"Mount Snow - Vermont" January 20, 2000  Before |
 During |
 After - At Mt. Snow |
 Future |
1999 Ski Trip || 1998 Ski Trip || Doc's Other Adventures
The X Rays || The Last Time Doc Broke Something...
Doc's Physical Therapy
It was January 20, 2000. Four of us headed to Mount Snow, Vermont, a place where we used to do a lot of skiing together.The crowds were light, since it was a Friday and the temperature was hovering around ZERO, with 15 mile per hour winds.
We were taking our 8th run of the day, when I took a terrible fall on Olympic, a Black Diamond trail on the North Face.
My ski boot self-destructed as I fell, and I knew instantly that I would not be skiing the rest of the way down.
"Mount Snow - Vermont" January 20, 2000 Before |
During |
After - At Mt. Snow |
Future |
The Ski Patrol arrived and quickly applied a "Box Splint" to my leg and I was transported to the Base Lodge on my back in a First Aid sled by Dan and Cheryl from the Ski Patrol, where the X-Rays indicated that I had a triple fracture, with surgical intervention a certainty, according to Dr. Harry.I knew it wasn't going to be pretty when Terry, his X-Ray Technician said with a smile, "You must have a high tolerance for pain. You're going to have to speak to the Doctor".
I remembered Dr. Harry Haroutunian from the "old days", when I used to rent a ski house in the area, so he and his friendly staff packaged me up for a return trip to Connecticut.
Surgery was performed on February 1st, when Dr. Spinella installed 9 Titanium screws and a metal plate in my right leg.
Before and After
April 1, 2000
Simply put:
- There is a transverse fracture of the medial and lateral malleolus and a fracture of the distal fibula.
- There is lateral subluxation of the talus with widening of the space between the fibula and tibia .
- The combination of fractures seen here is classic for ankle eversion. The lateral subluxation of the talus is associated with an avulsion of the medial malleolus. The displacement of the distal fragment of the fibula indicates disruption of the tibiofibular ligament.
Malleolus fractures are typically classified by one of two systems. The Lauge-Hansen fracture classification relies on the position of the foot at the time of injury and includes four types:
- supination-lateral rotation
- supination-adduction
- pronation-abduction, and
- pronation-lateral rotation
1999 Ski Trip
The Danis-Weber system is based on the level of the fibular fracture relative to the ankle joint . It includes type A, fracture below the ankle joint; type B, fracture at the level of the joint, in which the tibiofibular ligaments are most likely intact; and type C, which occurs above the joint and disrupts the syndesmotic ligaments. In both the Lauge-Hansen and Danis-Weber classifications, a fracture higher on the fibula indicates more instability and, therefore, a greater likelihood of surgical intervention.
The initial treatment for all displaced malleolus fractures is closed reduction and casting
followed by ice and elevation. If an anatomic reduction is obtained, these fractures can be managed with a cast. However, postreduction radiographs must show that the joint space is symmetric on a mortise view (figure 3) because even 1 to 2 mm of displacement of the talus within the mortise can cause dramatic changes in the contact area and pressures within the ankle. One study demonstrated a 40% decrease in contact area with a 1-mm lateral shift of the talus.
Because of this potential for change in the contact area and pressure in the ankle
with an intra-articular fracture, surgeons recommend open reduction and internal fixation of persistently displaced malleolus fractures to guarantee an anatomic reduction. An added benefit of operative treatment in an athlete is a more aggressive, early rehabilitation. Range-of-motion exercises can be started after wound healing, but compliance with non-weight bearing must be emphasized.
Most patients with a malleolus fracture require 6 weeks of immobilization. Patients with a displaced ankle fracture that has undergone successful closed reduction will typically require 2 to 4 weeks in a long-leg cast and then an additional 2 to 4 weeks in a short-leg nonwalking cast.
Patients with an initially nondisplaced fracture or who were treated surgically will generally require 4 weeks of non-weight bearing in a short-leg cast or removable walking boot, followed by 2 weeks in a walking cast or boot. The removable boot will allow for earlier range-of-motion exercises.
Maisonneuve. A Maisonneuve fracture--an external rotation injury of the ankle with an associated fracture of the proximal third of the fibula--is a serious injury that can have deceptively minor radiographic findings. Although less common than other types of ankle fractures, it is often misdiagnosed and can result in long-term disability. The typical mechanism and presentation are external rotation of the foot and medial ankle pain. On examination, the patient will have tenderness over the deltoid ligament and over the fracture site on the proximal fibula. Any patient who has proximal fibular tenderness after a twisting injury to the ankle should have radiographs taken of both the ankle and the tibia and fibula.Radiographs of the ankle generally reveal no fracture or only a small avulsion injury of the medial malleolus with variable widening of the space between the tibia and fibula. A radiograph of the whole tibia and fibula, however, will demonstrate a high fibula fracture. These patients require open reduction and internal fixation with one or two screws placed between the distal fibula and tibia to maintain the bones' normal relationship while ligament healing occurs. The screws are generally removed 8 to 12 weeks after surgery.
How is the ankle designed, and what is its function?
Miracles Can Happen
Saint Francis Hospital and Medical Center.
These guys are all genuinely good guys, and great doctors, and I couldn't have been in better hands. Thank You, gentlemen.
I may actually play violin again!
After I was released from the hospital, I'm was placed under the care of Registered Physical Therapist
Thomas M. Sweeney and his friendly, able-bodied staff and very capable assistant Sean, at Suburban Physical Therapy. Now I know where the expression "No Pain - No Gain" came from.
Photo From First Round of Golf June 4th, 2000Here are some photos from my Physical Therapy...
Meet Doc's Physical Therapists
OTHER ADVENTURES
1998 Ski Trip | 1999 Ski Trip
RELATED LINKS
[ VERMONT | WELCOME TO THE STATE OF VERMONT | TRAVEL LINKS ]
[ VERMONT SKI CONDITIONS | OKEMO | KILLINGTON | MOUNT SNOW ]
[ VERMONT SKI AREAS | THE BED & BREAKFAST CHANNEL]
[ The Deefield Valley News - Hometown Newspaper ]
References for Ankle Injuries Medical Links
National Institutes of Health
American Heart Association
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