Removal of plate and screws from tibia fracture

@caligirlian I can sure relate. I broke my ankle (both tibia and fibula) in a compound open fracture in May and I have 2 plates with 3 screws apiece and a screw inside the fibula. I am in physical therapy now and working on rehab. Some of what they are doing is related to retraining my body to stop feeling pain at the surgery sites. I am supposed to rub both my ankles with a dry washcloth or brush so my body pays attention to what that feels like for the normal uninjured ankle. Just yesterday, the PT did a graston technique where they scrape the skin with shaped steel tools. This helps stretch the ligaments and tendons and work out some of the inflammation to aid in range of motion. She also did this to stretch the scars that are attached to the bone. The trauma of breaking the bones and surgery creates scar tissue in the fascia which makes it tight and the purpose of the therapy is to break up the fascial tightness. The bones themselves do not have nerves in them, but the outer covering of the bones is highly innervated. When nerves are inflamed by an injury, they heal very slowly. I still have some nerves in my foot that get touchy and tell me when to stop and get off my foot. I also had a bad experience from a spinal injection a few years back that caused bad stabbing nerve pains from the pressure of the fluid and that took about 6 weeks to calm down, and I had cold sensitivity in my hand for a year and a half before it returned to normal. You are very early in your recovery from the plate removal, and it needs more time. I also have some pain with my hardware and my surgeon said if it still bothered me next summer, he could remove the hardware. The bones are actually part of the fascial (connective tissue) system which contain the hardened calcified cells. A fracture with displacement of the bone and surgical hardware will pierce the outer covering on the bone. My PT also does myofascial release to stretch the fascia and get it moving again. Right now, my leg is weak from staying off of it for 3 months and not aligned properly because muscles are not doing their jobs and it hurts my knee and hip to walk because of the mechanics issues. I developed tight rock hard muscles on the inside of my ankle that extend up and pull into my knee causing pain on the inside. I have to work to fix this because I don't want to wear out my knee because of improper walking. MFR can relieve pain when the tight tissue is released and it gets the body back to proper ergonomics. You may want to look into that and find a PT who also does MFR. There is a lot of information in our MFR discussion and you can search for a provider on the MFR website. Here is the link. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Hi,
Thanks for responding. I have not been to a Physio- therapist? I believe I’ve searched for one in the past and could not find one. I could ask my Orthopedic surgeon if they could recommend one. I understand some of what they do after reading about it. But in comparison to PT how will it help?

Now I use a tens unit w/ heat and ice.

My biggest concern is every time I walk I feel mostly tissue crackling, tendons or muscle stiffness & or tenderness which feels more like bone crunching which after awhile gets to my head and then I take something for the pain but I don’t want that to become a habit.

Very relieved to have my internal hardware taken out though. I don’t feel the real scratchy sensation that the screws created which felt more like glass cutting up my skin when I would turn the leg left or right I felt in my lower knee. I feel relieved to that my plate came out as well as my bones are relieved and the plate doesn’t press on my fibula or under my knee as much but the pressure is there still. I did some stretching and I believe it relieved that pain but it does come back. Maybe it will take time to eventually stop hurting but need to get more relief.

“The trauma of breaking the bones and surgery creates scar tissue in the fascia which makes it tight and the purpose of the therapy is to break up the fascial tightness. The bones themselves do not have nerves in them, but the outer covering of the bones is highly innervated. When nerves are inflamed by an injury, they heal very slowly.”

Oh just another thought; your above statement is pretty accurate in how I feel and that Physio therapist might possibly help. I’ve spent so much on PT as it is and I just don’t wanna spend anymore after everything now heading into two years from Oct. 2018 post- op trauma!

Thanks for putting words to what I was thinking. I really want this to over!

@caligirlian Oh I understand the costs. This is the worst year ever for out of pocket costs for medical care for myself and my husband and we have both hit the out of pocket maximum. The good thing about Myofascial Release is that once you understand how it works, you can do a lot of it yourself. Some things you can't do because you can only use your hands in ways and from angles that you can reach. You can also do a lot by laying on a ball or several of them. Stretching fascia is a shearing motion and you have to press and hold it and wait for it to release. A MFR therapist can train you how to do this and you will learn what it feels like when the release happens. There are also some books on fascial stretches written by physical therapists. They might be available on the MFR website. If not now, you could try MFR anytime. Bad habits or bad posture can add to fascial problems as time goes on because it create layers of tight tissue that you will need to work through in layers later on. Sometimes an early approach especially after surgery is better before a new pattern of tight scar tissue is set. There are also workshops taught for the public by therapists from Therapy on the Rocks (John Barne's practice, the guy who developed these techniques) usually once a year in various locations. You could also try a few sessions with a PT as an experiment and see if you think it will help, and then decide. If you do that, look for an "expert level" certified MFR therapist in the John Barne's methods. This is a highly skilled touch by the therapist who will be able to feel how the pattern of fascia tightness weaves through your body and where it will pull on something else. I have done this MFR work for several years and it has benefited me a lot. I do work on it at home and invent ways to stretch.

Hi Jennifer and @caligirlian, EEeeouch!!! I hate what you have and are going through! 😥 My skin is so painful that a washcloth feels like sandpaper on it. Oh I so hope this works for you even a little but mostly a lot!

