Years ago (just under nine years ago, to exact precision in my recall), I broke my leg, which is not what I told people when they looked in horror at the black cast engulfing my left foot and asked what had happened to me. I explained that I had a spiral fracture in my left fibula, just above the ankle joint, a hinge joint1, with a slight displacement of the fractured portion from the rest of the bone, although according to the orthopedic surgeon, the injury would not require surgery, despite what common sense might suggest. A spiral fracture is a particularly tricky flavor of bone fracture, as the mechanism involves a twisting force on your skeletal component, leaving a corkscrew-esque shape that resembles a spiral staircase. Lovely. If you are a biomechanist, you might be piecing together how a spiral fracture in the fibula could occur with no other diagnosed structural damage (except for a likely sprained ankle, although this was never confirmed). If you have deduced that I broke my leg by sliding on an indoor basketball court during the meaningless last day of baseball tryouts, when I had already landed a spot on the team, then you are correct.
Admittedly, the injury is both facetious and tragic in both parts. In part, it was my fault for wearing clunky tennis shoes - Nike Roshes to be specific, which are not known for their sturdy ankle support. In part, it was my head coach’s fault, a bumbling idiot he was, for having us do outfield drills indoors. For non-baseball folks, this means nothing to you; that is okay. Just know it is incredibly dumb to practice sliding catches on a hard, tacky, indoor surface that resembles nothing of the softer and more forgiving turf that makes up the majority of a baseball field. When it was my turn for a rep on the drill, I took my pre-pitch read steps, tracked the ball lobbed in the air by my coach with my eyes, closed on the ball as fast as possible, and stuck my left leg out to slide underneath its arcing trajectory, with my right hand (and glove hand) open like a picnic basket ready to receive the white piece of leather. Except when I went to drop my left leg on the ground, the sole of my clunky Nike Roshe snagged on the tacky surface of the hardwood basketball court, and created enough friction to slow the momentum of my leg without affecting the momentum of the rest of my body. My ankle bent in a direction it is not supposed to bend, and I felt a pop, fully expecting to roll over on the ground, look down at my left side, and see my foot protruding at a ninety degree angle. But I did not. I only felt a sharp pain. I tried to stand up, but my left leg could bear no weight. All the while my teammates (and good friends) were laughing at the slapstick comedic relief I had provided in an otherwise intense last day of tryouts. However, once they saw me hobble over to the sideline and throw my glove out of frustration and agony, they sensed something was wrong. I sensed something was wrong. The best way to describe the feeling of a broken bone is one of biological overreaction. A paramedic might refer to this feeling as shock - elevated heart rate, dizziness, nausea, sweating, labored breathing, general malaise and panic. Your body is a grizzled mechanic ready to spring into action the moment some structure needs repaired. Adrenaline is the anesthetic drug of choice. Cytokines are storming through your bloodstream. You are already operating on yourself.
Of course I did not know I had a fractured fibula until four days later. The injury occurred on Thursday; our athletic trainer gave me ice and a doctor’s note to rest and skip school Friday. By Saturday, the swelling had subsided, the pain had dulled, and I was attempting to jog on it around my backyard. Silly, silly, silly. I was screwed from the start though. The Fibulae only bear 20% of your bodyweight. Many people who undergo hairline fractures in the fibula do not even require crutches or a cast. And believe it or not, a broken bone does not swell nearly as much as a soft tissue injury, such as a sprained ankle. No swelling, improved stability in just a matter of 48 hours, surely I was good to go! I am a retard, and my mother is a Registered Nurse, and after her own examination the following Monday, she ordered X-Rays for me on Tuesday, because something “did not feel right.” Of course she was spot on with her diagnosis. I’ll never forget the shocked look of both dumfounded trepidation and sheer amazement on the X-Ray technician’s face when she asked me if I had been walking on my left leg since the injury while gaping at my mangled imaging on the screen. After confirming the fracture, my instructions were to walk across the hall on the floor of the children’s hospital I was being treated at, as I had initially gone to sports medicine to seek diagnosis, but once the sports medicine doctor had seen the nature of the fracture, he suggested I seek consultation with someone more experienced with spiral fractures.
It sucked. The first week sucked the most. My lower left leg was a seething hot ball of swollen fire under the suffocating rap of the cast, which might as well have been an ankle monitor for a con on house arrest. After the second week, the swelling decreased once again, and I went back to orthopedics for more imaging and instructions. The injury was healing just as the doctor had predicted, but the re-calcification was not yet complete, as the translucence in the new bone being formed in the fracture spot was not nearly as dense as the surrounding, uninjured bone. Three more weeks of crutch and cast.
