ANKLE FUSION SURGERY

On June 3, 2017 I had an accident that had profound effects on my lifestyle. This blog recounts my road to recover
Due to the severity of my original ankle injury which ruptured my Fibula, Tibia and Talus (all major components of my right ankle), ankle fusion surgery was always a possibility. Originally it was envisioned that ankle fusion surgery would not be required until later in life when/if arthritis arising from the injury would make walking and other activities too painful. Unfortunately, because of the magnitude of the damage done to the Talus in the original fall, the Fibula and Tibia were not healing properly and ankle fusion surgery was needed immediately as a follow up to the original surgery.
My surgeon was very thorough explaining the pros and cons of performing ankle fusion surgery at this point in time or trying a second surgery to try and repair/make adjustments to the original ankle surgery done in June. Ankle fusion surgery is a process which anchors/fixes all components of your ankle into one cohesive piece. For all intents and purposes, you lose the flexibility and mobility in your ankle. This is done with a series of screws and metal plates which are inserted. Future movement and mobility will be affected, however, one will be able to walk and perform a number of normal mobility functions. The foot itself has a number of joints so some flexibility will be maintained. Key to the surgery is the proper positioning of the ankle as the ankle will be locked into this position. Misalignment will cause future discomfort and make walking and other activities more difficult.
As I am an active person who enjoys many physical activities such as running, hiking, etc, ankle fusion surgery will impair my ability to perform many of these functions. Running in future will definitely be out. Some hiking or the degree of difficulty of my hiking will probably also be impacted. The alternative was to try a second surgery which may or may not be successful and optimistically would have a 50/50 chance of success, given the damage originally done to the Talus. A second surgery would also not eliminate the ultimate need for ankle fusion surgery down the road. Given these choices, and the fact that I had already been on crutches and couldn’t put any weight on my ankle for 4 months, I opted for Ankle Fusion surgery. As I see it, the sooner I can begin making adjustments to my future lifestyle activities, the better off I would be.
In my particular case, because I had recently had major trauma surgery when I broke my ankle in June, the ankle fusion surgery was a little more complicated. First, the original hardware (screws and plate) designed to reconstruct and hold the Fibula and Tibia in place would have to be removed. Next a piece of the Fibula would be cut to be used to reconstruct part of the Talus which had been shattered, to hold the Tibia in place and anchor it to the Talus. As the original surgery had two major incisions (one to repair the skin and muscle that have been damaged by the Fibula and Tibia breaking through the skin on the left, and an incision on the right to place/insert the screws and plates), the ankle fusion surgery would be done using the previous incision on the right. Normally the incision for ankle fusion surgery is on the top of the ankle. Operating from the right side of the ankle as opposed to the top of the ankle would make the surgery a little more complicated than the norm.
While ankle fusion surgery is not uncommon, it still is major surgery. As I lead an active lifestyle, the future implications to my lifestyle are a concern. I won’t know the final impacts until I’ve completed the rehab/physiotherapy and the recovery is complete. I do know running will be out. I am prepared to resume my cycling and swimming to compensate. I will be interested to see how it may impact my hiking ability. I have the utmost confidence in my orthopedic surgeon. He had been doing my regular post-operation check ups from my original surgery in June (original surgery had taken place in Pinehurst North Carolina where I was originally visiting my mother). He had been thorough in all my consultations to date and thorough in explaining the process and need for the ankle fusion surgery.
Regardless, ankle fusion surgery is major surgery and in my case complicated by my previous injury 4 months earlier. One always worries about the unknown future. Anesthesia is never without risks. While X-rays and CT scans gave my surgeon a good idea of the state of the ankle, until it is actually opened up, one never knows for sure whether there are any unforeseen challenges. What would the pain be like post surgery (I already had recent experience from my surgery in June, so I assumed it would be similar)? How would I cope with another 3 months of no weight bearing on my right leg, associated limited mobility and being dependent on others? My limited mobility would be further tested by the fact that living in Vancouver, BC, the fall season is the beginning of much rain, dampness and increasing darkness from shorter days. I would not have the ability to go out as much to enjoy daylight and sunlight. This can have a big psychological impact.
