# Torn deltoid ligaments and broken fibula (Maisonneuve)



## JS8 (Sep 12, 2011)

Well, I just discovered this section of the forum and figured since I'm gonna be laid out for a few months, I'd post my story.

I got back into mtb about a year ago, riding at least twice a week. Picked up a nice full suspension bike at an REI scratch and dent sale, having always ridden a hard tail. First ride out, new trail and new bike, noticed my cleats were popping off my pedals a little too easily in the parking lot, but figured I'd just tighten them down when we took a break.

Bombing through the trail (again, first time on this trail), came off a short jump a little too fast and landed on a bad line toward a tree. Steered right and hit the brakes (hydraulic discs, my previous bike had rim brakes), and the rear tire slid out, right-side-down. My foot caught the ground and popped out of the pedal and I heard it snap.

Tore the deep deltoid ligaments on the inside of my right ankle and broke my fibula. It's called a Maisonneuve fracture. Needless to say, our day was over.

Anyway, was lucky to get a surgery appointment just 2 days later. Had a plate and two Tightropes put in and the ligaments stitched back together. Spent 2 weeks on the couch in a drug-induced haze and the past two have been in a non-weight-bearing Aircast. I have my 1-month follow-up this Wednesday and will find out if I can start ROM exercises at home and when formal physical therapy will start. Doc says I'll be off the bike till Spring.

Should get more x-rays which will include my hardware in a couple days. Don't have enough posts yet to post pictures anyway...


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## JS8 (Sep 12, 2011)

Here's the damage prior to surgery. Will try to get some x-rays up of my new hardware in the next day or two.

Good news, bike was mostly unscathed...


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## davidfrench (Jan 25, 2011)

Nice one !
I need to put some xrays in my post too !


good luck for the recovery


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## JS8 (Sep 12, 2011)

Had my one-month follow-up yesterday. I have 2 more weeks of non-weight-bearing, then I can progress to full weight-bearing as tolerated. I can also start ROM exercises at home now, getting ready to dominate PT in a few more weeks. Overall, I'm progressing well, but I'd be lying if I said I was 100% sure I'll be back to riding like I did before. This has put things in perspective a little...

Here are some x-rays of my bionic ankle.








The two dark shadows that traverse the bones between the hardware are the holes they drilled from one side to the other. There are synthetic wires running through them holding the bones together. Fibula is still broken and will be for another 6 to 8 weeks.


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## davidfrench (Jan 25, 2011)

aouch !


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## dcc1234 (Nov 5, 2008)

Ouch! Grade 2 or 3 deltoid ligament sprain here. Happened this past July and still not 100% 7 months later. Hope your (much worse) injury is much improved owing to the fact that some time has passed since your post. 
Best...


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## RobLyman (May 8, 2006)

Wow. Almost same thing happened to me, except left side. 

Leaning into left turn, front wheel hit pine straw and broke loose. I fell to my left with my foot still clipped in. The inside of my ankle was dislocated and my fibula broke about 2" from my knee. The break near the knee wasn't bad, but the torn ligaments in my ankle required 2 screws going all the way through both my tibia and fibula, from the outside of my ankle to the inside. 

I had the accident on a Thursday (Jan 26th) and drove myself to the ER, where they put a temporary cast on my leg, from the bottom of my foot to 4 inches above my knee. On Monday I had an appointment with an orthopedist and had the surgery described above on Tuesday, 5 days later.

I am in a removalble boot/cast below the knee. I had a followup appointment 1 week after the surgery and my next appointment is at the 7 week point on March 14th.


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## ashaw (May 3, 2009)

Wow interesting stories and radiographs thanks for sharing. BTW the postop films look great.


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## RobLyman (May 8, 2006)

I had a follow up appointment last week. The new doctor (old one left to practice elsewhere) says the screws come out at 8-12 weeks. The old doctor said 4 to 6 months. With a third opinion, the majority now says to NOT walk or weight bare with screws in. The tibia and fibula rotate small amounts with weight, and the screws can be worked back and forth, resulting in the screws breaking.

The good news is that the screws are coming out next week, at the 8 week mark. I will need to be a bit more conservative for about 4 weeks after that, to ensure the ligaments/tendons have the full 12 weeks to heal. Then it is game-on for the full physical therapy. This may have me back at work a month earlier (ie climbing up, preflighting and flying helicopters). From injury to normal walking will be 3 to 4 months.

The mountain biking might have to wait a little bit longer.


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## ashaw (May 3, 2009)

Yeah I have seen broken syndesmosis screws before and I agree 8 weeks is our typical extraction time. I'd think some easy singletrack riding would be reasonable within a couple weeks after that, but of course that unforeseen emergency manuevre could cause a nasty setback.


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## dcc1234 (Nov 5, 2008)

Flat pedals might be a bit safer for these types of crashes. You guys sound great-- way to keep your spirits up!


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## mtnbikej (Sep 6, 2001)

dcc1234 said:


> Flat pedals might be a bit safer for these types of crashes. You guys sound great-- way to keep your spirits up!


No really.....broke my Tib/Fib and dislocation in a crash 2 years ago. As soon as I was able to get back on the bike, I had no hesitation to jump back onto clipless pedals.


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## Caffeine Powered (Mar 31, 2005)

I'm healing from the same injury. My fibula broke just below the knee and healed fine, but they had to repeat the surgery at the ankle. 

(1st surgery below and the 2nd with the added plate)

I had my cast removed yesterday and hope to be walking in 4 weeks.


