person there to coach and plan the program is a good investment. I wish I could keep him indefinitely, but he is expensive, as he spends that full hour right at my side, making sure my form is proper and safe and even counting repetitions.

I can tell I’m making progress as I’m able to do more without so much pain. Balancing on the bad leg is a pretty good indicator, since that was the most wicked thing to do after going to full weight bearing. I can now do warrior III (without the arms) all the way horizontal, holding for five breaths. That’s huge! Only three months ago, I struggled to just lift the good leg off the ground for a quick step.

Now I’m mentally working at regaining a normal routine, homeschooling, grocery shopping, cooking, and (very occasionally) cleaning. Everything takes longer than normal. I get tired by evening, especially after workouts or long walks of any type. Since that’s my productive art time, I feel I’m not getting anything much done. But slowly, ever so slowly, I am inching back. I’m just trying to view this as time to reevaluate what I’m doing, to think about new ideas, to let the creativity percolate before it comes whooshing back.

It’s hard to make people understand the magnitude of this injury. 99% of broken legs are different, with casts and crutches for 6 to 8 weeks and then back to life. Tibial plateau fractures are life changing. Sometimes people get totally back to normal, like the Olympic slalom skier who earned a silver medal eighteen months after one (was it normal, or should that have been the gold?). Sometimes people begin a long sequence of surgeries to repair problem after problem. It looks like I’m one of the luckier ones, even if I never quite reach that asymptote.

Recovery Update

The PMC conference was really good for my walking progress. You know how big a temptation it must be to have an incredible bead shop just blocks away from the hotel. Ignoring the bum leg is possible, if there are enough distractions around. I did make it to the bead shop, then further to lunch and back, with no assistance. Red coral, tanzanite, amethyst, chalcedony, green amethyst, moss aquamarines, freshwater pearls, aquamarines, and apatite were just too hard to resist.

I came home immediately and dumped the crutches for good. I don’t plan to use them again, although I still limp some — badly, even, when I’m tired. I’ve started walking down stairs in an alternating pattern, which is much harder than going upstairs, which I’ve been doing for several weeks now. For someone who lives with seventeen steps, being able to negotiate them multiple times per day is important. I just consider it part of my therapy, and go slowly, always holding the rail.

Finally, finally, finally, I think I’ve closed the unhealing wound on my calf. Everyone seems to think it was actually a very deep pocket open down inside that had to fill from the inside out. Going to the chiropractor three weeks ago was a turning point, as she has been treating me with cold laser therapy. The mechanism of that treatment is a bit of a mystery, but it seems to bump up cellular metabolism for faster healing. The scar that has bothered me a huge amount is also responding to the treatment, with lessening of the worst pain. 
Physical and occupational therapists are starting to hint that discharge is coming in a few weeks. I’ve graduated to the elliptical exerciser, which is quite difficult for me now, but I expect it to get easier as I work at it more. Balancing on the bad leg, even while standing on the small trampoline, is now doable, at least for a count of ten. I finally got one of the therapists to work with me on getting down to and then up from the floor. I thought it would be difficult, but it was actually quite easy. I’m thinking of going to a gentle or restorative yoga class to see how that would feel.
I did have to rest a lot this last week. Between visiting with my father, who arrived before I got home, and trying to get a few classes submitted for the Bead & Button Show next year, I just put my feet up a lot and tried to regain some energy.

A Bad Break

Today after I visited the surgeon, and got cleared to put full weight on the leg, I crutched myself over to the trauma hospital next door and got a CD full of the images of my broken body. Included are before and after X-rays of the leg and arm, as well as CT scans of my leg and head and the ultrasound run one night to see if I had a blood clot (negative).

side view

I’m pretty glad that I didn’t see these images until I had already assured myself that walking on the leg is possible. They might have scared me so bad that I would hesitate to try.

cross section

I knew that the original orthopedic surgeon who was consulted said “I’m not touching that. Those have high probabilities of bad outcomes. You have to go see the trauma guys.” I knew even the trauma specialists said it was a pretty bad break. I just didn’t really grasp how many pieces the bone could shatter into. Now I see why my operating surgeon said I’d pissed off the bone gods.