In preparation for the surgery, I had to fast as of midnight the night before. I wasn’t concerned about the fasting. Surgery had been scheduled for 9AM so I would just be missing breakfast. But I also could not drink anything, including water. I generally hydrate and drink a fair amount of water during the day/evening. Oh well, for one day, I could manage. I had to check in at the hospital by 7AM so they could to all the pre-op checks (ie medications, weight, blood pressure, etc) get me in hospital robes and ready for the surgery. Nursing staff were awesome. Very professional, friendly and attentive. My wife was able to be with me through out the preparation. Your partner is critical in the process. They provide much emotional and physical support, so their involvement is critical. Furthermore, the worries, concerns etc you experience as a patient, are magnified for your partner who is an observer.
Anesthesiologist was thorough in his explanation prior to going into the surgical room. They were also going to administer some pain blockers into some of the leg nerves to help with the post-op recovery. My orthopedic surgeon (who’s specialty was feet and ankles) also made sure to visit pre-surgery to check in and answer any final questions. I had none as he had been thorough in his pre-op consultations. Interesting – they put a marker pen mark on the leg that is being operated on to ensure there are no mistakes or confusion as to which leg/ankle the surgery is being performed on. Surgery would be 3 – 4 hours.
I was wheeled into the surgical room which was busy with a number of nurses who were insuring all the tools needed for the surgery were there. I was transferred from the gurney to the surgical table. Nurses were pleasant and introduced themselves, taking care to ensure I was as comfortable as possible. The anesthesiologist was quick to go to work. Again, explaining the nerve blocking procedure and process. I knew from my previous surgery that once they were ready to administer the anesthesia that I would be out like a light. Next thing I would know would be coming to in the recovery room. Prior to the anesthesia being administered, my surgeon spoke with confidence and re-assured me of the process. At this point I had no fears. It was all about getting on the with surgery so I could begin my final road to recovery and walking again (hopefully my Christmas present to myself).
Sure enough, hours later, I came to in the recovery room. My wife was there with me. Of course, I was oblivious to time and what had gone on. My orthopedic surgeon had spoken to my wife and given her a good report. My ankle was set in a splint so it was protected and immovable. Again, this was all familiar to me from my previous surgery in June. Coming to after anesthesia and surgery is always interesting. You are groggy and unfamiliar with where you are and what’s gone on. Your senses and reasoning are certainly impaired and impacted.
Plan was to stay at least one night in hospital (maybe longer, depending on pain management). I was eventually wheeled up to a ward room which I would be sharing with 3 other people. I didn’t make it up to my room until later in the afternoon, close to dinner time. I was looking forward to something to eat, as I hadn’t had anything since the previous night’s dinner. My surgeon was also going to stop in to check in.
The pain blockers that they had administered with the surgery would not wear off for about 12 hours. Swelling in the first few days would be the most severe, but keeping my foot elevated as much as possible in the early weeks/months would be critical to keeping blood pressure off the surgical incision and speed the healing of the incision and minimize the possibility of infection. The splint is a very firm piece that makes sure your ankle doesn’t move. It’s a combination of a plaster mold around your foot and ankle and a series of tensor bandages. My feet were elevated with pillows.
When my surgeon came in around dinner time, to check on my recovery, etc. my ankle felt very sore and rubbing on the splint from swelling. The surgeon opened/expanded it a bit for comfort. Ankle was still firmly in place. There was also some bleeding coming through the bandages which concerned me. I hadn’t experienced any bleeding my first surgery. The surgeon wasn’t concerned. It was the result of the swelling and surgery. He added some more bandages to absorb/control the bleeding. My surgeon was very pleased with how the surgery had gone. Happy surgeon = happy patient. There had been no surprises or complications during the surgery. He would come in the next morning to check in again on my recovery.
My night hospital stay was ‘interesting’ to say the least. Of course, sharing a room with 3 others, you never know who your ‘roommates’ are going to be.. All my roomates were older than myself. The gentleman across from me spoke very little English. He was Punjabi speaking. A number of nurses on duty during the day spoke Punjabi and could help him. He had advanced diabetes and was borderline deaf. He needed much assistance with all his needs (eating, toileting, moving) and was largely bedridden. The gentleman beside me also had complications from diabetes. He was also hard of hearing but was certainly better functioning than the gentleman across from me. His mobility, while better, was also limited. Lastly, the gentleman diagonally across from me was highly functioning and was in for some heart related observation. He was very mobile. He had been in all week for observation but was hoping to be released by weeks end. Everyone pretty much kept to themselves.