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## dcc1234 (Nov 5, 2008)

> No really.....broke my Tib/Fib and dislocation in a crash 2 years ago. As soon as I was able to get back on the bike, I had no hesitation to jump back onto clipless pedals.


When I'm clipped in on my spd's, even though I'm wearing stiff shoes, most of my body weight is pushing at the point of contact in the front of the foot.

I am not discounting your statement about getting back into clipless, and maybe my shoes are just worn out-- but I still wonder whether flat pedals where you can put more of your body weight directly over the ankle--weather this might be better for the recovering ankle joint.

Personally, I'm still clipping in on my spd M540's but I'm thinking about changing


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## RobLyman (May 8, 2006)

Caffeine Powered said:


> I'm healing from the same injury. My fibula broke just below the knee and healed fine, but they had to repeat the surgery at the ankle.
> 
> (1st surgery below and the 2nd with the added plate)
> 
> I had my cast removed yesterday and hope to be walking in 4 weeks.


Is your doctor leaving the hardware in? My orthopedist, a former Army doctor, sighted studies/results from Walter Reed that indicated the screws can, and do break when weight is placed on the leg/ankle. See my former post. It would be interesting to see what your doctor says about leaving the screws in as you begin recovery.


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## Caffeine Powered (Mar 31, 2005)

RobLyman said:


> Is your doctor leaving the hardware in?


Nope, The screws were removed the first go-around. This time, even with the bone fusion, he'll be removing the screws. We've discussed the when more than anything else. We/I want to make sure the fusion took and then we'll remove the screws.


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## RobLyman (May 8, 2006)

I have been putting weight on my left leg now for about a week and a half. I can walk slowly like a 90 year old man w/o crutches or at normal pace with crutches. I got in the helicopter today, powered up the hydraulics and went through a full flight control check (w/ and w/o hydraulic boost) and set and reset the brakes. Once I feel confident climbing up on top to preflight I should be good to start flying again.

The bike should come a little after that.


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## Caffeine Powered (Mar 31, 2005)

I'w where Rob is too. It's finally to the point where 75% of the time there's no pain when walking, but the pain isn't crippling when its there. Appointment and x-rays this coming 1st of May. We'll see what the Doc says about removing the screws depending on how the fusion has progressed.


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## RobLyman (May 8, 2006)

Weight bearing with crutches on 11 Apr. Cleared for flying duty on 11 May. I got to fly again on the 18th of May.

I went out and rode my bike yesterday. About 10 minutes around the block. I had regular tennis shoes on clipless pedals. No pain, but I was quite nervous about the stopping and dismount.

I am still taking 400mg ibuprofen 3 times a day. When it wears off, my ankle throbs. After physical therapy I kick it up to 800 mg.

To get back some muscle strength I want to ride more since I can't run, even if it means on the street in my neighborhood. Do I get some flat pedals to use temporarily, some platforms to clip onto my existing pedals (do they make them for eggbeaters?) or what? Hmmm.

Summary:
Accident 26 Jan
+ 5 days surgery
+ 8.5 weeks screws removed
+ 2 weeks weight bearing with crutches
+ 1 week no cutches but with air cast
+ 4 weeks no air cast
+ 1 week pilot helicopter
+ 1 week ride leisurely around neighborhood

17.5 weeks from injury to back on a bike. Granted, that is not off road riding yet, but the doctor said my dislocation was the worst he had seen with regard to the ligament and tendon damage.


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## SeptimusFry (Mar 7, 2011)

RobLyman said:


> Weight bearing with crutches on 11 Apr. Cleared for flying duty on 11 May. I got to fly again on the 18th of May.
> 
> Summary:
> Accident 26 Jan
> ...


Title

Amazing coincidence, I slipped on an icy slope and suffered a fracture bimalliolaire type Maisonneuve on 27th January 2017 just one day off a perfect repeat.
I was v lucky, the French health service being second to none. I fell at 12 noon, was in surgery at 4:30 and discharged the next day with a ´resin boot' and told not to put weight on. 
Friday 10th March, boot off with steel 4mm screw still joining bottom of tibia and fibula, told by surgeon to walk, no restrictions, and that I would start physio this week, 2 times a week, pin out after total of 8 weeks.
So, Saturday, following instructions, I did a total of about 1/4 mile with walking stick, terrible pain. At the end of the day my whole lower leg and ankle had blown up and bright red. Spent couple of hours with frozen peas on it and the night well elevated.
My problem is not knowing how much to push things, stopping if hurting means I will never start, so how much is too much.
Plus, I can't really elevate my toes toward my knee much before it feels as if a bar of some sort is locking me down, is that the screw? Or just flaccid muscles.
I would like to hear from Rob or someone as to how they actually progressively increased their rehab.


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## RobLyman (May 8, 2006)

My orthopedic surgeon said no weight bearing until the screws come out. He specializes in sports injuries and before that was head of orthopedic surgery at Walter Reed (ie soldier injuries). I too was concerned about the pace of recovery. I probably could have endured the pain and pushed through quicker. After all, I rode back 1 mile to the trail head with the injury. I was constantly asking how far I should push it. He was the one who had me no weight bearing. His concern was that the screws would work back and forth and could eventually break. He had seen it occur at Walter Reed.

I only took the opiate pain relievers for 24 hours after the surgery. After that it was 800 mg motrin, a favorite of the military (aka Ranger candy). 

For me, I pushed as hard as the doctor allowed me to.


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