Category Archives: health

Me and My IM Nail (Part 8) – 3 years on


by Jake McMillan

<<< Me and My IM Nail (Part 7) – 2 Years on

Broken Tibia X Ray

X Ray of IM Nail in Tibia

Three years ago I broke my tibia (see X-ray above) and fibula and the brand new term IM Nail (Intramedullary Nail or Rod) was introduced into my life … and my leg. Three years on I can still remember the pain, thankfully I don’t have that any more. Since the accident I’ve been blogging about my recovery as there was so little  information about it on the internet.

Unfortunately, three years later, there still seems to be very little information out there. However! One positive has been all the people who have taken the time to get in touch with me and comment on this blog to share their experiences of going through the recovery as well. A massive thank you to all who have commented and especially those who have said kind things as I really did not expect anyone to read my long posts about limping and pictures of scars and hairy legs.

For those who are not aware or have not yet filled it in, I have put together a short survey and will produce and share the findings with everyone. I’m just waiting until there are a 100 responses, with 80 people having filled it in so far (at the time of writing).

Scars and bruising
Over the three years the scars and bruising have gone down, but have not completely disappeared. Being a hairy-legged man helps cover them up.

Bruising and Scars after 3 years

So, three years post operation how is my leg doing generally?
It’s very similar to being a normal leg, it just has niggles. For example, if I leave it in one position it feels stiff/sore and kneeling on it is not comfortable (but is a bit better compared to a year ago I feel). There are some days it feels better than others, but generally speaking I can walk about, run and dance as badly as I ever did.

I am still cautious when it is raining and slippery, as if I expect my leg to cause a problem and always feel relieved when it is perfectly fine. I was in Singapore in March last year and I was wandering around, exploring after it had been raining and on a slippery stone I managed to fall straight down to the ground on my bad leg. It was just a case of poor grip, but I was so happy that I hadn’t hurt my leg or broken or bent my IM Nail I actually forgot the embarrassment of falling over in front of lots of people.

I haven’t done a lot of sports or exercise this last year but that has nothing to do with my IM Nail, it is been more me not making the time and effort to do it. I fully aim to do much more this year (we all say that don’t we?).

Last Sunday, I went to Richmond to meet some friends and I did so with some trepidation as it was a repeat of the exact same activities I did three years ago that ended up with me breaking my leg on my way home at Clapham Junction Station. I’ve been to the station and walked through the underpass (where I actually fell over and broke my leg) many times before so it should not really have been a big deal.

However, a friend made a joke over Facebook that they would break my other leg. They did not mean or intend any malice by this, just making a joke, but I did not take it in my normal good humour and realised that breaking my leg, the operation and its recovery was still a big deal. Apart from the pain and discomfort of the main recovery period, I was self-employed and it meant I couldn’t fulfil a contract that January or go for one the following month. I almost went bankrupt and barely managed to get by. My attitude remained positive, but it was a really tough time that I would not want to go through again.

In Clapham Junction Station Underpass

In Clapham Junction Station Underpass

As I walked through the underpass at Clapham Junction station last weekend I remembered the time laying on the ground 3 years ago whilst my friends decided that I actually did need medical attention (I had told them to leave me and I would hobble home to bed). I hoped I would not have a similar fate that evening. I am pleased to report that on my journey home I had completely and utterly forgotten about the accident and that it completely escaped my mind. Although, to give full disclosure, I had realised I was totally desperate for the loo and that was utmost on my mind. Nevertheless, although it’s something I still think about, the whole incident is very much in the past and the ongoing niggles of my leg don’t affect my life or bother me that much.

Will I have the IM Nail removed?
I have given this some thought and have still not yet arranged an appointment with a consultant to discuss this. I will do this as would like to know more information and will, of course, share it here. I would like to remove the IM Nail as would prefer it not to be in my leg, I think most people feel this way, but the question is whether it is worth the risk of further complications and pain. It does worry me what happens if I have another accident, how the metal might cause more damage, but then I cannot predict how bad that accident would be anyway? Some have had very successful removals and I know others where it has not given the desired result and caused further pain and problems. As I don’t get much discomfort and it doesn’t really prevent me from doing anything I think a consultant would say there is not enough justification to do it.

Sharing Your Experiences
Please keep doing this, I will continue to keep updating this blog and it really does help others to hear about as well as give support to others going through the same or very similar experience.

Thank you again to everyone who has contributed to the blog and wishing you all the very best with your recovery!

Jake


Me and My IM Nail (Part 6) – 1 year on


<<< Me and My IM Nail (Part 5) – 6mths after the accident

Me and My IM Nail (Part 7) – 2 Years after the accident >>>

12 months ago on January 2nd 2010 I had a silly but little drunken fall at Clapham Junction Station (London) and somewhat inextricably broke my tibia and fibula resulting in an operation to have an IM Nail inserted. However, I prefer to tell people the “official” story that I broke my leg jumping on to the train tracks to save a pregnant woman, a blind man and an endangered panda.

I was told it would take 6mths to recover and as I couldn’t find much about people’s healing experiences with IM Nails on the interweb highway I thought I would share mine just in case others found it useful or possibly reassuring. My last update was at the 6mths stage and so now is time to bring it up to date.

12mths since IM Nail Op - I still have bruise from where I broke the tibia and minor scarring from the operation

Still some scarring on the knee from the IM Nail Operation

Up until a couple of  months ago I was still concerned that I was getting a fair bit of soreness from the area just below my knee. If I sat in the same position or cross-legged it would be quite sore when I stood up and walked. Kneeling was also not something I was comfortable doing. This has changed quite a lot since then and the soreness is still around but is quite mild now and kneeling is much more comfortable than it was.