These images only give a few glimpses of slices through the bone at various points. Sitting at the computer stepping through the CT slices put me into near tears. It’s hard to believe that’s fixable. How is it humanly possible to do this much damage just walking along, with normal bone?

This 3D reconstruction gives a better feeling for how the top of the tibia is fractured into so many bits. I feel so fortunate to have great doctors who can screw and glue that back together, a healthy body that can mend quickly, and the fortitude to put in the therapy time that it takes to recover from this.

The doctor today said I’ve recovered remarkably well — can’t really ask for more. Only time will tell how I’ll do, but I am walking now with only one crutch, really for balance only. The leg is very, very tired this evening after pushing the muscles to take my full weight. Standing on the bad leg and raising the good leg to the side was one of the hardest things physically and mentally that I’ve ever done. Hopefully, I’ll sleep better knowing that walking is within my grasp.

Leg Hardware

I saw the surgeon yesterday and got rid of the arm brace as expected. The good news is that he also cleared me to advance from toe-touch only to partial weight bearing. That means I can now put 50% of my weight on the bad leg, allowing me to stand on both legs evenly although not walk yet. Well, as soon as I can convince my mind to put more weight over on that side. I’ll be filling my prescription for crutches after I return from Bead & Button.

A whole new range of exercises opened up for physical therapy, like tip toes on both legs. Hardest was the “Total Gym,” which allows squats at an angle so that the force is less. My quadriceps were seriously complaining after working five minutes at 30% total weight. Today I’m very tired afterwards. I iced down the knee, in hopes of heading off pain. I expect some serious muscle soreness tomorrow after the new work.

Here’s my hardware. The films from this week and six weeks ago look almost identical to me. I still need to go collect an image of what the knee looked like before the surgery. That might be scary, seeing that the surgeon said it was a pretty bad break.

Prepping for the Bead & Button Show

Four more days available to do everything needed before I leave for the Bead & Button Show. A little sense of panic begins to invade my space. Here’s my reality: I sleep in my living room in a hospital bed because I can’t get up the stairs. My usual studio space is up those stairs or down a couple of steps in the sunroom glass studio. I haven’t made it up the seventeen steps to the second story yet, but I did get out to the glass studio today by the roundabout route.

I used the walker shown above (see the platform for my right forearm, since I can’t put weight on the right hand yet?) to go out the front door over a couple of low steps down. It’s safer than letting my husband try to get me out in there in my wheelchair. Then I transferred to the wheelchair and he pulled me backwards over the new decomposed granite path around back (large wheel first is easier over uneven ground). Then he brought the walker around as well, and I could move around the studio. Perched on a tall stool, I cut glass tiles and molds for my students, then ground edges on the molds. It felt so good! And it made me want to spin around and try out the torch.

Yesterday I spent the entire day making tear-aways, reworking my procedure since I was having some issues with poor transfer. So today I have a collection of materials to pack. Check those off the list. Well, I did finish the copper electroforming handouts as well, a time consuming task.

Today I was very productive. Besides the glass work, I made new metal clay pieces for a Garden Window pendant. I need samples at various stages, including fired but unassembled. They’re in the kiln now. I edited my handout for that class. And I packed tools and supplies I need for the two classes I’m taking: a glass casting workshop with Susan Lenart Kazmer and concrete for jewelry with Robert Dancik. Two of my favorite teachers, so I should be filled with inspiration before I start teaching.

If you’re coming to Bead & Button and have Wednesday free, there are still a couple of seats in my class available. Or just come say hello.


Today marks seven weeks since my surgery. Next week I go to see the surgeon, hopefully to remove the brace permanently from my right arm. X-rays should show how well the bones in my leg and arm are mending and how much longer I’ll be wheelchair- and walker-bound. My face is still sore over the left eye, where I cracked the orbital bone, and I still have pink patches from the abrasions, but I don’t look like a car crash victim any more.

