Laura - Updates for Saturday, 12/29

One week since the accident!

Thursday was a good day. No surgeries and a quiet day of rest for the most part. Laura felt strong enough to get out of bed and sit in a recliner for a little over an hour. But mostly it was just nice to have a day without surgery.

Friday she was in surgery in the morning to open up, clean out, and examine the fasciotomy. The muscles are recovering nicely and they are putting pressure on the wounds to begin pulling them together so that they will be able to be closed up. The wound on the left side (inside) of the calf is pretty much closed, and the gap on the right side (outside) wound went from 10 cm/4" wide to about 5 cm/2" wide.

As far as next week goes, there are lots of ins and outs, but right now the basic idea is two surgeries on Monday and Wednesday (where they will close up one of the two wounds at least). Then the hope is to repair the tibia next weekend (January 4,5 or 6). As our surgeon says, that's an "optimistic, but realistic" schedule. So it seems likely that we'll be flying back to Boston early- to mid-week of 1/6.

So, this weekend it's all about rest. Nothing particular for us to do except for Laura to relax as best she can. She has for a few days now been moving back and forth between the bed and a reclining chair, and can use the commode herself. (Of course, it does help to have one or two people assist her make the transition with lots of equipment still hooked up, and someone to help manipulate the leg, etc.)*

The ex-fix

One thing I didn't mention before, as it wasn't relevant to her overall status, is that Laura has an external brace on her leg that holds everything in place and immobilizes her knee so that the broken parts of the tibia aren't moving around in there. There are two pins drilled into her femur and then another two drilled into (I assume) her tibia down near the ankle. Then a few bars run between the pins to hold everything stable. It's heavy, but makes a convenient handle when we're trying to move her leg around! (And it's a lot better to move the leg using that stable "handle" than it is to move her leg directly whereby you may inadvertently be moving a bone around that's not supposed to.)

Beware the Ides (last week?) of March December!

A tip for those of you who like ski vacations: the week between Christmas and New Year's is a hectic time, and according to the Vail Health folks, it's the one week out of the whole season that they see the most injuries. That certainly seemed to be the case on Wednesday, 12/26. Laura was scheduled for surgery at 9 am, but it got pushed back to noon, then 3, and on and on until she didn't have surgery until 9:30 pm. All because of emergency procedures that popped up that day. If you do decide to ski between Christmas and New Year's, be careful up there!

* A little plug for exercise

Laura has been exercising diligently and regularly for the past two years, and it is making a big difference for her in the hospital. I know one of the things she's disappointed about is that this is going to set her back on the exercise and fitness regime, but it's been really important here in the hospital. She is much more able to move herself between bed, chair and commode, so it makes a big difference to her quality of life in the hospital room. And, it has also helped with the ability of her muscles to bounce back and recover from the compartment syndrome. So far every surgery since the original fasciotomy has been on the positive side of the orthopedic teams' expectations, and as the primary surgeon has pointed out, it makes a dramatic difference operating on a fit person versus someone who is less healthy.

So, get out there and exercise! If you ever end up with a tibial plateau fracture and compartment syndrome, it will make a huge difference to your recovery!!! (I assume there are other beneficial aspects of exercise, too....)

P.S. I heard that some people had tried to comment on the previous blog post and it didn't work. I'm not sure why that was, but I think it's working now. Sorry about that.

Laura's Injury - Just the Basics

Hello, everyone. You're likely here to find out the details of what happened to Laura in Vail. Well, here is the info in as short a format as verbose old me is able to make it. I've tried to group things so you can find the relevant information you're looking for.

What happened?

Laura had a ski accident and severely broke her leg. She also had a complication that could have been really serious, but is now only relatively serious.

What does "severely broke her leg" mean?

She has a tibial plateau fracture. Basically, a lot of weight/speed/and force were focused through her femur down through the knee joint onto the top of the tibia, shattering it near the joint into a few pieces.

And the "complication?"

She developed compartment syndrome. The swelling in her calf (picture the calf just below the knee swollen to the size of a melon) put pressure on the muscles, nerves, and blood supply that run through two "compartments" in her calf to her foot. If the pressure builds up enough that it could cause damage (as it did in her case), a surgeon performs a fasciotomy, slicing through the skin and tissue between the ankle and knee on each side of the calf, stuffing the wound with medical sponges, covering with a medical film and placing suction on it to drain out fluids.

That sounds relatively serious, but you mentioned really serious?

I'll let the dry verbiage of the Wikipedia entry on fasciotomy tell the story: 

"Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome."

You're exaggerating, right?