Walking down stairs I barely notice anything different with my ‘bad leg’, but do from time to time. Lots of friends have asked me if cold weather effects me and say surely there must be expansion and contraction issues? Well, it’s been a bloody cold winter here in the UK and I didn’t notice any particular problems when I was out in the cold.

I have experienced one issue though … and that is with my good leg (the right one). I was trying to get back into jogging and was going regularly to the gym and running only on the treadmill (i.e. no hard surfaces). I was careful to build up the amount of running I was doing very gradually and had not quite reached being able to do 40mins of jogging (3 runs a week). Two days after a gym visit I walked off to a meeting and my right leg suddenly had a shin splint pain that was quite painful.

I thought my 2hr meeting would be ample time for it to rest but as I walked home it got really really painful. Like someone had stuck a knife in the centre of my shin and left it there. I have had shin splint problems before (prior to my accident) and normally rest will cure it and the worst case before it had been 2 weeks. However, this shin splint pain went on for about 5-6 weeks and I think has only just gone away. I was not able to walk for more than 5 mins without it getting really very painful.

My GP confirmed it sounded like a classic case of shin splints plain and said I should rest and take ibuprofen (for its anti-inflammatory effects). This did seem to help but I am not sure yet if it has fully disappeared and will be visiting the gym later this week to find out. Well, if I can get over 4 solid days of celebrating New Year that is.

Ironically, it gave the situation that my bad leg (the left one with the IM Nail) was actually my better working leg and I think somehow this has been good. It was a little bit like my right leg had said “enough with all attention and care on the left leg, what about me? Why do I always have to be the good one?”. My left leg was up to the task and has actually been like a normal leg!

If you’ve recently had an IM Nail or Rod, I wish you the best of luck with the recovery. Set short-term goals for your recovery rather than looking at the longer path and you will get there. It will be painful in the beginning and dominate your life, then it will be more frustrating and really testing your patience, as in “can it just get back to normal already?!” But it will get better.


Me and My IM Nail Part 5 – 6mths since the Op


<< Me and My IM Nail Part 4 (5mths on)

Me and My IM Nail Part 6 (1 year on) >>

In January 2010 I broke my left tibia and fibula and had an operation to have an Intramedullary Nail (IM Nail) inserted. The doctor at the time told me, I thought rather vaguely at the time, it would be “6 months before you could do the things you want to do”.

It’s now been 6 months since the operation and I can confirm the doctor was right. I can do the things I want to do, but the leg does not feel like it is completely normal and back to full strength and capability. This is not the end of recovery; there is still some progress to be made.

The leg is really starting to feel like a normal leg. I have finally lost my limp and this was confirmed by my physio and friends are very impressed with how easily I’m walking about.

Me with a couple of friends as I am stretchered away from Clapham Junction where I had the accident

I started jogging 2 weeks ago. Not on the treadmill, but proper jogging in my local park, Clapham Common. I just did 10mins and it was at a very slow pace. When I finished I felt so elated to have been able to do this and my leg felt fine as I walked home.

My physio recommended, after hearing of my initial 10mins run, to do 3 runs of 10mins every other day (to give the leg time to rest) to see if the leg was able to cope without any problems and then to slowly build it up from there.

I didn’t quite follow her instructions and have increased each run by 2.5mins and yesterday did a 20mins jog. I’m a lot slower than I used to be, at the moment, and it takes me 11mins to reach a marker I used to do in 10mins. I’m really quite unfit as have not been to the gym in ages, but in a way this is good as if I was fitter I would be tempted to run for longer and maybe push the leg too hard too soon.

My visit to the physio last week ended up being my last visit, touch wood, as she gave me the all clear. I still have physio exercises to do:

  • 3 sets of standing on tip toes 15 times on my bad leg and once this is quite easy, to start hopping
  • One-legged (on bad leg) lunges or rather lowering my body through bending my left knee
  • Using the wobble cushion (see below)

My physio recommended buying a wobble cushion as she said the receptors in your ankle basically go to sleep when they aren’t being used for some time and standing on a wobble cushion helps wake them up and will prevent you from falling over when on uneven ground. This type of rehabilitation is sometimes referred to as proprioception or proprioceptive re-education.

Firstly, you stand with both feet on the cushion and try to maintain your balance. Hopefully you will find this quite easy. To make it harder, try closing your eyes whilst doing it. It’s amazing how much you rely on your eyes for balance. With your eyes closed it just the receptors in your ankle giving information to your brain about how to stay balanced. Then try it with one leg (the bad one) on the cushion and then with your eyes closed.

I still have my scars and bruise from the accident and kneeling on my left leg is not really an easy thing or comfortable thing to do. A friend of mine who went through the same thing just over 18mths ago thought perhaps he would not be able to kneel properly ever again and then gradually he was able to.

Walking down stairs is easy but I am still very aware of my leg’s limitations and it doesn’t feel quite natural.

As it is 6mths since the operation I thought it might be useful to reflect on the recovery period so far.

I feel I worked really hard and put a lot of effort in the first 3-4 months, but after that either my will or energy seemed to diminish. Once I was basically able to move about (although with a limp), work and socialise I stopped trying so hard. It wasn’t a conscious decision, it just sort of happened that way.

I think I was really trying hard to beat the 6mths recovery time and when I realised I wasn’t able to, particularly when the physio told me I shouldn’t start running yet, I lost some of my motivation. But this could be a good thing in a way as I know others who have pushed themselves too hard and that has ultimately led to a delay in their recovery.

However, I am pleased to report to anyone else who is or about to go through the same thing that after 6 months I really do feel quite good and, as the doctor told me, I can do all the things I want to do.