I’ve learned a lot about tibial plateau fractures. For example, only 1% of all broken legs are this type, considered to be a very challenging break to manage. There is a classification scheme that further subdivides these fractures in terms of how they’re handled. Although I don’t know my exact classification, I gather from the amount of hardware in my leg and the reactions of the orthopedic surgeons that it’s one of the worse versions. I know that the bone was broken into three main pieces, with the ACL pulling one piece out of place. Now I have two plates, one on either side, and about ten screws pinning it all back together, along with bone graft material. On my list of things to do is call the hospital to get a copy of the X-rays and CT images.

Drop foot, caused in my case by surgical trauma to the peroneal nerve, has left me struggling to control the muscle that lifts the foot and toes. Without the ability to lift the foot at the ankle, walking is difficult since the toes drag while the foot moves forward. Electrical stimulation of the muscle and nerve has led to a huge improvement over the course of the past few weeks. I’ve become proficient at picking up marbles with my toes, which I can’t do nearly as well with the left foot. The nerve damage was apparent immediately after surgery, and the surgeon told me that the nerve was sulking, but 99% likely to recover. This week I had a physical therapist in out-patient PT who worked with me as an in-patient. She gushed over the amount of movement I’m getting with the foot, so that’s reassuring that the improvement is real. I’ve graduated to lifting my foot enough to tap my toes, which I do every time I think of it. It would seem the surgeon is correct that the nerve will repair itself. It’s just extra work.

Beyond the third incision leading to a sulking nerve, it also hasn’t healed properly. Somehow the sutures weren’t as even as on the other two incisions. The tech who removed my sutures at two weeks was hesitant to take those out on the third incision, but the surgeon “wasn’t worried.” Within a day of the application of the steri-strips, I had indications that it had opened up. When the steri-strips dropped off the two well-healed incisions, this one remained open. Prescription antibiotic ointment and a lot of bandages have helped it progress, but it’s still scabbed over at seven weeks. I think the hole under the scab is very deep.

In spite of the wound, the occupational therapists allowed me to go into the heated saltwater pool this week. They seal over the small scab with Tegaderm, a waterproof dressing. I’m “toe touch weight bearing” which means that I can touch the toe of the bad leg down enough for balance, although I usually just balance on the good leg. Technically, I’m allowed 20% of my weight onto the leg. The buoyancy of saltwater means that I can walk in water at chest level. So I’ve begun to slowly walk back and forth across the pool.

Seven weeks of avoiding pressure on the leg is long enough to retrain the brain on acceptable modes of transport. My brain now believes that hopping on the left leg is the way to go. The right leg never relaxes while standing, but always hovers in the air. Retraining the brain takes conscious thought. Reach the leg forward. Put the leg down. Push forward with the good leg. Put weight onto the bad leg. Lift the good leg, while leaving the right leg down (!!!! something I haven’t done in seven weeks!). Roll forward on the right foot. Push off with the right foot. Stand up straight. In actuality, the buoyancy is so great that it’s hard to get a lot of forward motion out of pressure on the foot. A one-pound ankle weight helps.

Interestingly, the amount of brain involvement in the issue becomes obvious by trying different walking directions. Walking sideways or backwards seems almost normal, because the brain has not retrained those methodologies. Treading water feels totally normal.

The standard treatment for this type of broken leg is no walking for ten to twelve weeks, so I have up to five more weeks to go until I can start partial (50%) weight bearing. Right now I’m looking forward to being able to weight bear on the right arm, which will relieve me of the platform on my walker. Regaining the right arm hopefully will make getting upstairs a possibility for me, as well. I’m wondering if the surgeon will recommend crutches as an alternative to the walker. I feel I might be a menace to myself on crutches. While my fine motor coordination has always been extremely good, the very fact of this injury lends credence to my lack of gross motor coordination.

Luckily, I’m not having much pain anymore. I totally weaned off the narcotics as soon as possible after seeing my regular doctor. Since I typically never take any painkillers, four weeks of heavy narcotics were scary. My very alternative medicine friendly doctor was obviously nervous about the oxycontin usage, even at the lowest possible dose, and recommended immediate discontinuation. I did manage to do that, with some withdrawal issues, and continued on the hydrocodone for another week or so. Now I take an occasional ibuprofen, but rarely need that. I expect pain management may become more of an issue when I can actually put weight on the leg again.