Eh, not really. Laura was rushed into emergency surgery on Monday morning, and it if had been started a half hour later, or if we had been somewhere that doesn't have a world-class orthopedic surgery team, she would likely be missing part of her right leg right now.

That doesn't sound like it should happen. Didn't you know about the potential for compartment syndrome?

Yes. We were aware of the possibility. But, the "danger zone" is mostly within the first 24 hours, and Laura presented at 36+ hours. Plus, it was the middle of the night, Laura presented in an unusual way, she has a high pain threshold, plus other factors and yes, perhaps the nurse didn't elevate some of the signs as he should have. But, really, we'll never know why it took longer to be identified than it should have. Bottom line, she should have been in surgery hours before she was.

So she didn't lose her leg. Does that mean she is okay?

Hmm. Well, she is mostly okay. Parts of her foot are numb, but her nerves appear to be unharmed, so the foot sensitivity should come back eventually. And three of the four muscles in the compartments came through unscathed. But, the surgery came late enough to cut things very close, and she did lose part of one of her muscles. It's the muscle group that pulls the big toe and ankle UP. Pushing down will be fine, but she will likely have less strength to pull the ankle up, and may never be able to pull her big toe up. If that's the case, the tendon can be tied together with the other toes so that she could pull it up, just not independently of the other toes.

That's just the "complication." What about the original break? How will that affect things?

Tibial plateau fractures are graded on a scale of 1 (lowest) to 6 (most severe). Being an overachiever in all things, Laura scored a 6. However, as the surgeon explained to us, while her break is in the most severe category, the tibia shattered into a small enough number of large enough pieces that it can be repaired to the point where it will have no impact on her at all in the long term. Which I guess is lucky?

That's of course if you have a great surgical team, which luckily we do. People travel to this clinic to have surgeries like this done. So there again, I guess we were lucky (not that it would have happened if we weren't here).

All right, so things can go back to normal, but how long will that take?

We don't have real specific answers right now, but the tibia repair can't happen until the swelling has gone down. It's hard to say how long that will take, but we're hoping it will be sometime next week. We won't know until later, but we're keeping 2 weeks from the accident (that is, Saturday Jan. 5) as an estimated date to be able to go home. An estimated date with a big range of error around it.

As far as further recovery, she has to keep all weight off of her foot for 8-10 weeks or so post repair surgery. She will be able to be mobile with crutches, I guess, but she won't be allowed to really "walk" until roughly 3 months post accident? Basically the end of March. Again, as our rough estimate, subject to significant change as time goes on.

And I'm guessing pretty serious physical therapy until June or later to rebuild strength.

I'm guessing the compartment syndrome added time before the repair can be done?

Not really, no. It takes 1-2 weeks post-trauma for the swelling to go down to do the repair anyway. Perhaps the compartment syndrome added a few days, if that. Mostly it just adds extra surgeries in between the accident and repair. Without compartment syndrome, Laura would have had two surgeries in two weeks. With it, she has had four surgeries in four days and will have another three to five before we leave.

Laura's in the hospital for two weeks or more?! Where is she, and who's with her?

She's in Vail Health Hospital and being operated on by surgeons from Vail's world-renowned Steadman Clinic. She has a private room with a big window looking out on the Vail ski slopes and everyone here has been so very kind. It sucks being here, but if you've got to be here, this is a great place to do it! (I hope that made sense.) And I'm with her. As in Jared. As in her husband.

Are you staying in her hospital room? I imagine there aren't extra rooms to rent in Vail between Christmas and New Year's Day.

Nope! Susan, a rather distant relative of Laura's who we didn't know previously is a seasonal nurse here and has an apartment with an extra bedroom. How lucky is that? (Plus Susan is fan-TAS-tic!)

What about the boys?

Uncle Cam was here with us skiing and he took the boys with him to Aunt Britt's house (in Minnesota) where they celebrated Christmas with Jared's extended family. Jared's parents are flying them to Massachusetts on Saturday (12/29) and staying until Tuesday (1/1) and then they'll be looked after by other people.

Do we know who yet? For God's sake, no! That's like six days away! We're kind of busy around here! However, we have lots of relatives and friends who have offered to help out (thank you, thank you!!!!) and we'll work on sorting out those details next.

I've been waiting to ask, same leg or other leg from the ACL repair?

Same!

Oh, boy. Will she need the ACL done again?

We hope not! Because the injury is down through the knee and there's not typically a lot of twisting, the tendons and ligaments in the knee are often okay. (The meniscus is likely destroyed, though.) We won't know until the tibia repair surgery for sure, but there's a good chance that Laura's ACL reconstruction is A-OK. That's what we're hoping for.