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    Old 11-02-2006, 08:11 AM   #1
    crystal50
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    Heel fracture question

    My husband fell out of a tree and broke his heel bone in 3 places. (FYI, he was attempting to put a deer stand in the tree). He's immobile with his foot elevated. We've had xray and CT scans done, met briefly with an Ortho specialist, and have another appt. next week to discuss treatment.

    I've been doing a lot of reading on this injury to get educated on the recovery time and prognosis... and from what I have read, I am not very hopeful! My husband is/was a sales/traveling, lots of time on his feet. I fear his ability to continue that career is all but gone. The company he works for offers NO benefits such as disability, or health insurance. We do have a health plan through my employer - thankfully.

    My question is this: Percentage wise, how many people have a positive outcome from the surgery as opposed to not having the surgery? Are there statistics somewhere that I could review?

    Thanks in advance for your responses.

     
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    Old 11-03-2006, 03:54 PM   #2
    Prin
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    Re: Heel fracture question

    My husband fractured his heel on August 15. The following week he had 12 screws and a plate put in, with bone pellets instead of a bone graft. He is NWB for 12 weeks after the surgery, which ends (Thank God) in 1 1/2 week, so I can't tell you how he will end up. He's in a removable cast and going to PT for ROM exercises. If the doctor will do it, your hubby definitely wants a removable cast. 12 weeks of no movement at all is too long, he will take a long time to walk right again. It takes 6 - 8 weeks for any broken bone to begin to knit, so I'm guessing either way he's out of commission for at least that long. Sorry.

    I can share with you what I learned. The main concern is for the sub-talar joint, which is the lower of the two ankle joints, it connects the calcaneus to the talus and controls lateral support of the foot. If the patient is having post-surgical pain and difficulty after he returns to walking, chances are that that joint will have to be fused in a second surgery. If he does not have surgery in the first place, he may need a fusion down the road. If he does have the surgery, there is still chance of a fusion, but it's not as likely. Every health professoinal we have talked to thinks my husband may need a fusion, even though the Xrays look good. Apparently, about 3/4 of these fractures end up fused.

    I recommend that you see more doctors, and preferably a sports doctor, and ask them straight up how many of these he has operated on, and his percentage of eventual fusions. A LOT of the outcome depends on the skill and experience of the doctor repairing it. No doctor should be insulted by your "shopping" and asking questions. This is important, and could affect the rest of your husband's (your) life. The doctor who did my bunion surgery wouldn't touch it, neither would our local ortho surgeon. We ended up driving an hour each way to a sports doctor who has done about 30 of these in 15 years. From what I hear, that's a high number, this injury is fairly rare. Let us know what you decide.

    One other thing I just thought of - If they do not perform surgery, and the heel does not heal in the proper placement, what can be done to repair that? I think once it's back in one piece, that's it.

    Cindy

    Last edited by Prin; 11-03-2006 at 03:59 PM.

     
    Old 11-03-2006, 11:50 PM   #3
    tchair
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    Re: Heel fracture question

    Hi Crystal,

    More important than statistics is what the docs can see and tell you. In what I've read over the years since my FX it looks like a third of the time the fracture is either not displaced (the bone pieces from each other) or they can be manipulated back into place. Another third can only be corrected with surgery so they will grow back together (Look up ORIF.) That leaves the remainder when there is a choice to be made.

    While surgery allows the doc to do more thorough repairs (re: Cindy's comment on fusion) it also is invasive and adds it's own complications - wound healing and hardware. From what I have read and others I've talked to the outcomes seem about even. I think your best bet would be to get several opinions. As Cindy said it is important and all good doctors recommend it. It's not just the opinions but the explanations of how they were reached that count.

    Questions to ask are: Is there displacement? Is it an intraarticular fracture (at a joint - usually yes with a fall)? What is the classification of the fracture and what does that mean specifically? (Two common classification methods are "Rowes" and "Sander's".) At what degree is the Boehler angle (Has the foot been flattened?) and does it need to be restored? What other damage is apparent and how does that impact on the decision? What is being risked in surgery or in avoiding it? Yes write these down as well as any other questions you have so you get them covered.

    The down time, worries and effort take a toll, but being proactive - learning all you can, asking, asking, asking, and working as a team - lead to the best results.

    TC

     
    Old 11-04-2006, 11:37 AM   #4
    Prin
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    Re: Heel fracture question

    Tchair has some great specific questions there. I would print them out and learn about the details online so you know what the answers mean when you talk to doctors. The swelling and internal bleeding have to be given time to calm down before they can open up his heel, if that is what you decide. It is common practice to wait up to two weeks (I have heard of longer, too) for this surgery, so you have time for the two of you to be thorough in your decision. Cindy

     
    Old 11-04-2006, 03:32 PM   #5
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    Re: Heel fracture question

    A terrible injury wrought with pitfalls but sometimes the worse ones turn out okay. The problem is a force generated that can fracture bone is surely enuf to destroy cartilage. The bone can be restored and healed but the cartilage usually dies and depending on how much and where, depends on how he will do. After all is said and done, if he is sufferring, a triple arthrodesis is what he will need. Do not accept only a subtalar joint fusion, later on the other two joints will degenerate and he will be back in pain...... whew... gotta go to dinner

    Last edited by WanderingMod; 11-04-2006 at 07:44 PM.