In January, now (as in July) seemed so far away and I didn’t want to think about all I had to go through to get there. Although the pain largely goes away, it is still sore and you are reminded of your leg problem pretty much the whole time, in every step you take, when you lie down, having a shower, etc. That is not the case anymore, thankfully. Yes, I am still quite often physically and psychologically aware of my leg’s limitations, but this seems to lessen by the day.

My advice to those recovering still remains the same, you should be very short sighted and set yourself small goals to achieve, try not to look a long way into the future.

Me and My IM Nail Part 6 (1 year on) >>


Me and my IM Nail Part 4 (5mths since the op)


<<< Me and my IM Nail Part 3 (4mths on)

Me and my IM Nail Part 5 (6mths on) >>>

The end of my last post a month ago ended on quite an optimistic note with what I thought was a conservative aim of jogging for 20mins on nearby Clapham Common. A visit to the physio a couple of days later was a reality check and led to a readjustment of my goals.

The physio visit initially was going well and she said I had good mobility in my ankle and feet. She asked me to stand on one leg which I could do (although wobbly) and stand up down on tip toes which I have been able to do with ease for ages.

She then asked me to try going up on tip toes but just on my bad leg. My cockiness went as I thought, oh, I’ve not tried that. I couldn’t do it at all.

5mths since the operation and the bruise from the tibia break and scars from IM Nail operation are still quite visibile

IM Nail scars 5mths after operation (just below the knee)

She said that I should stop running on the treadmill as if I couldn’t go up on tip toes on just my bad leg (the left) I would be significantly over-compensating on my right leg and this would cause problems. She also suggested that when I practice going up on tip toes that I try to do it more on my bad leg as I had been relying, without realising, on my right leg too much.

I left gutted and annoyed that I wasn’t able to do this and for the next week I practiced a lot every day and it was so frustrating I couldn’t do it. Then, whilst at a work event where 2012 Games chairman Lord Sebastian Coe was visiting my client, I suddenly realised I could do it! Not very well, but I could definitely do it.

I really felt quite happy as I had worked hard for just over a week to be able to do this and also noticed that my limp seemed even less pronounced and was virtually gone.

The next physio appointment was 2 weeks later and felt I had improved although I had noticed in the week leading up to it that I was getting a shin splints pain in my good leg when I did the 15mins walk to my local London Underground tube station.

She came out to the waiting room and called my name and I walked with her to her treatment room. As I sat down I felt good that I had walked well. She had a very different view. She thought my limp had got worse! Whereas I didn’t think I had a limp at all?

Basically I had subconsciously got so used to walking with a slight limp that I had stopped noticing it. She asked me to walk slowly up and down the corridor and describe what pain/soreness I had that was preventing me from walking normally.

She identified some joints in the front part of the ankle that were rather stiff and tried to massage them a little without any effect. She stressed that I should try staying on my left longer as I would put my right leg down too quickly. She also suggested holding off from jogging on the treadmill until this was sorted.

My physio gave me a blue rubber sex aid to add to my collection

This was also very frustrating as I felt I had been impeding my own development by not realising I was still limping. So since then when I walk I really try to stay on the left longer. This means it feels sore but it is necessary to loosen up the stiff joints that are causing the limp. It really means concentrating as it so easy to slip back into limping.

I thought I had been doing well but my neighbour last week said she saw me limp back from the local shop whereas I thought I had been walking well.

In spite of these setbacks, just over a week ago I went for a 9 mile ramble (4hrs) with friends near Windsor. A ramble, for those unaware, is a fancy term to make walking in the countryside seem more interesting and dynamic.

The Long Walk to Windsor Castle

The first two hours went very well and I coped with it fine and my friends said I seemed to be walking normally. Stopping halfway for lunch caused my ankle to seize up a bit so when resumed I started to limp again, but this went (I think) the more I walked. As we got towards the end of the ramble, we walked down the aptly named Long Walk to Windsor Castle and I was starting to suffer a bit.

Windsor Castle - I made it to the end of the 9 mile walk

We got the train back into London and when I got off at Vauxhall station I realised I had a massive pain in my right foot (the good one), on the right hand side almost at the heel. It wasn’t a blister/skin type pain, but felt like a metal bar was digging into the bone every time I put weight on it. So I was in the odd position of now limping on my right leg and the left one was the good one!

It took a good 3 days of rest for the pain to go away on the right foot, but all is fine now. I have another physio appointment next week and hope to be given the all clear to run on the treadmill again.

So it is slow progress, but it is progress and my leg is starting to feel like a proper leg again.


Me and my IM Nail Part 3 (4mths since the op)


<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>

Since the last update a month ago I don’t feel like I have made as much progress as I should have or maybe hoped for. When I was initially told there would be a 6 months recovery period, I really thought I would be able to beat that, but it seems I am exactly on track to meet that timeframe.

I’ve been a little disappointed with myself as there were a couple of weeks this month where I could have tried harder. Work and life meant I wasn’t able to get to the gym like I wanted to do, but even so I could have done more physio at home. However, reflecting on this now I realise I have been pushing consistently hard recovery-wise for over 3 months, so having 2 weeks where I wasn’t 100% focused on it was probably a good thing.

I won't be visiting here for another 4mths

I still have my limp, which I really hope would have gone by now, but it is much less pronounced than it was before and I can walk long distances (45mins plus) without it causing discomfort. So I know the limp is due to disappear soon, I just have to keep at the physio and going to the gym to build up the muscles.

Since the last update I have also been back to the hospital for another check up and the consultant is very happy with how I am healing with the IM nail. He even suggested I could probably start having a go on the treadmill. My physio has not suggested this so I was a bit sceptical but felt positive after the visit.

I hate waiting! It's normally over an hour for the X-Ray and then another hour for the consultant

I met up with a guy I work with from time to time who had broken his leg 18mths ago, but I didn’t realise he had an IM nail put in too. It was really good to quiz him about his experiences. The first thing you will be pleased to hear is that he is about to run a marathon in the next couple of weeks.

