X-Rays - September 7, 2005

Quite a mess, huh?  It is amazing to look at these x-rays, and compare them
to the ones taken right after the accident.  There just doesn't seem to be very
much difference.  I understand that the foggy areas represent new bone growth,
but apparently there are several non-union sites that are not healing.

Dr. Turnbull took a good long look at all these x-rays from September 7, and
decided that the bones just are not healing on their own.  There are several options
for treatment, and he wants me to get another opinion.  They arranged for me to 
see Dr. Phillip Kregor at Vanderbilt University Medical Center's Orthopedic 
Trauma Clinic on September 19.  I took my entire packet of x-rays with me. 

I drove in to Nashville on Monday, September 19, expecting to see some stuffy 
academic doctor.  Nothing could have prepared me for Dr. Kregor, who turned 
out to be about Dr. Turnbull's age, with that appealing combination of confidence 
and accessibility.  He has a good sense of humor and an easy bedside
manner, but it is apparent that he is one of the best in his field. 

Dr. Kregor and his team agreed that the bone is not going to heal by itself. 
He recommended installation of an intramedullar nail with reaming, and with
bone grafts from the iliac crest (upper rear pelvic bone) to fertilize the non-unions. 
The "nail" is a titanium pin 16" long by 1/2" in diameter.  When I am under 
general anesthesia, an incision will be made just below my right kneecap, and 
they will drill through the upper end of the tibia and bore out the intramedullar 
canal down the center of the bone.  The nail will be installed in that bore, with 
pairs of screws through the bone and the nail above and below the break.  
Supposedly that will provide enough strength to support my full weight, 
but there will be no running or jumping.  

It will take a while to build up the muscles in the foot.  Swimming builds up the 
thighs, hips, arms, chest, etc., but has little effect on the muscles in the lower leg 
that control the ankle and foot.  I will be walking with a cane for a while, but that 
will be a big improvement over crutches.   

Surgery is scheduled for Tuesday, September 27 in Vanderbilt University Medical 
Center.  The wife of one of my students is an emergency room nurse at Vanderbilt, 
and she said that Dr. Kregor is very good.  He's the one that gets the difficult orthopedic 
trauma cases that are life-flighted to Vanderbilt.  He said that he could do the surgery, 
or I could have Dr. Turnbull do it.  I think very highly of Dr. Turnbull, and I am so 
thankful for everything he has done for me, but it just made sense 
to have the surgery done at Vanderbilt.

I hate the idea of more surgery, and I understand that recovery from the bone
graft is very painful, but I am just so anxious to get back on my feet.  I'll put up with
just about anything.  Dr. Kregor warned me that the recovery would be painful, but
then acknowledged that after all I've been through, it might not seem that bad.

Through my research on the internet, it seems that the correct name for my injury
is a "compound spiral butterfly distal tibial fracture."  "Compound" refers to the fact 
that a piece of bone penetrated to the outside initially.  "Spiral" refers to the diagonal 
fractures spiraling around the bone.  "Butterfly" indicates that several spiral fractures
cross over one another in opposite directions.  Distal means that the fracture is 
towards the distant end of the bone, versus a "proximal" fracture.  "Tibial" simply 
refers to the tibia.  It's a lot of words, but then, I seem to have done a hell of a job 
of shattering my lower tibia into lots of pieces, so it seems appropriate.

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