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Vince : A beautifully shattered tibia
Diary entry posted Wed 11:44am 11 May 2005

It has been three months since I broke my leg on February 12, but it is such a bad break, and healing is going so slowly, so I have decided to start a diary here. I am inspired by the stories I read on this website. So many of you show such courage and resilience in your struggle with the healing process.

This first entry will be quite long in order to bring you up to date.

I was hiking with a friend along the Caney Fork River in Rock Island State Park in Middle Tennessee on February 12, 2005, and jumped down off a low ledge. At the age of 56 I walk several miles every day (well, not right now!) and do a lot of hiking. I take very good care of myself, I am nimble on my feet, and love "boulder hopping" along rivers. In this particular case, the cause of the accident was a dumb mistake on my part. We always learn by our mistakes, but it really sucks when a mistake has this kind of consequence.

The ledge below me was in the shade, and it looked like level bedrock with dark and light striations running over the surface. In reality, one of the striations was an edge with about a 4" drop.

My left knee has always been a bit problematic, so I intuitively land on my right leg first. In this case I landed with my full 250 lbs. on my right foot squarely upon that invisible edge, snapping the foot violently to the side. Amazingly, the ankle and fibula were unhurt, but the the lower tibia was shattered - a compound spiral fracture, with one bone fragment initially protruding 5" above the ankle on the right side of the tibia.

As some other people have commented in their narrations, I distinctly heard the bone snap, and it is a sound I hope to never hear again. It wasn't a simple, clean snap, and I was very worried about what I had done. The subsequent x-rays confirmed that I had shattered the bone.

Needless to say I collapsed, and fortunately I fell backwards in a sitting position, instead of tumbling forwards onto the rocks below. The pain was very bad if I allowed the break to flex at all, and I gripped the leg around the break in an attempt to keep it stable.

I will never forget how my life changed at that instant. My first thoughts were "What have I done to myself?" and "How will I get out of here?" but I couldn't possibly envisioin the implications. Almost immediatly I thought "What about my students? Who will teach my classes? How long will I have to stay off work? How will I tend to my basic needs?"

My wife teaches at a university in another state, and I live alone, so I was immediately worried about the everday realities of living.

My friend Tim was up the canyon a ways, unaware of my plight. Across the river, two couples were hiking on the rocks, and I called out and got their attention and pointed to my leg. I remember letting go with one hand to point to the leg, and experiencing a wave of intense pain. I think they saw me grimace, and thus knew the gravity of the matter. One of the women hurried over, and it turned out that she and the other woman were twin sisters, one a nurse and the other a physical therapist. The nurse's husband surrendered his teeshirt, and they tore it into strips and bound straight pieces of driftwood on either side of my lower leg as a temporary splint.

By this time one of the husbands had gotten word to Tim, and he called 911 on his cell phone. The first to arrive on the scene were the park rangers, then the local volunteer fire department, then the EMTs (with pain medication, bless their hearts), and finally the Sparta/White County Rescue Squad. They strapped me onto a backboard stretcher and then into a crash basket. For a while they were talking helicopters, but then they just hoisted me up a cliff and carried me a half mile to the ambulance.

At the time of the accident, I could have sworn that Tim and I plus those other two couples were the only ones in the area, and yet by this time a crowd of fifteen or twenty "observers" seems to have gathered, in addition to all the emergency and medical personel. I have no idea where they all came from.

I was taken to Ccookeville Regional Medical Center, and luck of the draw, the orthopedic surgeon on call was Dr. John Turnbull. I am very impressed with him. He has an excellent bedside manner, and involves the patient in all discussions and decisions.

I was x-rayed in the emergency room, and I can remember how my heart sank when I saw those x-rays. I couldn't imagine how they could fix such a badly shattered bone.

Dr. Turnbull operated on me a little later that afternoon, installing an external fixator, with two 1/4" stainless steel pins screwed through the upper tibia, and two screwed into the big calcaneus bone below the ankle. It was quite a shock waking up in recovery with that thing on my leg.