     
    Old 11-05-2006, 07:01 PM   #6
    crystal50
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    Re: Heel fracture question

    thank you so much for the detailed information. Wow, what a wealth of knowledge - Now I'll know what to ask the doctor.

    Thanks again!

    crystal

     
    Old 11-05-2006, 07:34 PM   #7
    Hooty2915
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    Re: Heel fracture question

    Based on what you described to me is that he fractured his calcaneous bone in his hind foot. If that is the case, there are biologic products out there that act as bone and set up harder than bone. I had a friend that had this done and they used Wright Medical's Multi Compression screws the 7.0 (used 2) and used Miig or Micro Miig as a bone substitute for positive bone holding. The products from Wright Medical worked very well. My friend is 32. When and if you do have this done make sure they use biologics with DBM (demineralized bone matrix) in it. I know after reading about Miig that it has 86% in it, this acts as an osteoconductive way for the bone to heal. Hope that helps.

     
    Old 11-07-2006, 11:18 AM   #8
    crystal50
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    Re: Heel fracture question

    We went to the Ortho doctor today for the post injury 2 week appt. He showed us the CT scans and explained the complexities of the injury quite well. My H has a total of 8 fractures in his calcaneous bone - three of those with 4mm+ displacement, and major bone portions... the rest are smaller pieces on the outside and inside of the foot. Basically, he's shattered much of it, the exterior (outside part of the foot is pulverized) not enough bone there to do pins. He could pin the interior, and use bone grafts from the hip to build up the outside. Successful outcome from the surgery - not taking into consideration the risk of infection is 50/50. My husband is a smoker too, and the doctor said that would impact his healing abilities. We also discussed fusing the bones as that will long term aleviate the pain. The doctor basically said he'd be surprized at a good outcome with surgery on this injury due to the extensive damage done. The surrounding cartilage has been damaged also, and it does not regenerate well.

    The doctor has only done 4 of these surgeries of which two were successful. We live in a smaller community (pop of 75,000) so this type of injury is rather rare.

    The doctor said 4-6 weeks before any weigh can be beared on the foot without surgery. With surgery 4-6 months to assure no movement in the pin reconstruction.

    My H is trying to make a decision on what course to take.

     
    Old 11-09-2006, 01:17 AM   #9
    tchair
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    Re: Heel fracture question

    crystal,

    The description sounds very much like my injury, some displaced big pieces and a lot of little ones. I heard how complicated this was, got three seperate opinions and settled on a doc who routinely treated this injury and would have experience with all of the options. Although I smoke the plate and screw surgery (including hip bone) worked out. I may be biased towards surgery because I had it. But I feel that having the calcaneus in the proper shape and the bone graft restoring my arch resulted in better mobility.

    No matter what course is taken, the first year is going to be hard with proceedures, healing and rehabilitating. But it is the condition of the foot for all the years after that counts. It is worth the investments in second and third opinions, travel time, and down time if surgery is performed to get the best results.

    Even if internal fixation is not an option it would be good to know this from more than one doctor. I have heard of external fixation when the bone fragments were too small. Now is the time to find the best course for the structure of the foot. Fusion of the joints would be further down the line, so it can be wait and see then do as much or little as required.

    TC

     
    Old 11-09-2006, 08:02 AM   #10
    mitzi t
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    Question Re: Heel fracture question

    My Daughter Had A Bad Accident 5 Years Ago When She Was Hit Head On She Had Her Seat Belt On But Her Feet Took The Impact Where Both Calcaneouis Heel Bones Were Crushed She Still Has The Metal Plates And 10 Screws In Each Foot And Still 5 Years Later She Has Developed Osteo Artritis Spurs And Other Things Wrong With The Right Foot Her Opthopedic Surgeon Wants To Fuse That Bone That Has Arthritis But Family Practicioners Don't Agree That This Would Help She Is In Chronic Pain Most The Time Sometimes So Stiff In Feet She Ca'nt Get Out Of Bed What Do'es Anyone With Similar Injury's Think?

     
    Old 11-13-2006, 11:57 PM   #11
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    Re: Heel fracture question

    My husband fractured his heel 10/20/04. He had a nine hour surgery to repair it(orif). He had two metal plates, 24 screws, 10 wires and cadaver bone. He was in a wheelchair for four months and went back to work one year after surgery. He worked part time and in immense pain for about 6 months...then the doctor decided to take out the hardware to see if that was the cause of his pain. During surgery they discovered a wire that had broken off and was stuck in a bone which wasn't healing. So they thought that was what was causing his pain. Now it is November and he hasn't worked since May and is having yet another surgery the day before Thanksgiving to see if they can find the cause of his pain....

    Sorry for the long story. The one thing his doc has told us repeatedly is, "This is a life changing injury" and it truely is! I would recommend trying to find a doctor with a lot more experience. My husband's doctor is a a major trauma center and has quite the reputation in his field.

    I'm not trying to scare you, just telling you our story. I hope things go much better for you. My husband installed commercial ceilings and wore stilts all day at work so I understand your fears about him not being able to go back to sales. I have gone back to school so if he can't go back to work I can get a decent job.

    Sorry, if I'm being a bummer....just trying to be honest.
    Please, keep in touch...it's a long road and there are others here who have been through it.(like tchair)~Mush

    Last edited by trowftd3; 11-14-2006 at 09:01 AM.

     
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