Hospital: New X-rays: Gap in tibia.

Today I was back at the hospital for X-rays. It's now a month since the operation to fit the frame, and all 12 adjustments of the frame are complete. I was expecting therefore to be able to see the big gap that's opened up in my tibia. I wasn't disappointed!

Today's X-rays. Top view (left), side view (right). Note gap :)

I knew my consultant wasn't going to be there today, but he will see these X-rays on Wednesday and tell me whether or not the bones are in the right positions now. If not there'll be some more tweaking to do.

Here's a comparison between the last X-ray (after 3 adjustments; left) and the current one (after 12 adjustments; right).

My leg is getting quite swollen when I spend too much time with it vertical, so I think what I'm doing on days like today is the limit at the moment. I imagine that now that the adjustments have stopped, it will have a chance to settle down - after all, I've been moving my broken bones around so there was bound to be some swelling. Sometimes at one point it's almost touching the frame, so I'll have to keep my eye on that.

#12 - The 'Final' Adjustment

OK so today I made the 'final' adjustment. Whether or not it really is the final one or not depends on the results of my X-rays on April 30. We might be able to get a bit more length out of it, I think the consultant said, so we'll see. Needless to say it looks a lot more of a normal shape now than it did before!

Day 0 (left) - Day 12 (right).

Day 0 (top) - Day 12 (bottom).

Apple Time Machine wireless backup no more?

** see below - it does work! **

Today I discovered that under OS X Lion, backing up with Time Machine to an external hard drive on another computer over wireless is no longer possible. This worked under Snow Leopard, but apparently now Apple have decided not to support this any more. I guess they want us to buy Time Capsules, which are hard drives with their own wireless base station built into the shell. They are ridiculously overpriced and I won't be getting one! So I guess I'll have to just periodically plug my external hard drive into my laptop and back up like that. Not very impressed with that one Apple!

UPDATE: hmm maybe you can do it over afp shares, let me check that...

UPDATE: OK it does work over an afp share, so it will backup over wireless, but now of course it wants to start over, so it says the initial backup will take 3 days. sob!

UPDATE (30/4/2012): OK well the initial backup of 183 Gig took 4.5 days (!) but it did finish and now it works perfectly with the little incremental backups.

So, the answer is, set your backup directory on your external hard drive as am afp share using System Preferences > Sharing. Then when you can see it on your laptop, you'll be able to use it in Time Machine. The initial backup will take an age, but then it will work! Great :)

Adjustment 11

Here's today's pictures, plus one I tried to do showing both pictures on the same image... which was more difficult to do than I expected... I guess it's more difficult than it sounds to always take a picture from the same position!

Day 0 - 11.

Day 0 (left) - Day 11 (right).

Day 0 (top) - Day 11 (bottom).

Adjustment 10/12

Just done adjustment 10 as well as my pin site cleaning / dressings etc. I feel like I made a bit of a dog's dinner out of my dressings today.. oh well.

Day 0 (left) - Day 10 (right).

Day 0 (top) - Day 10 (bottom).

Adjustment 9/12

We're at 75% now :) When I looked at today's picture, I was struck by exactly how bent it was at the beginning! When I move about now my left foot feels a lot flatter on the floor too. And I don't know if it's my imagination but I think I can move my ankle a bit more now than last week...

Today it has been a bit swollen and sore though. Have I done anything strenuous? Well, I went down to the shop to get a chicken and some bread and stuff, and then I was standing in the kitchen a little bit today - nothing major, maybe for half an hour, but clearly that was still a bit too much for it at the moment.

Day 0 (left) - Day 9 (right).

Day 0 (top) - Day 9 (bottom).

In other news, Boro managed to win today despite being typically useless and conceding a goal in the first minute of the game! Honestly, today was a must-win if we want to have a chance still of reaching the playoffs, so you'd think they'd have gone out steeled with at least keep it tight for the first 15 minutes. It's hard work being a Boro fan sometimes. Now we have to rely on Cardiff losing at Crystal Palace next Saturday lunchtime, while we have to beat Watford on their ground. So it's not likely we'll get there, but it's not impossible either.

Adjustment 8/12

Today's adjustment and dressings change completed. Two-thirds of the way there now... It's still quite painful in my ankle on the left side. It's going to take some serious work to get my ankle working again I think...