By week 5 in cast, I was walking on it once again, this time with no limp, pain, or instability, evidenced by the wear marks on the bottom of my cast. Orthopedics did not appreciate my eagerness to return to normal activity, although orthopedics did understand my eagerness to return to normal activity, and after another round of minor acute radiation poisoning, I was offered a saw, and then a walking boot. Two more weeks in the walking boot to begin the re-strengthening and re-coordination process, and if the X-Ray was clean, I would be freed.
In total, my fractured fibula took 7 weeks to completely heal, and I suspect it may have healed even faster if I was not dicking around during the first few days of injury. I consider myself lucky; after re-examining the mechanism of the injury in my mind, it could have been much, much worse. Bone protruding out of skin worse. Even orthopedics agreed with my assessment. With a new lease on life, I was ready to jump back in to playing America’s Pasttime, with there still being a few weeks of high school ball left, and an entire season of summer ball just a month or so away. Boy I was wrong.
It is difficult to conceive the idea of a secondary recovery period when you are so focused on the primary recovery; that is, healing the bone in its entirety, to the point where the probability of obtaining a new fracture on the bone is equal to the probability of fracturing the same bone before the injury and subsequent recovery had occurred. It’s black and white with skeletal structures; you’re not healed, and then one day you’re 100% healed. With soft tissue injuries, which are often described as nagging injuries, the recovery is not so straightforward, and the pain and discomfort and instability may reappear after a perceived full recovery and rehabilitation.
Regardless, you become so shortsighted and focused on getting back on the field, that you fail to realize just how much muscle and joint atrophy can occur in a period as short as 5 weeks. My left calf was an entire half-inch smaller in diameter than the right calf. The first attempt to run after removing the walking boot can best be described as a baby giraffe trying to run from a lion, if the baby giraffe had been fed a few gallons of grain alcohol. There was arguably even more pain and discomfort and weakness following the primary healing process, despite my fibula being 100% healthy.
And now, the worst part: it is likely naive and overly-optimistic to assume that one will ever make a full recovery over the course of one’s entire lifetime when you consider second and third order effects of the traumatic injury. In fact, I would argue it is downright impossible to fully recover from any lower body fracture. 5 weeks completely off your feet is devastating. Over the course of 5 weeks, my left ankle developed an inflexibility that is noticeably different than my right ankle, in part from the scar tissue, and also in part from the frozen supinated position it was in for over a month. I had on and off arthritis for the following two years after the injury. Soreness was more common after prolonged usage. And I worked my ass off once I was cleared to return as far as rehabilitation goes. This is not even to mention the muscle imbalances the fracture likely caused in other parts of my body, such as my back.
This is not a sob story though, simply a reflection on my first moment of mortality, dumped on me at the ripe age of 18. Acute mortality; not the tired trope of “I’m getting older” or “my back hurts, I must be an adult”. Fuck off with those adages. If you’ve also broken a bone, especially a leg bone, you know the exact feeling of acute mortality I’m talking about, and you also felt it in waves following the recovery, rehab, and return to normality periods. It is incomprehensible how anyone from our past was able to cope with and heal a broken bone. I assume that if you ever had a compound fracture, they just took you behind the shed and blasted your brain stem with a double barrel shotgun, a likely more fruitful method of death than infection. There is archeological evidence of early humans using wooden and other plant-based devices to create makeshift splints. The same goes for moldable plaster, which we now colloquially refer to as a cast. In the future, we will grow bones via stem cells; a good friend of mine had his ACL recovery expedited with the use of stem cell injections, and this was also ten years ago. I’m sure future generations of homo sapien are in for a treat.
Onwards,
Tony,
Humble Wordsmith
Writer Boy
Self-Repair Specialist
Terrible at Diagnoses, But Could Probably Manage As A Field Medic
You know, the joint that moves like a door hinge. Open and close, or in the case of the ankle, flexion and extension. Hinge joints are only meant to move in one plane, so when you roll your ankle, say sliding on an indoor basketball court wearing tacky shoes, the structures of the joint and the structures surrounding the joint are put under an immense and abnormal amount of pressure, which may lead to damage, such as sprains (tearing), strains (overstretching), and fractures (no explanation needed).