It´s not the injury itself, it's the time you're off the bike not being able to do what you really love. Months and months of training and waiting to get there again. The very first day back on the bike you realize it's worth it. You're back where you belong to, BACK to RIDE.
Hmmm... I have come to a conclusion in all my infinite wisdom... As someone who lives for riding mountain bikes and kayaking whitewater I now know, if the god that I don't believe in, sends me to the hell that doesn't exist, that hell would consist of me stuck on a couch with a broken leg, watching someone ride their mountain bike in slow motion, with clips of slow moving water in between...
That 3.5 fully-threaded syndesmotic screw is too long. It is at least 4 threads past the distal cortex and appears to be directed from lateral-anterior to medial- posterior as well... It juts out in an area where a pile of tendons, a big artery, and a big nerve run. I think it will become troublesome down the line. Not to mention that long spiral fibula fractures can occasionally come with soft tissue interposition in the medial gutter. There is certainly a bit of mortise incongruity from the views presented. Was that looked at?
We leave them long in order to be able to retrieve the screw from the medial side if it breaks (especially if you're gonna use a wimpy 3.5mm, we typically use 4.5mm). Also the syndesmotic screw should be removed prior to returning to weight bearing so I doubt it's still in there....but what about that posterior malleolus fracture????
I would leave that posterior malleolus alone - it's not gonna be a problem. We often leave small ones like that. Syndesmotic screw - either you remove it prior to loading, or not - than it breaks and that is still fine. Functional outcome is the king here. Interposition after open reduction? Doesn't look like it, that would be major screw up. About that mortise incongruity - good point. Projection looks like is a legit AP...
Good point about the length and 3.5 failure. Have always used 4.5 or tightrope so that didn't even occur to me. Why would you use a fully threaded 3.5 there? That's like running 32mm stanchions with 9mm QR for DH riding. Not to mention having to overdrill the already compromised fibula to generate lag. I would leave the posterior malleolus... it should heal on its own.
Soft tissue interposition - was referring to a piece of the deep deltoid getting stuck in the medial gutter. The same mechanism of injury that causes the spiral fib fx is also known to shred medial structures. Had a 4 month post-op that we had to take in again to pull a chunk of fibrous tissue out of the medial talar dome. Fibula reduction looks decent, pulled out to length. It's a guess as to why there is incongruity.
Atleast the plate is not posterior. I got my foot caught in the dirt on a section I've ridden 100s of times and externally rotated my foot snapping my tibia and fibula. My surgeon put my fibula plate posterior and 2.5 years post op i had to have it removed. Suspicions of peroneal tendon damage were confirmed as mine was found to be shredded and had to be repaired. 6 weeks non weight bearing. Im at week 10 now and just starting impact training. I hope to be back in the saddle soon but to chicken at this point.
Tightrope is the new gold standard for syndesmosis injuries. JOT just published a long term study showing 30% or more are malreduced when using screw fixation. 0% when using a tightrope. No second surgery to remove a broken screw and sooner weightbearing.
Can someone look at my X-Rays, and tell me if mine looks OK? I had a broken collar bone, broken arm, broken ribs, and shattered shoulder. Accident was at the end of last summer, and Im still in Physio attempting to regain full motion in my arm. All screws stayed in.
Apparently, there was risk of the screws breaking at some point, but that never happened. And, the is risk of the ball of the shoulder/arm losing blood in the future, requiring a full shoulder replacement. Obviously, I hope that doesnt happen.
OUCH! Your pics look like a similar injury at the collar bone. Not fun
Mine happened on my first day out, after a long break from downhill (a few years). Went too fast over a big drop, and missed the transition on the landing. Front wheel hit the area that was more flat, and I got catapulted over the bars. Happened very fast, and I didnt even have a clue I was in trouble, prior to the crash.
At Blue Mountain, there is rock and hard clay, so I think first impact on my arm/shoulder may have hit something hard. Then I flipped and rolled. I was wearing full body armor and a full face helmet, but still got pretty banged up. I can only imagine how bad it would have been with no body armor.