He is into his running and told me he pushed too hard when recovering and this actually set his whole recovery back by over a month. He was advised when able to start running again to start with 5mins and then to build it up one minute at a time. However, after a few goes he felt good and ignored the advice and ran a bit longer and then did a 40mins run but after that he couldn’t run again for a few days as it would be very painful and sore.

I went to the gym 3 times last week and felt good about that, particularly as last Monday I went on the treadmill to jog for the first time. That felt very weird! As you are not sure how your leg will perform. I took it very easy and did a 5mins jog at very slow speed. I was able to do it, which was good, but still ran with a bit of limp and was unsure whether that was right or not?

The observant of you will have noticed that the person above is not me ... I have better, but hairier legs

On Wednesday I jogged for 6mins at a slighter faster speed and then 7mins on Friday going slightly faster again. I haven’t felt any bad after effects from doing this and so can continue with confidence.

My physio gave me a new, stronger rubber sexual aid (Green) to continue with the ankle exercises which I have to be honest and say I have not really been doing, even though I do keep them near me when watching TV at home. The physio has also got me standing up and down on tip toes and standing on just my left leg (the bad one). I’ve been doing a lot of these as it is very easy to fit into normal life … whilst brushing teeth, making a cup of tea, waiting for a bus/train, etc.

Standing on one leg helps to build up strength and although I could do this before the physio asked me, I was very wobbly and it was hard to balance. Whereas now I can do it with my hands in my pockets without needing to put my arms out to balance. It’s not as good as my right leg, of course, and it still wobbles a bit (the muscles around the ankle and knee move about to maintain the stability of the leg).

Standing on tip toes is something  I’ve been able to do for ages, but a month ago I tried walking on tip toes and that was a very different story. I could barely manage it and it was similar to when I first started walking, or rather hobbling. A month later and I can now walk on tip toes better, but with a major limp.

The guy I worked with also recommended that I keep up with the rubber sex aids as when he was able to start running he gave up on the ankle exercises, but wished he’d continued.

I haven’t reached my goal of losing my limp, but have jogged on the treadmill for 7mins which is ahead of what I thought I would be doing. So I hope by the next update the limp will have gone and I will have jogged for at least 20mins on Clapham Common.

I also still have the bruise from where the tibia broke which I think is also a reminder that as much as you can push your physio and exercises, you can’t speed up how quickly your bone heals.

<<< Me and my IM Nail Part 1 (2mths since the op)

<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>


Me and my IM Nail – Part 2 (3mths since the op)


<<< Me and my IM Nail Part 1

Me and my IM Nail Part 3 >>>

It is now April, 3 months after I had my accident and had an intramedullary nail (IM Nail) put into my lower left leg and 1 month after my original post. I’m happy to report that things are progressing well.

Two days after the last post I made it to the kitchen and back to my room without the aid of crutches. I was walking! Well, I say walking, it was hobbling and moving at the speed of a 150 year old man. I was able to put my weight on my bad left leg very briefly, maintaining my balance before my right leg would take over in a much more assured way.

Leg 3 Months on - I still have a bruise from the Tibia break and you can see the scars from the screws attached to the lower part of the IM Nail

I then made another attempt and I began to feel more confident in my hobbling. It was brilliant! Using crutches is so limiting and annoying it is extremely liberating to have both arms free and I have never had so much pleasure in making a cup of tea for my flatmate and was able to hold both cups of tea!

It wasn’t pretty, but it was technically walking.

Leg 3 Months On - The scars just below the knee are healing well but are still quite visible

Since that day, I have not used my crutches (except once to get sympathy from a delivery person). The progress was quite good the first week of walking and then has been slow and steady after that.

I initially practised walking around the flat and going up and down a couple of steps. The next test was to make it to my local shop and back (down 7 flights of stairs and a 50yrd walk) and it felt so good to be independent.

The next test was to go to my friend Alex’s house in Tooting (Yes American readers, there is a place in London called Tooting; British readers, Americans use the word tooting to mean farting) which meant a small walk and a bus ride. I passed both tests well and boy does that feel so good. You know you have a long way to go in terms of recovery but you know that you have got the worst of it over and you can resemble being vaguely normal again.

I'm not going to miss these

My mood had definitely improved and I was feeling very positive and could not wait to start my physiotherapy. This ended up being nearly 3 weeks after my last hospital visit due to some rather poor bureaucracy between St. George’s hospital and St. Thomas’s hospital. My postcode meant I would not have physio at St. Georges, where I had my operation, but would be referred to St. Thomas. I spent nearly a week chasing this up, not being able to get through to anyone who could tell me what was going on.

Then I got a letter from Kings’s College Hospital saying I could come into one of their open physio sessions on a first come first serve basis. I wasn’t sure why they had been in touch, but was pleased they had and was so looking forward to starting physio that I didn’t mind the hour and half wait to be seen.

The physio was really good and I was glad I had my x-ray photos on my phone as I was able to show him in detail what had happened and he said this was very useful. I was given a long bit of rubber (shown below) which looks like some sort of bondage sex aid. You use it to help strengthen the ankle muscles by pushing on it away, to the left, to the right, etc.

My Physio Aid

I mentioned to the physio I was a member of a gym and asked if I would be able to use any of the equipment. He said absolutely and seemed pleased I suggested the idea. He said that I could use the bike, the cross-trainer, the one where you push your legs together, the one that you push your legs apart and the one where you sit and push your lower legs up. He said not to go crazy, but it would all help build up the leg muscle again and help stop the limping.