My wife Linda drove down from St. Louis, and I stayed in the hospital two days. Linda took me home on Monday the 14th, and that afternoon several friends and students showed up and built a ramp to bypass the steep and slippery stairs that access my front door. I bought two sheets of plywood and a roll of roofing for a non-skid surface, but otherwise the materials were all left over from a friend's remodeling project.

My neighbor lady Ruth practically adopted me, and after Linda left Ruth came over every morning for the next few weeks to fix my breakfast and lunch. At work they created a sign-up sheet for people to come over every evening and fix dinner for me. I cannot imagine what I would have done without this wonderful kindness and generosity, or how I will repay people for all their help. But I've been thinking about it, and I guess that isn't the issue. It isn't necessarily a matter of directly repaying those who help you. It is more a matter of responding by helping people who need it.

Linda came back down for Spring Break, and while she was here I went to school and experimented with getting around in a wheelchair. I am using a walker at home, crutches elsewhere, but the doctor thought that with the fixator, a wheelchair would be best at school, and he was right. It is the most versatile and comfortable option.

I returned to teaching part time right after Sring Break, in the third week of March, and full time the following week. It was very awkward at first, but everyone was anxious to help, so things worked out well.

I went in for a checkup with the orthopedist every few weeks, and the x-rays never seemed to change. It was very dispiriting. I tend to be an optimistic and resourceful person, and I am keeping myself entertained, doing worthwhile stuff, but it was very hard going back to the doctor's office again and again and seeing the x-rays with all the same breaks and gaps perfectly visible, and no sign of any healing taking place. It has been difficult not being impatient.

With the slow healing, Dr. Turnbull predicted that I would get a "nail" (titanium pin inside the tibia) after the external fixator was removed. The plan was to remove it after eight weeks and then give me a temporary fiberglass cast for a few weeks, and then install the nail.

On April 8 I had surgery to remove the external fixator, and they installed the temporary fiberglass cast. Ten days later I went back for a checkup, and the physician's assistant Chris said that they were still planning to do surgery to install the nail. We scheduled the next appointment for May 3, in order to give me time to finish the semester.

On April I expected them to schedule surgery to install the nail. Two weeks earlier I had been told that I would have no cast, and within two or hree weeks after surgery I would be able to start swimming and physical therapy. I cannot overstate how much I was looking forward to that.

However, I have a history of strep infections in my legs going back about 20 years. A specialist at Vanderbilt diagnosed them about eight years ago, but could not say why I am so susceptible. I always carry antibiotics to deal with any infection, and I have not had one for several years. However, whenever installing an internal fixator inside a bone after removing an external fixator that was threaded into that bone, there is always an elevated risk of bone infection. With my higher risk factor, the orthopedist recommended that we postpone the surgery for at least a month and then see how the healing is progressing. I asked him about the implications of infection inside the bone, and he replied "Worst-case scenario, you loose your leg."

So, obviously, it was an easy decision to postpone the surgery, and so they put on another fiberglass cast. Dr. Turnbull warned me that I might very well have a cast for at least three more months, and predicted that it will be at least a year after the accident before I will be walking comfortably.

It is frustrating that healing is going so slow, and especially that I am in the cast for one to three more months.

As mentioned, I am a positive and optimistic person by nature, but I love the outdoors, swimming and hiking, and I normally travel out West ever summer. This summer is pretty much a washout. I will make good use of the time, doing lots of reading and writing, watching every DVD I've been wanting to see, playing my guitar, but that's the kind of stuff I have already been doing for the last three months. It is hard to continue the same old stuff with the weather so beautiful outside. I need to avoid any kind of strenuous exercise, because sweating inside the cast is what starts alien colonies growing in there, causing itching and rashes, and in my case increased chance of leg infections.

If you are interested, you can check out the images and captions on my website at http://iweb.tntech.edu/wpitelka/Digital/digital_photography.htm. Scroll down to the lower part of the page. You can even see images of Dr. Turnbull removing the fixator pins with his nifty stainless steel cordless drill.

I'll add to this diary as things progress, and I promise that subsequent additions will be shorter than this one. I'll be interested in your comments.

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 Wed 11:44am 11 May 2005
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