My Tibial Pilon Fracture

On November 28, 1998 at 4:05 PM, while hiking with Reba and her nephew Justin along North Chickamauga Creek near Soddy-Daisy, TN, I slipped here and began falling into a ravine. When I had passed that spot earlier, I noted that it was a dangerous area on the trail - slick, narrow, and inclined toward the creek below the trail. I again recognized the danger when I got there on the return trip. I recall looking at a small tree growing out of the bank almost horizontally a couple of feet below the trail, and thinking, "if I fall, I am going to grab that tree." I grabbed that tree, but while falling I realized something bad was wrong with my right foot. When I looked down at it, instead of the toes being straight ahead, they were rotated to the right 15-20 degrees. By Justin holding to a tree and reaching out to Reba, and her holding Justin's hand and reaching out to me, and me scrambling with my good leg and other hand, we got me out of the ravine. I tried to put weight on the ankle, and realized immediately that was impossible. It felt like hot liquid inside my ankle, and I could feel the bone parts move around. Yes, it hurt. It had been an unseasonably warm day, and I was wearing only T-shirt and shorts, and it was already cooling off. Reba and Justin tried to support me, and let me hop along, but I couldn't do it. We were about 2 miles from the trailhead, and we had no flashlight. So Justin hiked to the car, then drove to a phone and called 911. In the meantime, we moved down the trail the best we could, I on my hands, good foot, and behind. Emergency responders from the Soddy-Daisy and Montlake fire departments came about 6PM. It was dusk, and all of them together had one small flashlight. Six of them began carrying me down the trail in a thing that resembled a plastic snow sled. They would often put me down (not easy) to switch positions. One time one of the men accidentally kicked the injured foot. That hurt, too. After a while we met a few more people who had more lights, and they relieved the ones who came up first. Near the bottom we met still more. After we crossed the creek, they put me in the back of an ATV of some sort, and took me the rest of the way to the ambulance at the trailhead. We reached Erlanger a little after 8PM.

I was x-rayed, and examined by an emergency room physician. He showed me the x-rays, and I could see several fracture lines. He told me that with that kind of break, surgery would be required, and that he had arranged for Dr. Mark Sumida to do the surgery the next afternoon, Sunday. One of the things he did was rotate the foot back to the proper orientation. Both the tibia and the fibula were broken, each in several places. I spent that night in the hospital, with a splint on my left wrist (which was slightly fractured) and a splint on my ankle to stabilize it. I slept well because of pain medication they gave me.

The surgery was begun about 1PM November 29, and lasted about 2 hours. Dr. Sumida talking to Reba compared the break to an eggshell that had been hit by a hammer. A few big pieces and lots of small ones. He used a metal plate and 10 screws, 8 small ones in the fibula and 2 large ones in the tibia. I was supposed to go home the next day, but because of swelling, fever, and difficulty getting the urination process restarted, I stayed two additional nights. I went home with a catheter and a urine bag attached to my leg, with a splint on the left forearm and wrist, plus one on right calf and ankle. I had an appointment Friday, December 4, with urologist Dr. Marty Scheinberg, when the catheter and bag were removed. He gave me an injection of a strong antibiotic.

My first appointment with Dr. Sumida was December 11th. The staples were removed from the 3 incisions, and a cast was put on my arm, but the ankle was still too swollen for a cast. Another splint was put on, and I was scheduled to come back December 23, the 24th day. A cast was then put on the ankle, up nearly to the knee. Both casts were black, made of fiberglass.

I went back to work January 11th, after being out from work six weeks. Because of the cast, I was unable to drive. Reba drove me to work, and then drove herself to work at Rock Spring. She took me to work five weeks before I was cleared to drive after 11 weeks. All this chauffeuring around to work and to appointments was hard on her and caused her to miss work. She took very good care of me during the entire recovery.

The third appointment was January 18th, day 50, a holiday. Both casts were removed, and I was given an orthopedic boot to wear. This was much better, because until then I had to bathe in the bathroom sink, but the boot, being removable, allowed me to shower using a chair. Dr. Sumida cleared me to use crutches, wearing a brace on my wrist. Until then I had been getting around at home by scooting or crawling on the floor, and elsewhere on a walker with a platform for my left forearm, so that no weight would be placed on the fractured wrist. It was hard to make that thing go. We also had a wheelchair which we used when going out to eat, or to other public places, except church. By the end of the 8th week, I was using crutches. I was also given some foot and wrist exercises to do.

The next appointment was February 12th, day 75. Because of swelling in the foot when it was not elevated, they gave me compression stockings to wear to reduce the swelling. The x-rays indicated healing was proceeding well, and I was instructed to begin putting 25 pounds on the foot (calibrated with a bathroom scale), increasing 25 pounds every 5 days. At this point I began going to the Livewell Center and spinning the exercise bike within the limitations imposed on me. After I could put some weight on the foot, I learned how to go down stairs on crutches. I was also cleared to drive - I had to continue wearing the orthopedic boot everywhere during the day except while driving. I obtained a permit to park in TVA's handicapped lot.

By the time I returned for my fifth appointment on March 5th, day 96, I was up to 125 pounds of weight on the foot. I was given an "aircast" brace to wear inside my shoe to prevent the ankle from rolling over, and told that I could wean myself from the crutches as fast as I wanted to. I used them to get back inside the TVA building, but that afternoon began walking around the office area when I needed to go somewhere. I used one crutch some for a few days, but soon was not using them at all.

On March 21, I walked across Walnut Street Bridge and back, 0.9 miles. I then began to walk gradually increasing distances, always with over-the-ankle boots.

Dr. Sumida released me on my sixth appointment, April 23, after 21 weeks. I told him I considered myself fortunate to have been under his care. I asked him about his comparing the break to an eggshell hit by a hammer, and said that implies a few big pieces and lots of small ones. He said that was right, that he spent a lot of time putting the small pieces back in place, and getting screws in them to hold them together. The incisions on the front and left side of the ankle were for putting small pieces back in place. He explained the fibula was broken in several places in the lower 3 inches, and the tibia had 3 main breaks, with some smaller pieces broken along the lower edge. This type of fracture, called a tibial pilon fracture is most often the result of considerable impact, like a carpenter falling off a roof, a skiing accident, or an auto accident.

This ordeal was difficult for Reba because she had to do not only her regular chores, but also all my chores, plus things she did for me personally, which was a lot. I appreciate all she did for me.

On May 8th, I hiked from the Nature Center up Lookout Mountain to Bluff Trail near the base of Sunset Rock in 53 minutes. It is a climb of about 1300 feet in about 2.1 miles. The day before I fell, I hiked up in 36:30, my best time until then. My next effort was July 3rd (85F and muggy) -- I completed the climb in 47:04. On July 10th (not as hot) I made it in 44:30. On November 11th (58F) I reached Bluff Trail in 39:30 and Sunset Rock in 43:40. My next effort was November 28th (65F, the first anniversary of The Fall), and the time was 42:20 to Bluff Trail.

July 29, I hiked 11 miles around Cades Cove in the Great Smoky Mountains National Park, followed by 5 miles each on July 30 and 31. This was too much -- the metal plate interacted with my boot to cause soreness and swelling.

I was wearing ankle-high boots when I fell. If I had been wearing my other boots, which go a couple of inches over the ankle, this would not have happened.