He also suggested I slow down my walk as the quicker I walked, the more pronounced my limp was. He said slowing down the walk would get the leg used to walking normally (as a small part of the limp is psychological) and combined with the physio and exercises it would all help me lose the limp. The physio also said to listen to my body in the sense that if you are feeling intense pain, then stop and rest and don’t push it, but that feeling a little sore and having swelling is all very normal and part of the healing process.

I’ve been to the gym three times since the physio appointment and although I realise how unfit I have become it felt good to be able to do these exercises and be proactive in my recovery as the first 2 months I felt very passive as you have to be patient and concentrate more on healing and looking after your leg. I’ve had the flu unfortunately this last week so have not been to the gym, but I am still making progress.

Leg 3 months on - Scars below the knee

My walk still has a limp but when walking slowly it is not very noticeable, but I am able to get about just fine (buses, London Underground, stairs, walking about, etc.). I have found walking down stairs the most tricky and for the first couple of weeks I went down one step at a time (i.e. one foot on the step, then the other before moving onto the next step) but have progressed to walking down more normally but I do notice the transition from stepping down on my left foot to the right foot is a bit heavy and fast. There is still not quite the control and fluidity that should be there.

Walking long distances (more than 15mins) does take its toll. My parents came up to London for the day and I met up with them and we walking around for a couple of hours and although we were not walking fast, it did feel sore and my Dad noticed I was limping more by the end than at the start. My leg had swelled a fair bit and was sore that evening and the following day.

The improvement in the leg means sleeping is better as I can get into my more normal sleeping position, but still get woken up with a bit of pain if I have been lying on it wrong somehow.

I still have a fair bit of recovery to go, but feel good about where I have got to in 3 months, especially as I was told it would be 6mths before I could do all the things I wanted to do. I feel I have got over the halfway point.

Recovery does seem slow with only gradual improvements (e.g. you notice little things get slightly easier, like getting in and out of the bath shower, putting on trousers whilst standing and walking down stairs), but it is nice when friends notice you are walking better than you were a couple of weeks ago.

I have my next and suspect last hospital check up later in the month and it will feel very nice to give the crutches back. I will not miss them. I also think that I will be quite close to being as recovered and able as the guy I saw at my last hospital visit. He was able to walk quite freely and easily but had a very slight limp.

My next goal is to be able to walk without a limp at all.

<<< Me and my IM Nail Part 1

Me and my IM Nail Part 3 >>>


Me and My Intramedullary Nail (2mths since the op)


Me and my IM Nail Part 2 (3mths since the op)>>>

Me and my IM Nail Part 3 (4mths since the op)>>>

Just over 2 months ago I had a fall and broke my left Tibia (at the shin) and Fibula bones (the lower leg bones) and had to have an operation so they could put a big metal rod (known technically as an intramedullary nail or rod) down the bone to help the healing process. There is not much information available on the internet about this procedure, particularly the healing process, so I thought I would share my experiences in case it is of help or comfort to others going through the same thing.

Tibia Break

Fibula Break

My fall did not seem like a major one and so it was a shock that I had broken a bone, let alone 2 bones and a massive unwelcome surprise that the breaks were so severe I would need an operation?! I was told that they would likely do one of three options: 1) put in a metal rod inside the length of the tibia bone; 2) put a metal plate across the shin area or 3) put in some sort of metal screw/nail horizontally through the shin.

I asked what the risks were and they said the intramedullary nail does have some risks and if I was having circulation issues before or during the surgery then it could lead to them having to amputate. I thought this was just a normal disclaimer but when I pressed the issue the doctor said there was a significant risk, although small in percentage terms of about 5%. The alternative would be not to have the surgery and have a cast, which would not guarantee the bones would heal okay and would also double the recovery time from 6mths to 12mths. I gave written consent that I was alright with them going ahead with the surgery.

It was only as I was being wheeled down to theatre that I was told they were going to do the more risky option 1. I told myself that 19 times out of 20 it would be fine, but couldn’t help but wonder if I would be the unlucky 1 in 20 and looked down at my left foot (well toes, as I had a cast pre-operation) and thought it might be the last time I would see it. When I stirred in recovery afterwards, my first action was to see if I still had my leg and was very relieved to still see it there.

My leg after the operation

Looking back on it, the hospital (St.George’s Hospital in Tooting, South London, UK) did not give me much information about what would happen to me and I was pleased to discover that I didn’t have a cast. Apparently, the point of intramedullary (IM) nails are that they help the bone heal a lot quicker by keeping it in position and also partly carry the strain the bone normally endures. As the ankle and knee joints are not restricted by a cast with this approach, it means partial weight can be applied and then increased when the bone and leg have sufficiently healed.

The technique was developed by German surgeon Gerhard Küntscher and first performed in 1939 to treat soldiers and helped get them back to health (and to fight again) much quicker. Having a cast and therefore a totally inactive leg for a minimum of 4 months or so requires a great deal of time and physio work to get back to normality. Whereas the IM nail approach would sometimes have soldiers back fighting within 6 months.

I found this You Tube video clip of an operation showing the insertion of the IM nail which would have been very similar, but not identical to the one I had. Note: It’s not particularly graphic but if you are a little squeamish, then probably best not to watch it.

I was told the metal used was a stainless steel alloy. People keep asking me if that means I will set off metal detectors at the airport and to be honest I still don’t know as I keep forgetting to ask. This article here suggests I probably will, but it won’t be a big deal and that airport security staff are quite used to it.

For the first day or so after operation, with a very swollen lower leg, I was on a morphine drip in the hospital and then was given Tramadol as a painkiller along with Paracetamol.  I was taking two Tramadol at a time, every 4 hours, and they made very drowsy as well as making me feel quick sick in the stomach. I let the doctors know and they reduced my intake to one every 4 hours, but I still hated the way they made me feel so decided after about day 3 to stop taking them, but kept them just in case I needed them.