Day 0 (left) - Day 8 (right).

Day 0 (top) - Day 8 (bottom).

Adjustment 7/12

Here are today's pics - day 7/12. No problems or issues. Didn't see it move so much today, although on the top view picture today I did notice how much strut 2 (on the left with the orange badge) has contracted by.

Day 0 (left) - Day 7 (right).

Day 0 (top) - Day 7 (bottom).

Adjustment 6 - half-way there.. with spanners!

Today I have made the 6th adjustment to my frame. In so doing I had to replace strut 5 which had reached its limit of 120mm. This was not difficult - fortunately I didn't need bolt-cutters - it came off easily enough. The new one goes out to 150mm, which is where it will be after adjustment 12. Today it went to 124mm.

Step 1: the strut comes off...

Step 2: the new (longer) strut goes on...

Step 3: attach it at the bottom.

New strut 5 - by the end this will be at 150mm!

Day 0 (left) - Day 6 (right).

Day 0 (top) - Day 6 (bottom).

Adjustment 5 - You can really see it now!

Just done today's adjustment. You can really see it straightening out now.

Day 0 (left) - Day 5 (top).

Day 0 (top) - Day 5 (bottom).

Hospital, X-rays, Bolt cutters (!), Adjustment 4

Today I was at the hospital in Preston again, for my first check up post latest operation. Quite a lot happened! 

First of all I went for an X-ray - I think the consultant has given the radiographers a bit of a challenge with the position of the X-ray because it seems to take some messing about to achieve. I guess the goal is to see the movement of my bone under the adjustments of the frame, so ideally the top rings should be in the same place on each X-ray. As it turned out, seeing the movement of the bone was easy as the gap that's being opened up is clearly visible. You can see that in the following picture which shows a comparison of today's X-ray with the one taken a couple of days after the operation. 

Here's today's X-ray with a comparison from before adjustment started.
(1) gap opening up in tibia; (2) fibula broken and bit removed.

The point marked (1) shows where the gap is opening up - the bone is moving! - eventually new bone will grow in this gap. Point (2) shows where a section of my fibula was removed - before there were jagged bits which I could feel through my skin and caused strange sensations in my foot when touched. That doesn't happen now, because that chunk of bone isn't there anymore! There's also a bit of bone floating around in there somewhere which my consultant tried to find and remove but couldn't :) A good question is what will happen to my fibula? The answer is nothing - it will remain broken. I asked about this and your fibula only supports about 10% of your weight. In any case, apparently my tibia is so thick now that it'll more than compensate when it's healed up.

After X-ray I had the three shortest struts changed out and did the 4th adjustment at the same time. Well, it wasn't as simple as that! First strut (#6) changed and adjusted no problem. Second one (#5) took a bit of getting off! Evidently the threads on the bolt had crossed somehow and my consultant struggled with the spanners before deciding to call for bolt cutters! This had never happened to him before with these frames. Anyway, after a bit of a wait the bolt cutters arrived and fortunately with a bit of effort and someone else holding my leg steady, the bolt was cut through and the strut was off. I say fortunately because the next option was a hacksaw and I don't think that would have felt very nice with the vibrations through the pins etc..  Anyway, strut 5 was off and the new one attached.... no! because it wouldn't fit - too long. This is because the one that was removed was not fully extended and so the gap between the rings at that point is not yet wide enough to put the next longer strut in place! SO, the old one went back on, and I will have to replace this strut myself in a couple of days when it's fully extended. More fun for me :)

After all that strut 4 was replaced easily and the remaining adjustments done. So we're now at 4/12 - a third of the programme completed. From today's photos which I took just now at home, you can clearly see it's straightening out.

My consultant said that from the X-rays the bone was moving the right way, so everything looks good so far. I remembered to ask a few questions which I've had during the strut replacement procedure: for example, I had been wondering about whether the reason the correction is done gradually is more for your soft tissue than your bone. I was almost right, it is partly that but mainly because of the nerves - they can only stretch safely 1mm/day. Another thing I was curious about is whether the adjustment takes place in both planes simultaneously. It does, so even though it looks like the front/back movement is happening first, it must be an illusion. In fact, from today's pictures I think the side/side movement is more pronounced now. The computer program that works out the adjustments takes into account the positions of your nerves as well - pretty impressive - I think it's web-based, maybe I'll ask to see it next time ;)

Day 0 (left) to Day 4 (right).