For the foreseeable future, three days per week of therapy, two hours per day, will be my lifestyle. Add in the hour round trip travel and my days are shrunken. Add in the fact that EVERYTHING, from showering to dressing to loading into the car takes at least twice as long as normal, and the days don’t have enough time in them for everything I’d like to do, like writing more on this blog.

For my initial post on my injury, telling how I got into this crazy predicament, go here. For Frankenstein photos of the injury, try here. For a laugh over my garage shower, see here.

Garage Shower

Every invalid deserves a shower, even if they can’t get up the stairs to the built-in kind. Outside showers can work, for example, camp showers, but neighborhood privacy can be an issue, not to mention the hobbling to the location. Then there’s the deluxe garage shower build by a handy brother-in-law. I’m thinking I should write this up and take it to the rehab hospital for them to show others in the future that have the same issue.

This is essentially a shower fixture, with handspray, mounted onto a piece of plywood, then suspended from the two door rails in the center of my garage. Eyelets and rope hang a couple of shower curtains around the shower bench (standard medical supply issue). A non-slip mat and ladder shelving complete the ensemble. Just makes you want to zip outside for a toasty warm shower, doesn’t it? Oh, remember the garage is too large to steam up, so a warm afternoon is best. Just hook up the water lines via long hoses to the nearby laundry room washer supply and open the garage doors to drain.

Making While Disabled

Healing is humbling. It’s just such a total mental shift to suddenly, unexpectedly, be unable to do all the things you take for granted. How to cope?

In the hospital, one morning with delayed rehab, I started doodling my standard branches with birds onto my cast. Understand, I’m right-handed and the cast was on the right hand. It took an inordinate amount of time to dig through the art supplies left-handed, testing all the pens in my tote bag to see if anything would mark on rough fiberglass and plaster. Then it took even longer to slowly, carefully etch in a few branches and a bird, left-hand style.

I had such grand plans for that cast, color washes and detail work, a page from my bird journal worn on my arm. And then the surgeon cut it off after less than two weeks! I never took photos because it was a work in progress, and I thought I had weeks of work yet to go. Funny how you can cheer the saw (and plead for a moment to scratch before they immobilize the arm under the X-ray) and simultaneously rue the loss of a canvas not completed.

Now that I’m home, the first order of business was to set up some means to create. That’s the real test of an artist, I suppose — the need to make something, even something minor, no matter the limitations. Despite stupor inducing medications, drudgery with weights and therabands, extreme fatigue that turns an insomniac into an afternoon napper, and a body that isn’t up to it’s usual stroll across the room, let alone artistic finesse, I need something to show for the long hours, some distraction that reassures that at heart I’m still functioning.

My dear family understands that I must make things. After all, I left a science research career after the birth of my son made clear that some readjustment was required to leave time for sanity-saving making. Hence they rearranged the downstairs for me (suggesting that this was all a plot on my part to take over even more of the house for work space), complaining of sore calve muscles after myriad trips up and down the stairs to bring load after load of supplies down. The “nice” dining table is now covered with metal clay supplies, pliers and punches, bits of wire, and finally my desktop computer, so that I can access the full array of photos and back e-mails that need attention. DH has become my studio assistant, trundling trays of clay out to the kiln in my sunroom studio, two unnavigable steps down, a world away, and doing his best at shooting the results in my photo tent upstairs.

I have slowly regained more capability with the right hand, even adjusting to typing in the brace, only erasing ten times more than usual, rather than a hundred. I’ve learned to hammer left-handed, to give verbal pictures to direct DH to whatever I need upstairs or outside, to make slow but steady progress on little bits of stuff.

Maybe simplification is the order of the day. Or working in components. At any rate, I’ve told myself that what I make doesn’t have to be good, it just has to be. So, I finished off the almost dried-out clay from three weeks ago and opened more. I completed the clasp parts sitting there waiting and fired them. I tried the new flower templates and made a couple of pairs of earrings as a test.

Progress, slow but steady. The artist heals, as does the body.