I hate being in hospitals and could not wait to get out. I am in my early thirties and was in a 6-bed ward full of much older men with various issues more significant and serious than my own. Alfred, who was in the bed opposite me, was the undisputed wet fart champion of the ward. One evening there seemed to be an unconscious competition between the others as to who could fart and snore the loudest. Alfred was again the winner. One of the men was quite friendly and chatty but kept wanting to show me his stomach, which I was not so keen to do.

My view in hospital and wearing hospital slippers

I was admitted to the hospital late Saturday night and had the operation the following evening. I was told that some people, particularly the elderly, need to stay in hospital for a couple of weeks to recover but by the Thursday the doctors said they were happy for me to go home as long as the physio gave me the all clear that I was safe and competent on crutches.

I was desperate to get out of the hospital and could not stand to be there any longer than I had to so I needed to pass this crutches test with the physio. I’d been given the crutches late on Wednesday by a physio but unfortunately my first attempt was not a great success and only managed a few feet before having to lie down again. This was partly due to being very woozy from the painkillers, it also was my first attempt at being vertical since the operation and most likely due to me accidentally ripping out a poorly inserted cannular with the crutch and then started bleeding down my arm.

My swollen leg - taken when they were changing the bandages

The following day I stopped taking the painkillers and felt more awake and alert. The stomach guy on my ward had done the crutches test before and in return for finally showing me his stomach he told me what I needed to do to pass. You needed to go up and down the ward with confidence and then go up and down some stairs after they showed you the safe method of doing it.

The truth was it was an effort to get out of bed and even using the crutches to visit the toilet was a major ordeal. Having to wee into a container for several days was degrading enough, but I had refused to do a ‘number 2’ and so when I got the crutches I was able to go in a proper toilet for the first time in 4 days and boy did that feel good! Anyway, I had done a couple of practice runs on the crutches down the ward corridor and was not quick but felt I was competent.

The doctors had said I was allowed to put partial weight onto my left leg which meant when I walked with crutches I could put my left foot on the floor but not put any real weight on it. This is rather tricky at first as every instinct you have says not to put your painful foot (or rather leg) onto the floor. Keeping your leg raised in the air is a lot easier on crutches and you are assured that you are not doing any damage.  When putting the foot on the floor you have to time pushing down on the crutch handles ensuring your weight is carried by your shoulders and not your damaged leg.

My crutches

The physios wander the hospital visiting different patients and so you never know what time they will come round. Whenever I went to the loo on the Thursday I would do so as quickly as I could in case I missed the physio and would have to wait another day. He finally arrived in the afternoon and was a different person to the day before. He looked at my file and wasn’t sure if I was allowed to put partial weight on the foot or not. I told him the doctors had said it was okay and he asked a nurse who said she didn’t know. He then disappeared for ages and came back and confirmed I was allowed to. We went up and down the ward and he seemed okay with that and said that was enough for today. I told him that I wanted to go up and down the stairs and he said he wasn’t sure and went off to check something. I never saw him again that day and had to stay another night.

Poor old Alfred shat himself during the night. As in he properly shat himself and stank out the entire ward. Elsewhere along the corridor I heard a woman screaming in pain needing attention. I had to get out! I decided that whatever happened the next day, whether the physio showed up or not, I was going to leave in the evening.

A close up of just below the knee

I waited patiently for him to arrive and he did so just after lunch. Being off the painkillers (I only took them at night to help me sleep) made me feel a lot better and alert and when the physio arrived I felt confident I would pass the test. I asked him if we would be doing the stairs today and he said we will see how it goes. I then made it very clear to him that he was the only person preventing me from going home and that my bed could be used by someone more deserving than me. I gave him a look that made it clear we would definitely be doing the stairs.

We got to the stairs and he asked me if there were any stairs at my home and if so, were there any hand rails? I live in a flat so the kitchen, toilet and bedroom are all on the same level so that was fine, but I live on the top floor which means going up 7 flights of steps, plus a stoop at the bottom. I could not remember if it had handrails or not but needed to get out of the hospital so told him I had 3 flights of stairs and there were handrails on both sides!

I got my wish and passed the crutches test and could go home. My parents kindly gave me a lift from the hospital back to my flat which also turned out to be a bit of an ordeal. The U.K. had been hit by snow whilst I was I was recovering from the operation and so it meant the pavements and roads were very slippy. Not ideal for someone uneasy on crutches and a broken leg.

My ward seemed to be miles away from the exit of the hospital where I could get picked up by my parents’ car, but I was determined. My parents were stressing and fretting, getting annoyed with each other and I with them. When parking outside my building, my Dad preferred to use the side street from the main road but that was far too slippy and so he had to reverse onto the main road. Walking from the car onto the pavement was really quite tricky and very cold! I wasn’t able to put shoes on (my left foot and ankle in particular was very swollen) and so was wearing these pathetic and most unsexy hospital slippers.

Hospital Slipper

My parents were either side of me looking very anxious and every unsteady movement I made they over-reacted putting their arms out to catch me and making ‘aargh’ noises. They were just worried and wanted to help and make sure I was okay. However, it wasn’t helping me and I was in pain and quite cold so I got rather impatient with them and was quite rude to my poor Dad at one point. I got through the gate and to the stoop when I first had to start going up steps. I had forgotten the exact order of the method the physio had told me, but after step 3 or 4 I remembered and was able to get up stairs a lot easier and quicker than I thought I would, albeit one step at a time.