I'm just being a turd about the posterior malleolus Rarely does it need additional fixation if it reduces nicely, as this one does. Here in the states the Tightrope is gaining ground for sure.
@halo777 yeah man that sounds horrible. I hit pretty much solid ground too right at the landing of a teeny weeny step-up, no idea how it happened. Was having a laugh and then oops, over the bars and down i went.
That looks like a way way too fixated fibula, and for cert the biazzare ( uk / AO plate mantra) long screw to the tibia needs early removal, it will snap for sure.
I did a cirurgy last week abomninal hernia. doctor say 5 to 6 month without Downhill... before the cirurgy a did tons of laps in my local Bikepark, did a epic 30 minutes downhill trail with river bath and tons of beer and joints at the end. now I have to wait but Im ok with that. with almos 46 years old the health becomes weeker but I will be back, and if god want I will be in Whistler in the end of the season for Bikepark closure and ride local trails...
My x ray of my injury is almost identical to that. I had this happen to me while riding a foam pit www.pinkbike.com/photo/8594922. I was a bit cheeky and started riding 3 months later while still wearing a cast. Its crazy to think that back in the day, in injury like that would leave one for dead. Thank god we have all the technology we do today. Its amazing that we can walk after something like that, let alone ride again!
That looked like some bad azz conditions to make your comeback riding vid in. I'm stoked for anyone that comes back post op. I know I'll never be the same with screws and plates but I still love to push it further than I ever have.
I did the same thing. Only consolation is I caught mine on video. Happened on opening day too, which really sucked. Heading up there for opening day this weekend again (year later). Hopefully I walk away this time!
I was off my bike for a whole year with health problems. I recently got released from the doctor to ride. To anyone whoever had to deal with this you can understand the joy and excitement of that first ride back!
MTB viddy is pretty cookie cutter lately, this was a missed opportunity to narrate a cool story. Anyway beautiful photography, wish I knew what gear they were using?
kinda felt like some big companies used this 'back on the bike' video just to promote their products and it kinda sucks to do marketing with the injury of someone.
ok, -the guy is able to smile -the moviemaker didn't read his camera's leaflet, he only know hot so film slowmo -it probably rained the night before -the guy like to put his head into litte waterfalls -the guys who made the """"music"""" knows the drums, and nothing else
Can someone look at my X-Rays, and tell me if mine looks OK? I had a broken collar bone, broken arm, broken ribs, and shattered shoulder. Accident was at the end of last summer, and Im still in Physio attempting to regain full motion in my arm. All screws stayed in.
ep1.pinkbike.org/p4pb11387691/p4pb11387691.jpg
ep1.pinkbike.org/p4pb11387737/p4pb11387737.jpg
Apparently, there was risk of the screws breaking at some point, but that never happened. And, the is risk of the ball of the shoulder/arm losing blood in the future, requiring a full shoulder replacement. Obviously, I hope that doesnt happen.
Btw go check my injury pics.
OUCH! Your pics look like a similar injury at the collar bone. Not fun
Mine happened on my first day out, after a long break from downhill (a few years). Went too fast over a big drop, and missed the transition on the landing. Front wheel hit the area that was more flat, and I got catapulted over the bars. Happened very fast, and I didnt even have a clue I was in trouble, prior to the crash.
At Blue Mountain, there is rock and hard clay, so I think first impact on my arm/shoulder may have hit something hard. Then I flipped and rolled. I was wearing full body armor and a full face helmet, but still got pretty banged up. I can only imagine how bad it would have been with no body armor.
Get better soon man!
B) bums brands
C) Is rather boring
D) Overall, its not great.
www.youtube.com/watch?v=M7DRJrtsuBc&t=9m10s
-the guy is able to smile
-the moviemaker didn't read his camera's leaflet, he only know hot so film slowmo
-it probably rained the night before
-the guy like to put his head into litte waterfalls
-the guys who made the """"music"""" knows the drums, and nothing else
CCL, NOT CONVINCED AT ALL, 3outof10