Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. Her first words were “you’ve lost the joint space, the cartilage is gone. With pilon fractures, there can be total cartilage death after 6 months. This is very typical.” She went on to say that the impact of the initial injury (the talus bone ramming upward and shattering the plafond of the tibia, ripping the cartilage to pieces in the process) leads to cartilage death many months after. In some cases (those luckier than me) the cartilage survives enough t allow pain-free walking and much normal use of the ankle.
I almost cried. While I knew that the likelihood of pilon fracture-related cartilage loss and joint collapse was very high, I was very hopeful that I was going to be one of the luckier patients and get a few years of fun in before I had to deal with arthritis, more surgery, etc.
I tried to convince her that I had some good results from PT, and massage, but she ignored me and said it was time I find a ankle specialist who was skilled in post-pilon fracture treatments, and explore my options. She said my lack of dorsiflexion was from the bone at the front of the tibia hitting the talus, and that wasn’t going to stop happening through more physical therapy. She said ankle fusion or ankle replacement were her assumptions of my next procedure but that it wold not be her that did the surgery (Dr Herzog is a orthopedic trauma surgeon and the person who fixed me up when I came into the ER on March 6th.) (She is also very awesome)
So with this horrible news on my mind I drove home contemplating more surgery and no good thoughts. I have been studying up on ankle fusion and replacement, assuming that was where I’d eventually end up, and the downsides of those solutions had me very sad indeed. While they fix the pain of walking, they are by no means the return to normalcy. I still remember the first time I learned what a pilon fracture really was…and that it spelled the end of running, and in many cases, walking for those of us unfortunate enough to receive this injury.
I see the surgeons this week and I am seeking more specialists to talk to before I take the plunge into more surgery. I am hopeful that I find some good news.
Not to be a total downer, here is a story about things I CAN DO while hobbling around on this ankle.. https://www.strava.com/activities/413271549/embed/ddf196e6cd9d52343e4c9b9651d9dd63ba126def” target=”_blank”>Click here for a glimpse of the possibilities for those of us with a bad ankle.