The safe method of going upstairs (or down) with crutches is to hold the hand rail with one hand and then both of the crutches in the other hand. One of which is used as a crutch and the other is horizontal as you are just carrying it, effectively. This is a safe method, but it is slow. It is also cumbersome when going up flights of stairs as when you have got to the top of one flight, you revert back to 2 crutches as you go round the corner and then have to change back to one crutch as you go up again. The alternative is to hop round, with the 2 crutches still in the one hand, which is what I ended up doing. After a few weeks you may feel confident to abandon this safe method altogether and use both crutches going up and down the stairs. I have been doing this for the last month, although I am sure physios would disapprove.

I got into my flat and lay on my bed, in my own clothes (not the horrible hospital gown) surrounded by my stuff in my bedroom that would not be disturbed by some nurse in the middle of the night asking if they could take a swab of my nose and groin. To which my response was initially okay and then as I realised what she had asked, “Hang on, you want to do what? Why do you need to do that? You do realise it’s my leg that has the problem?”

Being at home felt great and I was so relieved to be out of the hospital. My parents tried hard to persuade me to go and be with them in Somerset (2-3hrs drive from London) whilst I was convalescing. As the bedrooms are upstairs in their home it would mean them converting the living room into a bedroom for me. It would not be ideal and also, more importantly, it wouldn’t be my home. It wouldn’t be my bed and I wouldn’t have my stuff or my independence. It was better, although harder work for me, that I was in my flat. I don’t regret that decision in any way.

I’m still single at the moment and quite an independent, self-reliant sort so it was quite hard to be in my position where I did actually need a bit of help. My parents had been to the supermarket so I was stocked up with food and would not need to go to the supermarket for a while. A lot of the supermarkets do internet ordering and home deliveries and my flatmate offered to get stuff for me too so I knew I would be okay on that regard.

My first day at home alone was interesting. It’s the day the full realisation of your situation hits you as you figure out all the stuff that you are no longer able to do. So much of what you do in life depends on you having two able arms and legs.

Showering suddenly is a very precarious activity as you are balancing really on one leg and cannot move around. You can only wash yourself with one hand as the other is needed to hold on to the wall. It was only a few weeks ago someone suggested that you don’t actually have to stand up and you could sit on the floor in the shower/bath, I wished I’d known that at the beginning! As you have bandages, you need to have something to protect them from getting wet and my mum sent me the below which worked quite well.

Lower-leg guard

I am pleased my kitchen is quite small and so I can hop from one side to the other and rest on the counter without having to use the crutches. I was very pleased when I made my first meal for myself … some toast and a cup of tea. However, to get this from the kitchen to my room necessitates only using one crutch and carefully holding said plate or cup of tea and hopping gently without dropping or spilling anything. So transporting a simple plate of toast and a cup of tea turns into a palaver of two trips and even a third one to get the other crutch if you did not think of this when you first left your bed.

Going to the toilet is a bit tricky too and you have to be quite careful initially at lowering yourself down and standing up. It helps my loo is nearby and very narrow so there is always something to lean on or hang on to. I’ve also had to go from being a scruncher-stander to a scruncher-sitter.

As important as the physical side of things, is your mental attitude. After my operation in early January I was told it would be a minimum of 3 months until I was better and actually more like 6 months before I could “do the things you want to do”. Basically, all the plans and expectations I had for 2010 had just been thrown out of the window. I was hoping to get back into my jogging routine (having abandoned it for 3mths) and now I was being told that it would likely be July before I could think about doing something like that.

I feel I have approached the whole scenario quite well and in good humour. In fact, I have been quietly proud of myself in this area. I haven’t been angry about the situation or thought about ‘why me?’ or that is really unfair. It has happened and so you just have to get on with it.

I have focused on short-term goals rather than the end goal finish line. These goals were getting though the operation okay, then getting out of the hospital and then my first hospital check up about 2 and half weeks later. The next milestone was the following check up about 5 weeks later (a couple of days ago as I write this). More of this a bit later on.

The first week at home was the toughest week by far. The leg was still very swollen and very painful when not in a well-cushioned elevated position. Whenever I stood up, it felt as if blood was rushing in to the lower leg all and would be extremely painful for about 5-10mins. The kind of pain that leaves you out of breath and so I had to psyche myself up for every trip to the toilet or to the kitchen. It would be such a relief to get back to my bed and get my leg back on the pillows.

The swelling of the lower leg, ankle and foot meant that the leg seemed distorted and when I put the foot on the floor and tried to straighten it, I could only get my foot flat by standing at an odd angle with my other leg slightly bent. I was quite concerned that maybe something was wrong and that the metal rod was misaligned. However, when the swelling went down, all was fine.

After the first week at home, the swelling in the leg went down and it started to look quite normal and the pain gradually subsided. The 5-10mins of tremendous pain every time I stood up got less and less in time and intensity and I felt a lot better and was motivated to be more mobile.

I had been house-bound for over week and felt it was now time to venture outdoors. I planned a trip to my local shop to get a few sundry items, something that previously would be a nothing task that would take only 10mins to do. Now I had to plan this carefully as I felt sure I could get down the 7 flights of stairs and then the 50 yards to the shop without any problems. However, I was concerned about the actual shopping part as I would not have a free hand to carry the items I wanted to buy.

My solution to this was to use a rucksack which when in the shop would come off my back and, using the small top handle, would rest on one of the crutch handles. That way I could walk around and simply put in the items as if it were a basket. When full of items it does become a little difficult to walk about with, but overall has been more satisfactory than the hassle of putting the rucksack on and off again throughout the shop.

When I ventured outside onto the street I felt very vulnerable on my crutches and was really wary that someone would accidentally bump into me and I would fall over and damage my leg more. That feeling of vulnerability reduces the more you heal and the more confidence you gain on the crutches.

I was more than a little chuffed at having got to the shop and back with my shopping. I felt independent and quite knackered! Two days later I went with a housemate to meet a mutual friend at a nearby pub for a drink. The pub is a 7mins walk, but on crutches it seemed to take forever and was quite uncomfortable. I had got some padded bike gloves to use with the crutches but still managed to develop blisters. Some people wrap bandages or padding around the handles and I think this may be a better approach.

