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

by Jake McMillan

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

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.

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

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

IM Nail Removal – Carl’s Experience

by Jake McMillan

Morning after an IM Nail Removal

Carl had his IM Nail removed a few days ago on Aug 13th 2012 and he has very kindly allowed me to share his experiences, including a few photos! He had fractured his right tibia and fibula a year ago in Aug 2011 during a football match.

He attended physio and all seemed to be going well up until about 6 months after the procedure when he started to experience pain in the area of his ankle and his knee would regularly swell up like a balloon.  He revisited his consultant to see what could be done. Carl explained he was lucky as the consultant listened to his experiences and issues and on reviewing the x-rays could see the nail was causing the swelling to the knee.

Carl’s original tibia break

Carl’s IM Nail

Removing the IM Nail was then put forward as a solution to the problems Carl was experiencing. However, he would have to wait until August 2012 as no removal could be authorised until a minimum of 12 months after the original injury in order to allow the tibia to heal. Carl was also advised that there were risks to having the nail removed:

• the tibia could fracture again
• the nail could snap and they would have to leave it in

As Carl very much wants to continue to participate in contact sport (in particular football), he decided to go through with the removal of the IM Nail. He was advised if he had another break with the nail still in, it could cause more problems than when taking it out. (I think we are all a bit concerned at the thought of what our nails might do in such an accident!)

Carl’s operation was a success but it turned out to be more complicated than expected in his particular case. Normally this procedure takes approximately an hour, but in Carl’s case it took two and a half hours due to the fact the screws had embedded in the upper part of the tibia. In order for the screws to be removed they had to make a window in the bone which took some time and he was told it was difficult to do.

Post operation he was fine, apart from a some swelling as to be expected. He has stated that he would go through the procedure again and at this stage he is not experiencing any concerning pain other than mild discomfort which is managed by paracetamol and ibuprofen.

The knee the morning after the IM Nail removal

The ankle the morning after an IM Nail removal

He has been advised to wait 3 months before doing contact sports and was encouraged to do other sporting activity such as cycling and going to the gym. He can currently walk around without crutches, however, he has learnt it is best for him to use one crutch to practice full weight bearing (heel and toe) rather than limping which he has done previously in a failed effort to speed up his recovery.

A massive thank you to Carl for sharing his experiences, I hope this is of use and interest to everyone reading this.

IM Nail Survey

by Jake McMillan

To all those who have had an Intramedullary Nail (IM Nail or Rod) procedure, would you please take a few moments to complete the 10 Question Survey (via the link below) about your experiences, it’s a mix of multiple choice and optional free text questions.

As such little information exists about going through the experience of having an IM Nail, the recovery period and possible ongoing problems, I thought it would be useful to collect a mixture of quantitative and qualitative data. The aim is to share the collated data and analysis with everyone.

To complete the anonymous survey, please use the following link:

www.surveymonkey.com/s/TSFX3DZ

If you have any questions about this questionnaire or would prefer to have it posted to you or conducted over the telephone, please email me.

Update (25th January 2013): Thank you to all who have filled in the survey so far (95 responses!) … I will wait until I have got a 100 before writing up the findings, but may share some early findings before then.

I shall also be putting together a survey about IM Nail removal.

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

<<< Me and My IM Nail (Part 6) – 1 Year after the accident

Me and My IM Nail (Part 8) – 3 Years after the accident >>>

Wow! It is hard to believe it has been two whole years since I broke my tibia and fibula at Clapham Junction Station and had an operation to put an intramedullary nail (IM Nail) into my left leg in January 2010. Getting to this point now seemed like a lifetime away shortly after the accident as I only let myself concentrate on short term goals. I took things a month at a time and 6mths seemed too far away to think about, let alone two years. However, here I am and happy to report things are good!

Before getting to specifics, I would like to say a massive thanks to everyone who has contributed to this blog, not just for some of the nice things said, but especially to those who have shared their own experiences.  I started writing about my own experience as there wasn’t (and still isn’t) very much on the interweb about IM Nail recovery and what to expect. It has been very helpful and reassuring to me and to everyone else that others are going through similar problems, worries and issues. Please do keep adding and updating your own experiences as well as any handy tips as lots of people have got in touch to say how useful it is to read them all.

Right, a few people have asked me some questions of how the leg is 2 years on, so I will answer those:

Does the leg feel like a normal leg now?
Almost, but not quite. If you have broken your leg to such an extent that you need an IM Nail inserted, then your leg is never going to be quite the same again. You have to accept that having a large bit of metal in it means that it is not a normal leg any more. Two years on and it feels normal most of the time, but not all the time. For the first 6mths and year of recovery you will be very aware when walking that one of your leg feels noticeably different. However, as time goes by, it starts to feel less and less different to the extent that you don’t think about it much, but you are still aware of it. Don’t be disheartened into thinking you can’t do the things you did before, as you can, you will just be much more aware and careful with your leg. Doing the physio and exercising the leg can actually make it stronger than it was before the IM Nail.

Do you still get pain?
No, I wouldn’t describe it as pain, but I get niggles from time to time. For example, yesterday I had a few niggles just below the knee whilst in Central London. I’ve been ill with a fever and been stuck in bed so it was the first time I had walked anywhere in a few days. I had to sit in an uncomfortable chair for an hour or so and when I got up and had to start carrying/moving stuff around I noticed the niggle. No great pain, just small blasts of it feeling sore and a bit weird. It didn’t prevent me from walking around or doing what I was doing.

Have the scars gone?
Nope, they have faded a bit, but not a lot. As you can see below there is still an annoying brown/bruise type mark where the tibia broke. I had hoped that this would have gone away as it’s nowhere near as sexy as an operation scar. Oh, and apologies about the hairy legs!

Will you have the IM Nail taken out?
It’s definitely something I am considering doing, but because I don’t get lots of pain, just niggles, it is not a priority. I am going to organise a visit with the consultant to see what the options are and review the risks.

Have you had any other issues?
Two months ago (November), I had a problem with a shin splint type pain in my bad leg so had to rest it for a few weeks. Shin splints are caused by muscle imbalances in the legs and I think because I hadn’t been keeping up my exercising (I cancelled my gym membership a few months beforehand) this caused this issue.

Any words of advice or encouragement?
Yes, absolutely. Although the above has focussed on issues I have had, I feel my leg is really good right now and I am happy with it. Although doctors tell us that it takes 6mths to recover, it is actually longer than this. We will still get pain and soreness for much longer even though we can be very active on our leg. Be patient with any pain, it should subside eventually. If you are still getting a lot of pain after a year then definitely go back to discuss with your consultants. Even when the leg is feeling good a year after the operation, do keep up some of the physio. I still do the standing on tip toes on my bad leg from time to time (sets of 15).

Can I get in touch with someone who posted a comment as it seems they experienced what I am going through now?
Potentially yes, this has happened already. I will get in touch with the person and ask if they are happy for you to contact them.  Please send me an email: jake.t.mcmillan@gmail.com

Please share your experiences! It really is useful for others to hear about what you have gone through. Also, if you have any questions or worries, then maybe others have an answer.

Jake McMillan

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<<< Me and My IM Nail (Part 6) – 1 Year after the accident

Me and My IM Nail (Part 8) – 3 Years after the accident >>>

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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) >>