The Fracture Clinic

 Monday 25th November 2014

The fracture clinic the next day was busy due to the weekend referals from A&E, and it was inevitable that my appointment was delayed. When I finally got to see the consultant he removed my backslab, spainfully queezed my calfs and pronounced I’d ruptured my achilles. He went on to explain that it could be treated by surgical or non-surgical means whith neither being that much better or quicker than the other, and what with the possible extra complications with surgey and the fact I wasn’t a professional sportsman that he was recommending the non-op method for me. Then explained that it was 4 weeks in a full leg cast followed by another 4 weeks in a below knee cast  and finally another 4 weeks in an air-cast boot. He did however want to check that the ends of my tendons were touching while in the rquine position, and was sending me for an ultrasound scan.
They couldn’t however fit me in for a scan until the next day and thus I was put into another backslab til then. This time however it was a full length one, immobilising my knee as well as my ankle and foot, making walking with my crutches even harder.

The plasterer also told me to buy a “limbo” to help with washing, which with hind sight is an excellent product http://www.limboproducts.co.uk/

That night I woke up a few times with pains and twinges in my bad leg, I think from lack of circulation and movement. On standing up I could feel the blood running back into my calf causing a dull throbbing - this didn’t bode well for a first night in plaster.

Tuesday 26th November 2014

First stop was back to the fracture clinic to get my backslab removed again, before hobbling to the ultra sound department. I wasn’t to worried about this scan afterall I’d seen it when my wife was pregnant, they smear on some gel and then painlessly move the probe over your skin…. I hadn’t realised they would want to do the painfull calf squeezing again and then even worse, they wanted to scan with my foot perpendicular.  As the pushed my foot up the pain was excruciating, probably no worse than the rupture itself but that was instantaneous whereas this was continuous agony.
Eventually they confirmed that the ends did indeed touch while my foot was “equine”, and I was sent away to get my permanent cast on.

It was while talking to the plasterer that I realised that ATR treatment was be no means a cut and dry proceedure, as  he explained that even within the hospital I was attending each consultant would treat ATRs differently. That was my first wake-up call that there may be other options to my treatment.

5 Responses to “The Fracture Clinic”

  1. AARGH!! The good news is that a full cast would really hurt that evil incompetent consultant in a soft spot. Grrrr! What are they THINKING? What have they read, or heard?!? I’ve never heard or read a word even hinting that immobilizing the whole leg might have any benefit in ATR treatment, it’s just mindless torture.

    What you were told about op vs non-op is probably arou d average in 2013, though still a bit behind the best evidence. We used to hear that surgery was best for everybody who was fit enough to go through the op, though some other inactive geezers might like to skip the pain and the scar etc. That still persists in rare backward corners, long after the new randomized trials started showing equivalent strength, ROM, & rerupture rates.
    Now that several such trials and one meta-study have all confirmed that result (provided a fast modern rehab protocol is used, not old-fashioned “conservative casting” with multiple casts), the old mandatory-surgery story has almost died out. But it’s still rare to find a pro or elite athlete who goes non-op, so the op-pushers are now using that instead. Fortunately, there are a few pro or elite athletes who have gone aggressive non-op, and a few have posted their great results on YouTube or elsewhere. Cdn footballer Brady Browne comes to mind, but I think there are already a few others, and their ranks are bound to grow. I hope to live long enough to see the day when the story you were told is nearly extinct, too!

  2. Hi Ross suspect your consultant is my surgeon’s cousin, ha ha. Unbelievable how many different approaches there are to “treating” ATR. My surgeon wanted me non weight bearing at 30 degrees for 6 weeks post op. I chose surgery as I hadn’t found this site and as a surgeon myself, albeit for cats and dogs, psychologically surgery was the option for me as I needed to know that those 2 tendon ends were nicely back together. Having now read all the multiple studies I think that if I had to “do a Norm” and rupture the other one (thank you Norm, your double rupture has been invaluable to all of us), I would go non surgical. I wasn’t brave enough to challenge my surgeon’s treatment plan so read as many of the ATR blogs that I could and all the associated info and then started on my own treatment plan. Am doing well, FWB in my Vacoped at end of week 5 and back to my clinic on a part time basis as from tomorrow. Follow up appointment with surgeon on Thursday, not quite sure whether I should crutch my way in or stride in in my Vacoped and see if I can enlighten him………
    Keep us posted as to what happens. Gentle healing. Jen

  3. Norm is so right about torture with a full leg cast. It is ridiculous in this modern world to consider such immobilization necessary. I would not be able to take it and probably would have cut if off myself. As is was I screamed at the doc to put me in a boot after one week. Now if this doctor is quite old then he could have done his training in the 70’s with text books written in the 50’s from evidence gathered in the 30’s. I would find another doctor and get another opinion. As there has been no cutting then another doc will be more inclined to get involved. I don’t believe any damage has been done just yet by going this way as it is early days of treatment and the important thing is to get the collagen laid down around the injury.

  4. Hi Ross
    Welcome to my world! I’m at week 16 on the non op conservative route. Lots of reasons why I’m on this route, not least because I didn’t find this site until too late! It would appear that your surgeon has relatives all over the world!
    Norm, Jen and Stuart are right. Nothing wrong with going non op, but early rehab is the key. Don’t, and every subsequent stage just takes longer, putting you in the danger zone of rerupture for longer.
    Convincing a surgeon to change his protocol with what you have read off the intent is always going to be a tough call, so I would second Stuarts suggestion. However if you find yourself with no other choice, you could invest in a hacksaw and a Vacocast - As some others have done on this site!
    All the same, best of luck with it and take your time as you are laid up to trawl thru this site. It’s a gold mine!
    Cheers Hoppy

  5. Thanks for sharing useful content, I was looking for it.

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