Going Home from the Hospital

I’m thrilled to be heading home today, on day 17 of my hospital saga.

The cast has been removed from my arm and replaced with a removable brace so that I can shower without the plastic bag encasement. My leg looks so much less Frankensteinish now that the sutures are gone and fifteen steri-strips reinforce the seams for a final week. The swelling has reduced dramatically, so that I no longer fear my leg would pop if stuck with a pin. My face has healed very quickly, and while I no longer look like a car wreck victim, I still have a knot over my left eye where the bone is knitting back together.

There’s still a long road ahead, as I am forbidden to put any weight on the right leg for 10-12 weeks total. That’s the standard for tibial plateau fractures. Evidently the top of the tibia was crushed and collapsed. The surgeon glued lots of pieces back together with bone graft material and it needs time to do its job. Any weight in the first three months just serves to recompress and collapse the plateau again, so I will avoid that assiduously.

Casting is not done on these breaks however, because knee mobility has to be regained right at the very beginning or lost forever. Hence the past ten days of painful therapy to get that leg to both straighten and bend, while still supremely painful from trauma and surgery. I also had the extra fun of a damaged motor nerve from the surgery that is luckily responding to electrostimulation. It’s there, but needs to relearn how to bend my foot properly.

I’m told I have a good attitude in that I look at each day’s small progress as a victory and try not to think about how many months remain before I can walk again. See, those perfectionistic tendancies can be good — I can see the little stuff!

Meanwhile, I search for meaning and some insight into what I should do differently. Mostly, I think it’s just a sign that life is not controllable. We do the best we can; and we adapt when things fall apart. Ultimately, we can’t really control what happens to us, just how we respond.

Yes, unquestionably I was overscheduled. The electroforming class scheduled for today just could not be managed, but maybe I can practice my wheelchair instructor technique next month.

The trip to visit my father to start sorting through my mother’s things will be postponed for some time. I got car transfer training with a physical therapist at the rehab hospital, but they don’t seem to offer small plane transfer training. 😉 I’m having trouble visualizing climbing the wing of the plane with a walker.

The weekend bed and breakfast escape for our wedding anniversary on the 19th was substituted with gorgeous flowers and a box of chocolates. NOT the same, but the B&B was understanding, and we have a year to reprise the holiday.

The workshop next weekend with German lampworker, Anastasia, is not to be. Banned wrist movement on my dominant arm will not yield pretty beads, so I hope someone on the waiting list has a fun time.

The trip to Italy with DH and DS has been canceled. I simply can’t imagine tolerating those long flights, not to mention hobbling through Florence streets and Italian train stations on one leg. Later… Unfortunately, Keenan still has to go for work. That means I’ll have enough challenge just to be at home without him the first week in May. The 16yo is a huge help, and I have tons of offers of help that I WILL be accepting, but emotionally it’s hard to face it without my other half. Please behave nicely, volcano! I need him back ASAP.

As of now, I’m still planning to attend Bead & Button. With the help of my incredible friends and family, I trust I can still teach my two classes. That’s one dream I’m not yet willing to give up.

Maybe that’s part of the lesson here: pare down the focus to the things that really matter and make those happen.

At any rate, I’m looking forward to being at home, surrounded by spring in my new garden, my tools and art supplies, real food, and people that I love. Time to get going back in my normal direction, albeit with one foot off the ground and one hand hanging free.

Freak Accidents

So I’ve vanished from the planet, unless you saw my two short FB posts.

What has happened is a freak accident. I went for my regular morning walk with DH. I took a bad step on the back part of the neighborhood loop, and inverted the knee hard enough to snap the tibial plateau. Then I fell, cracking the orbit of my left eye and fracturing the right wrist.

After surgery by the central Texas specialists in such trauma, I’ve spent several days in the trauma hospital, weaning off morphine. Now, I’ve transferred to a rehab hospital, where I’ll learn the skills I’ll need to go home.

Already I’ve learned to push myself one-handed in a wheelchair and how to dress myself. Very tight schedule here, and not my usual aides, so blogging is short-changed. Read about my enamel project on the Master Muse blog.