I asked about my top wire pin which is the only one I am concerned about. The skin around it is a bit red and inflamed. I've now got some antibiotic cream to put on that area in case it's the first sign of an infection (really hope not). If it doesn't clear up I have to start taking antibiotics again :(

After all the strut stuff and looking at my X-rays, I went to the treatment room to have the clips that stapled my two main wounds from the operation removed. They really are like staples and John, a student nurse, removed them with what looked pretty much like a staple remover. Apparently they go in with a staple gun!

Day 0 (top) to Day 4 (bottom).

I have my next appointment on April 30, 2 weeks away, when the current adjustment programme will be complete. Depending on the results of the X-ray that day, there may be some more adjustment necessary because the measurements they take that define the programme are not 100% accurate (they couldn't be). So maybe in total there'll be more than 12 adjustments, don't know yet.

In the last 2 days I've spent quite a bit of time upright - crutching around to the station, train, hospital etc.. My leg is a bit more swollen now so I will have to take it easy for the next few days. It's OK, I've plenty of programming work (programming's not really work though it's fun) to do. 

The adjustments will now take place every day, so next pictures tomorrow! A few people have asked what it feels like making the adjustment. The best I can do is that it feels like the frame is getting tighter - like you had your leg in a vice and tightened it up a bit. It doesn't hurt at all.

Colne Valley Mountain Bike Challenge 2012

This year's CVMBC is on 13th May. If you want my advice, do it! It's a great race with a great and varied route. It's one of the best organised events I've done on my mountain bike. I'd be there if I wasn't still recovering from my accident... See my report from 2010 on this blog or enter at www.cvmbc.co.uk :)

Adjustment 3

Yesterday I made the third adjustment, which takes strut 6 to its limit, 94mm. I think I can see that the change is being made more in the front/back plane than left/right at the moment, although it's difficult to tell so maybe it's my imagination.

Day 0 (top) - Day 3 (bottom).

On Monday the consultant will change struts 4,5 and 6 for the next longer ones so I can continue with the adjustment programme. I'll also try to get a look at my X-rays to see how the bones have moved already.

Day 0 (left) - Day 3 (right).

My pin site look good - I'm only a bit worried about the little pin at the right nearest my knee - it seems to be stretching the skin there and making it a bit red and sore. I will ask about this on Monday but I suspect what is happening is that the adjustments are also pushing back on the top rings and those wires are there on purpose to prevent that. Probably after the adjustments are finished things will settle down.

Taylor Spatial Frame Adjustments 1 & 2

I started adjusting the struts on my frame 3 days ago. I can't keep exactly to the schedule prescribed because some of the struts (the 3 shortest ones) will need changing for longer ones on 16 April when I'm at the hospital, so I decided to spread the first 4 adjustments over the days between 09/04/12 and 14/04/12. 

Top view: from left to right: 09/04/12, 10/04/12, 12/04/12

Shown here are the first 2 adjustments, so the photos from 09/04 show the initial state. So far, strut 1 has got longer by 2 mm; strut 2 shorter by 4 mm; strut 3 no change; strut 4 longer by 2 mm; strut 5 longer by 7 mm; strut 6 longer by 6 mm. I think you can already see some change in the position of my lower leg - even though it has only moved millimetres on each strut. There are another 10 adjustments to go before it will be straight.

In the photos taken from above you can see struts 2, 1 and 6 (left to right); in the photos taken from the side you can see struts 6 and 5 (top to bottom). Strut 3 is on the left side of my leg - it will only move 2 mm (shorter) in the whole process. Strut 4 is the most difficult for me to see - it's under the left side of my leg.

Side view: from top to bottom: 09/04/12, 10/04/12, 12/04/12

I'm using my camera to take pictures of the struts that are hard for me to see so I can tell when I've adjusted them enough; here you can see strut 5 before and after today's adjustment, which was from 106-110 mm.

