skibigsky's Diaryland Diary
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Just an update on things.
Okay, so all the gory details from Mr. V.’s surgery. (Don’t worry – I’ll warn you before the really gory pictures appear.) BTW, this post is photo intensive. Consider yourself warned.
So, you all know the story; Mr. V. was skiing on slalom skis in flat light , hyper-loaded the tips, hit a grooming seam, and got pitched 30 feet straight downhill. After a mis-diagnosis from the clinician at the resort, (“Yeah, go ahead and ski as tolerated. Minor tear if anything, nothing significant. Go ski.”), an inconclusive MRI (“Could be something, but too much swelling to tell. Go ski.”), and another inconclusive MRI (“Yep. Looks like there could be some issues, but you’d really need a more high-tech MRI to actually tell. Go ski.”) Of course, he skied the whole time. (Although in all fairness, Brent’s wife – an OB/GYN – saw his ankle at one clinic and decided that the deltoid ligament was gone; should have listened to her…. Clearly she knows her anatomy quite well…)
And then saw a specialist whose general response was, “Dude, this is really cool; I’ve never actually seen this injury before. So… How’d you do it?” (And no offense to Dr. Saltzman, but you could almost see him salivating; which is fair – everyone likes something new and interesting to show up in their ‘task list’ at work! *grin.)
And he skied the Nationals held together with duct tape.
And on Tuesday at 9:30am, he was at the University of Utah Orthopedic Center getting ready for surgery. Complete with cute gown and cap.
And attitude. Yo! Dude!
And no, he hadn’t had any good pre-op drugs at that point…. *sigh.
However, since it’s winter, he hasn’t shaved since November, the nurse had to shave his leg for him….
And after his “The Less that You Wear, the More you need Nair!” moment, he was ready for surgery.
WARNING. GORY PICTURES COMING. Don’t say you weren’t warned.
And then the good doctor was ready to work his magic. And, of course, as soon as he got into the ankle, discovered that things were a tad worse than he had expected.
THIS IS YOUR LAST WARNING. IF YOU LIKE PICTURES OF CRAB MEAT, CONTINUE. IF NOT, HAVE SOMEONE LESS SQUEAMISH THAN YOURSELF SCROLL DOWN PAST THE GORY PICTURES FOR YOU. Again. You have been warned.
Before the gore (just in case you weren’t sure about the above warnings), I’ll give you a brief description of the ankle joints, liberally borrowed from this site
The ankle is a complex mechanism. What we normally think of as the ankle is actually made up of two joints: the subtalar joint, and the true ankle joint.
Mr. V.’s injury is primarily related to the subtalar joint, so I’ll skip to that.
Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and calcaneus on the bottom. The subtalar joint allows side to side motion of the foot.
The ends of the bones in these joints are covered by articular cartilage (1). The major ligaments of the ankle are: the anterior tibiofibular ligament (2), which connects the tibia to the fibula;
The lateral collateral ligaments (3), which attach the fibula to the calcaneus and gives the ankle lateral stability; and, on the medial side of the ankle, the deltoid ligaments (4), which connect the tibia to the talus and calcaneus and provide medial stability.
Okay. So. On to what was done to Mr. V..
First, he had ripped off the articular cartilage on the talus (and possible elsewhere…. I was a little unclear on this). And it was floating around on the outside of the ankle (I confess, I never remember which is anterior, and which is medial….). So, they went in and ‘cleaned it out’ (nice, euphemistic phrase there), and then poked holes in the bone (approx 0.5mm in size, each) to get the bone bleeding, which will (ideally) result in scar tissue, and ultimately help stabilize the ankle. (To give you a sense of things, the widest part of the instrument in this picture is 3mm wide… which is fairly wide when you think that it is scraping out parts of your ankle….)
Then he moved on. The deltoid ligaments were completely detached. Meaning no medial stability. Here is a picture of some of the detached ligaments.
That big canyon in the middle? Shouldn’t be there. Hence the no stability. And if I understood the doctor correctly, this is the ‘money shot’ – the one he wants to go in the text books. Just a general note: any time they want to put a picture from your surgery in a text book, things are Not Optimal.
Another, better picture of the ‘deep’ tear in the deltoid.
This falls into the Really Not Good category.
Anyway. He also tore lateral collateral ligaments. But because of how they had to fix the deltoid ligaments, they couldn’t fix these. But, a lot of active adults are missing their lateral collateral ligaments. So no biggie. (It's all relative, you know! *grin)
But why didn’t they fix them? Well.
To reattach the deltoid ligaments, they had to actually MOVE the calcaneus to reattach the deltoid ligaments. If they had tried to attached the lateral collateral ligaments, they would have been immediately stretched, and wouldn’t have provided support.
So, Mr. V. is casted at an angle, which supports the calcaneus (allowing the deltoids to heal), but makes it so that he absolutely can not put weight on the ankle until this starts to heal.
For the Cliff Notes version, here is the MD’s picture for me. The heavy red marks are Where Bad Things Happened.
For translation, M = malleolus, T = Talus, and C = Calcaneus
The MD, and his assistant, are still quite surprised by the whole injury (the picture doesn’t show it, but the MD really does sort of look like John Belushi, and you don’t quite get the eyebrow raise here, but trust me…. He’s absolutely looking askance at this whole thing! Although he’s already penning the first draft of his journal article. *grin.
And Mr. V.?
Well, let’s just say that the nerve block is wearing off, and having had 3mm things poked into his ankle, he’s not a happy camper.
Anyway, the MD has seen all the pictures (including the cankles and the ski racing (pics coming)), and is REALLY interested in Mr. V.’s rehab. So, we’ll be starting a thread on his rehab. We’ll get links up as soon as it is ready.
In the meantime? He’s coming home tomorrow, and I imagine that our hands will be full for a couple of days, but I’ll update as I can. In the meantime, thanks again to all the kind thoughts!
That was the day before yesterday.
Mr. V. got home yesterday, had a very rough night last night (no surprise.... he did have surgery after all), and is fairly uncomfortable, and cranky.
Oh yeah... And the ski races at Steamboat? I sucked balls on Friday, but got my shit together and had one of the best races of my life on Saturday. My ass was handed to me by the two other women in my class (a former US Ski Team chick....., and a former elite figure skater), but on Saturday I skied very well for me, and I was pleased with that. Yeah, I was 3rd out of 3, but I am thrilled beyond words at how I skied.
Oh, and I met my 'twin'! (I'm the bigger of the two of us!) For wearing a really unique speed suit, it was actually really cool to see someone else (on my hill, nonetheless!) in the same suit!
6:53 p.m. - 21 March 2008
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