Just reading what you guys have been through with your fractures, makes my decision whether or not to begin bisphosphonates even more difficult. I was thinking that the potential side effects to the toxic drug my not be as bad compared to the pain etc. you have endured with these fractures, healing, Etc.

My warmest, heartfelt regards, Sunny flower. 🤗

@sunnyflower I think you are describing the drugs like Fosamax to build bone mass. My mom takes that. One of my doctors told me that it does put calcium into bones, but also if you do break a bone, it breaks into more pieces because it is harder and doesn't flex a little like normal bones should. That would be a hard decision. Bioidentical hormone replacement also helps prevent bone loss, but has to be done and balanced properly to avoid complications like blood clots. It seems every choice also carries a risk. That's why we always need to ask about the risks before we choose. My pain is minimal now except when I get fatigued. If I'm just sitting on the couch, I forget that my ankle was fractured until I need to get up and it reminds me, so I'm careful and ease my weight onto my foot. I'm also doing myofascial release with my PT and that helps reduce pain and swelling and to get it moving better. Thanks for your kind words.

@tc125 Hi, I know what all of you are going through or I should say my daughter knows. She was getting off a horse and fell on the ground the horse stepped on her ankle and she ended up with a compound tibia and 3 broken bones in her fibula and has a fixator cage for her tibia and a plate with screws for her fibula. She is in rehab now and working on hopping up on a step. She lives on the second floor. She's on strong pain meds, but since she has depression and anxiety, she's doing well, but they are giving her meds for that too. She weighs around 200 pounds. I called her doctor with my concern. So her comment was once she gets over her ashma, they would start working on it. She hasn't been as hungry at the rehab. I just hope she's eating healthy. She will have the fixator cage removed, but I guess the plate will stay in longer. So those who are suffering, it's not fun. Take care all of you.

My primary doctor put me on tramadol, but my surgeon didn't want me on anything like that, but my primary care didn't know why so her put me on is. I only take it at night, put I still have struggle getting to sleep. Once I get to sleep I sleep well. I am 3 months plus since my fusion. I also had stenosis L4 and 5. I try to walk one mile a day, but I don't always make it. I still have some pain, but mostly down low where my stenosis was fixed. Walking does help. Hope you are better soon. Soon

My son is now 28 years old. He had a really bad ankle, tibia and fibula fracture end of January. Surgeon put a plate and screws in ankle, tibia, fibula. PT was interrupted a bit due to covid. The added stress wasn't/isn't great either. Insurance capped at 20 PT visits, he has got some more now through a local hospital, he does not walk as before, pain starts after standing for a while or walking approximately 2-3 blocks. I am not sure what follow up has the surgeon suggested or any follow up images he has taken.
Does anyone know the optimum modalities, therapies, approaches, dos and don't so the bones heal well for continued good health, mobility, strength, movement etc?
Would greatly appreciate if anyone knows of effective, quality PEMF devices, read about those on another mayoclinic link. Thank you. Await your reply.

@archanagupta I am rehabbing from a bad tibia fibula open fracture that happened in May. I've spent the last month working on strength and range of motion in PT. After 3 months of a cast and no weight bearing, I have a lot of work to do to rebuild muscle that was lost and my entire leg is smaller, but it is regaining muscle. Some of what I'm working on now has to do with muscles for balance and I do lunges on a half therapy ball. My foot is unstable, but that is what starts to strengthen the muscles I need. It is slow progress, but I make gains every time I go to PT. I also have a lace up ankle splint that helps a lot, and it prevents me from rolling my ankle which would re-injure my ankle. My injury was basically a twisted ankle and dislocation that broke the tibia in pieces and snapped the fibula. I have 2 plates on the tibia and a screw inside the fibula. This type of injury takes a very long time to recover from. The brace supports my ankle enough so I can do more walking before it gets tired and I have custom orthotics from a podiatrist that help a lot. I got an ASO brace from medspec.com. It laces, then a strap crosses over the top of the ankle and velcros up the sides, and then an elastic band closes around the front. I got the one with plastic stays for extra support. That supports the ligaments and tendons that were stretched during the injury. I found this for about $30 online when I searched, but it was listed around $50 at a lot of websites. My therapists also manually work on the muscles that get tight in my lower leg and make sure my pelvis is balanced. I also stretch the hip flexors in front because that is so tight for sitting so much. For your son, I would think after 8 months, the bones likely are set and the pain may be due to weakness and limits on range of motion, but that's a question for the PT. Things can be slightly misaligned in the ankle because of muscle weakness not holding it properly so it doesn't glide, and my PT has gotten my ankle "unstuck" which helped immediately. I have to keep stretching the plantar fascia, the hamstrings, the front of my thighs (quads) to keep moving with less pain. I still have limits on how much I can do and I just rest when I need it. My therapist also does myofascial release to release tight tissue. Some of that you can do yourself by laying on a ball on the tender spots. I do have some sensitivity around the plates and incisions, and my PT has used a Dolphin neurostimulator to lessen that pain. That is a very expensive device that sends a current between 2 handheld wands. A TENS unit can also send current between adhesive electrodes that stick on the skin and that can help with pain temporarily. Those can be a lot less expensive. Here is a link to our myofascial release discussion. Topical Arnica gel may help too. It blocks pain temporarily and lessens inflammation.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/