Strut 5 12/04/12 before (106mm)

Strut 5 12/04/12 after (110mm)

Dressings change, here's how.

** Warning: close up photos of bits of metal going into my leg! **

I just did my dressings. Probably the most important thing with external fixation is to keep the pin sites clean - if they get infected the infection can travel down the pin into the bone and that is not good :( At the moment this means I'll need to be doing the following every day. Hopefully when the sites are more healed up it will get a bit easier.

First, I made sure I've got everything nearby - at the moment I'm using this little lot - Mepore dressings, Inadine dressings, tweezers, scissors, saline solution, gauzes, tape, antibacterial hand gel. Later on this ingredient list will no doubt change. I have heard that there is a spray on dressing called Opsite - I will try to get my hands on some of this next time I'm at the hospital - but I probably will only be able to use it when the wounds have healed more anyway, so for now we're good.

After cleaning my hands, I took all the old dressings off and cleaned everything up with the saline solution and gauzes.

There are 10 points where metal enters my leg: 2 big pins near my knee, 2 big pins near my ankle, 4 little wires near my knee, 2 little wires near my ankle.
Here's a close-up of the 2 big pins nearest my knee. You can see that the wounds are still a bit open but there is no discharge - so far, so good. This area of my leg is all graft - muscle from my back and skin from my thigh. Remember that? Seems like ages ago now...

First I put Inadine around the pins. Inadine is a mesh-like dressing which is soaked with iodine which helps prevent infection. I'll only use it for the first few weeks until the wounds are healed more. It's a bit fiddly because it's sticky and I have to try to get it in the right place working around the metal rings..

Then I used the Mepore dressings to cover over. You can be creative and cut little slits into the dressing to get them in the right place. The tweezers and scissors help to get things under the rings.

I also used Mepore to cover the incision wounds left and right, and did the same Inadine + Mepore job with the 2 pins near my ankle. I covered over 2 of the little wire sites because they still look a bit open, but the other 4 seem to be fine and so I have left those open to the air.
Here's the final product.

It took me about 30 minutes this time, but I'll probably get faster. I had a lot of experience with pin sites before - I did my own dressings for the 4 months I was in external fixation from Aug - Dec 2010. In all honesty I prefer doing my own dressings - nobody will take as much care as me! It's my leg!

Leg update. Taylor Spatial Frame etc.

So it's been a while since I posted, but I intend to do a bit more now. Last week I had another operation - this time to fit a Taylor Spatial Frame which will correct the malunion of my tibia. Basically in January this year the consultant told me that if my leg was straight, it would be ready to start trying to walk again etc.. But it isn't straight, it's healed up with a 17.5 degree bend, which is too much for your ankle and knee joints to support, so it has to be fixed.

Here's the last picture I took of my leg before the operation. Taken 25 March 2012.

The way to do that is with a Taylor Spatial Frame. These allow precise adjustments in all planes, so in principle you can correct any malunion or deformity with one. I had the procedure on Friday March 30, and was in hospital until Monday April 2. My consultant fitted the frame to my leg in about a 4 hour operation. This involved cutting through my tibia at the point where the bend is, and rebreaking my fibula as well as that was splinting my leg on the left side.

Taken 2nd April 2012. Operation was on March 30 2012.

The frame consists of 2 rings just below my knee and 2 rings just above my ankle which are pinned to my tibia. Joining the sets of rings are 6 numbered struts which are adjustable using thumbscrews and have a mm scale on them. Starting on Monday and over the next few weeks I will adjust the struts to move the lower set of rings into alignment with the upper set, moving my tibia with them of course. I find this amazing. I can't wait to start fiddling with the struts. Of course I will follow the prescription perfectly, but I can't wait to see it move.

I think you can see from the photographs that there's been quite a bit of swelling again due to the operation. The incision on the right hand side was done to break my tibia and that on the left to break my fibula. As far as I know, my fibula will not be reconstructed, but it is not so important because that bone doesn't bear weight.

At the moment I can't put any weight on it, but that will change over the next few weeks. Hopefully the pin sites will heal up nicely so that I won't need to do dressings every day, although I am doing at the moment.

At my next appointment on April 16, the consultant will remove the clips from the two incisions, and also change out three of the struts as they will have been adjusted to their limit by then.