In the pub we sat on stools and had a drink and it felt good to be doing something normal again. It was my first social engagement since having the operation 3 weeks previously. It was not a comfortable experience as at that point whenever the leg was not elevated it became sore quite quickly and so I was always readjusting my position to try and make it more comfortable.

The elbow crutches I have are really quite good, but the one issue I have with them is that it is very difficult to keep them standing upright when resting against something. It only takes a slight nudge and they will fall over, something that happened many times when at the pub. However, it did act as a good ice-breaker to talk to people (women) who would ask what I had done.

Not having a cast was really good but sometimes it would have been useful to have one. People would notice the crutches and then look at the leg and because there is no cast they are less sympathetic, like I’ve just sprained my ankle or something.  Once the swelling went down it was easy to put on shoes and socks so apart from the crutches I look quite normal and able-bodied. So out an about on buses and trains people don’t give you as much space and are less wary about bumping you as they would if you had a cast.

My first hospital check up appointment was an important milestone I was working towards and I would need to get a bus for the first time whilst on crutches. Buses in London have a big step up to get on and I was worried about finding a seat in time before the bus started moving, not getting hit by other people and then getting off as you cannot stand up until the bus has stopped.

The bus experience was not as bad as I thought on the way there, early afternoon, and I was able to get on the bus without a major jump up or anything and found a seat relatively easily. However, the journey back was at rush hour and I had to fight a swarm of people to get on and then find a seat. It was okay, but I wasn’t comfortable.

The hospital check up went well, apart from the ridiculous waiting time and had an X-ray done and then spoke to a consultant who confirmed the IM nail was aligned exactly as it should be and that I should come back again in 5 weeks time. He said if I started to feel better that I could start putting a little more weight on the leg.  Rather than stitches, I had metal clips and these were removed at the visit. They have a little device a bit like a fancy staple remover that takes them out and is mostly painless.

Metal clips below the knee, just before they were removed

Bottom left is the bruise and mark on the shin from where the bone almost came through the skin

It was the first time I got to actually see the metal in my leg and was a little shocked as I saw more metal than I expected! When I was told that I would have a metal rod in my leg I had pictured in my head a thin rod and some small screws at each end to hold it in place. As you can see the IM nail is quite substantial and the screws holding it in place are the width of the leg, seeming like they may pop through the skin at any moment! The doctor let me take a photo of the X-rays.

X-Ray of IM Nail in my leg - top left is my knee and the whitest parts are the nail and screws holding it in place

Another angle - showing the IM nail just below the knee

Passing that first big milestone was a real motivator and confidence boost as all the worries I’d had were now gone and I was feeling more comfortable and less in pain as each day went by. Thankfully I work for myself and so it meant I could now start to get back to work and earn some money. Unfortunately, I am self-employed and so I had no income at all for January and I was not cash-rich when the accident happened and so it has left me in a difficult financial position, one that I have not yet resolved.

The next few weeks I ventured out a bit more, went to a few work meetings, to a friend’s birthday celebrations and even travelled by train on my own to Birmingham (2hrs from London) for another friend’s 30th birthday. Actually that latter trip was a tough day as it was a Saturday but I was doing some work for a client in West London and the plan was to finish up there and then head straight to Marylebone to catch my pre-booked train. I realised as I left my client that I had left my train tickets and wallet in my flat so had to go all the way back to South London to pick up my wallet and then travel across London again and buy a new much more expensive ticket to get to Birmingham. I was so annoyed with myself.

Using the London Underground is not the easiest thing in the world as most stations are not geared up for people with disabilities. To get through the turnstile you have to swipe your oyster card and quickly get through the gate before it shuts on you. You feel a bit vulnerable on the escalators and it is a bit hairy if the person in front of you decides to get off at the very last moment. So far people on crowded buses and trains have been really good and someone has offered up their seat when it has been busy.

My next milestone was a couple of days ago with my second hospital check up. I have been getting really bored and tired of being on crutches and the pain has pretty much gone, just a little soreness. In the week leading up to the appointment I had felt a lot better and had been putting a bit more weight on my leg, but not too much as I still have a bruise and swelling where the tibia break was (the shin). I was eager to start physio and start the process of being able to walk again and did not want another 5 weeks of being on crutches.

The appointment went well and was told I was healing fine and that I can start putting more weight on the leg. I showed the consultant that I could stand on tip-toes unaided and could walk without crutches, well, I can do this rather slow pathetic hobble walk. The consultant made a ‘lame’ joke about is that how people walk in Clapham (where I live) and said I needed to start physio and putting weight on the leg would aid the healing process. The nurse told me that when I started putting more weight on the leg and doing the physio my leg and foot would swell up, but this was normal.

I left feeling very happy. I had passed the milestone and was onto the next phase. I now only use one crutch when moving about the flat and although it is not a fluid movement and still a bit of a hobble, it is a lot better than before. I can now put the used tea bag straight into the bin from the cup (as you need two hands to do this) rather than putting it on a plate and emptying it later.

When I was waiting at the hospital I saw another guy who had crutches. He could walk without them and had a very slight limp and walked into his appointment carrying the crutches and then came out without them. That is my next goal, to be like that guy at my next appointment in 6 weeks or so.

My ultimate goal is to be able to do a 10mins jog. Once I can do that I will feel like I have recovered, but that is a long way away and I am just focusing on the next goal.

If you have your own experiences to share or know of useful information or resources online please add them in the comments below.

Me and my IM Nail Part 2 (3mths since the op)>>>

Me and my IM Nail Part 3 (4mths since the op)>>>

Jake McMillan