I eventually had a dinner brought to me. My wife had left to go home by this time. It had been a long day and draining day for her. We also have 2 dogs at home that needed a walk, etc. Dinner was a ‘yummy’ selection of jello, and soup… Had the jello and tea. Then the nighttime ‘festivities began… There was a nursing change at 7pm for the evening. During the change over, the new nursing staff come by to introduce themselves and check on you. I would be checked for vitals every 4 hours during the evening to ensure there were no post anesthesia and surgery complications and also to check on my pain (especially as the pain blockers wear off). While I hate pain killers, I knew from my June surgery that the first few days they would be key for post surgery pain management.
I wasn’t sure how my evening sleep would be. It would be a balance of being exhausted from a long day from the surgery and pain management from my ankle surgery. Well, my pain management and recovery seemed secondary to all my roomates evening activities… The heart patient diagonally across from me slept most of the night. None of my roomates could hear anything.. The roommate beside me snored and farted himself to sleep and through the night, oblivious to all..
Then there was my Punjabi roommate across from me… WOW.. I couldn’t get a wink of sleep in.. He spoke to himself in Punjabi ALL night long. Not in dulcet tones, but like a normal conversation. The nurses came in many times to check on him, but none of the evening staff spoke Punjabi. Throughout the night, his bedside alarm would go off from his movements. He urinated his bed once, so nursing staff had to change him and his bedding. Later he would urinate on the floor. I felt so sorry for the nursing staff (and of course the patient). He was totally dependent on others for care. Sleep would not be happening this evening… Finally around 3AM, the nursing staff wheeled him into the hallway in a wheel chair.. I was finally able to dose off for a couple of hours sleep.
After the pain blockers wore off in the evening, I began taking some painkillers every four hours to control the pain. Breakfast seemed to come early, for someone who hadn’t slept all night.. Again, another gourmet delight of hard boiled egg, oatmeal, toast and yogurt with coffee. Had the egg and toast with coffee (which was terrible). I couldn’t wait to get out of the hospital. There was no doubt in my mind that I wasn’t staying another night. I knew what to expect re pain and swelling from my June surgery. My wife and surgeon couldn’t get there soon enough…
My surgeon got there around 9AM to checking on my evening and recovery. Again, he re-enforced that the surgery had gone well and he was pleased with how things had gone. He had no doubts that the ankle fusion surgery was the right way to go. He showed me a copy of the x-ray of my ankle post surgery.. 9 long screws and a metal plate were bolting everything together. He checked on the pain, etc. There had been no further bleeding from the wound. He asked if I was ok with the pain to go home. I couldn’t wait to get out. Nothing some pain killers couldn’t take care of until the swelling continued to reduce.
My surgeon gave me the green light to go home. He knew from my previous consultations that I would look after myself. While this surgery was different than my first surgery in June, it was also similar in many ways. The recovery would be very similar. Priority initially is to keep the foot elevated and pain management. While many things seemed the same as my June surgery (ie splint, pain, etc), the ankle felt different this time. I could tell there was something different in how the ankle felt this time. See, the June surgery was a trauma surgery. As my surgeon at the time said – The priority was to put my leg and ankle back together. Priority was to get the bones back into my leg and positioned for recovery. This surgery was a ‘planned’ surgery, so both myself – the patient and my surgeon knew what was going to happen. There was a plan. I could tell from the sensation within the ankle that it was different. With everything bolted into place to never move again, I could tell it felt different. Not better or worse, just different.
I’d better get used to ‘different’ as my future would all be different. While my recovery process would be similar to the first surgery (no weight for 3 months, then rehab), my future would be different. I’m going to have to learn how to walk again. I’m going to have to learn how to drive a car again. I’m going to have to learn what exercises I can do going forward. I’m going to have to learn how to simply get around without pain or discomfort. I’m under no delusions. I know the rehab and physiotherapy will be a difficult challenge. But I’m looking forward to getting there. That means I’ll be one step closer to walking and starting my life over again…
The next 3 months until I get to rehab will continue to be both a physical and mental challenge. One, I’m ready for. The difference this time is this should be my road to a final recovery. There will continue to be good days and bad days.. If nothing else, I’ve learned through the first 4 months that having a positive attitude and not letting this adversity and setback define or limit me are key to my recovery and well being.