How'd it happen?
On December 25th, 2006, Kathy was out with her Dad and siblings on Dad's boat. Out for a swim and just to hang out together with the family. She jumped out of the boat (into pretty shallow water) and clobbered her heelbone (calcaneus) and some of the bones "north" of it. Here's the ER Doctor & Radiologist's report:
"Comminuted subtalar fracture of the calcaneus and anterior process, exacerbated by osteopenia of the central calcaneus. This lucent area appears chronic with the cortex surrounding it. Cannot rule out incomplete fracture of the distal fibula.
Marked soft tissue swelling with small joint effusion. Ankle mortise joint intact.
Cannot rule our tiny bone fragments posteriorly and inferiorly off the talus, though these may be contributed to by the adjacent calcaneus.
No dislocation identified."
What's this mean in English?
- Her heelbone (that's the calcaneus) is broken in several places
- There are little bits of bone hanging around
- It's worse because she has osteopenia (precursor to osteoporosis)
- The lower legbone may be fractured toward its end, but it isn't completely broken.
- Its swollen (duh)
- But aside from the fact that her heel is in pieces, the pieces are where they are supposed to be.
Date with Doogie
Through our HMO (Health Maintenance Organization), Kathy got referred to a Specialist at Brigham and Women's Hospital in Boston (about 40 miles from our home). We were referred to a young surgeon, Dr. Chris Chiodo; his website photo is even younger than his actual 39 years, so we have taken to calling him Doogie after the TV show of the early 90's (15 year old prodigy gets medical degree, experiences hospital residency and puberty at the same time...). We found him personable and confident and, maybe it's a new (and welcome) trend in medicine, or maybe just his style, but he was quite candid about the available choices, the statistical outcome of each, as well has his experience personally. We wish all clinicians were like this.
Conclusion
As it turns out, none of the pieces of Kathy's heel bone were "displaced" (all the pieces are more or less where they're supposed to be), and all but one of the fractures were not in the neighborhood of the talus, so they didn't affect the space between the joints.
There was one fracture that did reach the joint, but it was offset only the tiniest bit. Given this "lucky break", even with with no surgery, Kathy has a "very good to excellent" prognosis - the downside is that at some later date, she might start to get arthritis, at the uneven part of the joint, and if it gets bad enough, they eventually would fuse the two joints together. Fusion removes the ability to move a foot side to side - not a major loss.
On the other hand, if Kathy had surgery, her prognosis would be a little bit higher toward the "excellent" side, but she'd go through complicated & tricky surgery, which carries a number of complications - relatively frequent infections, potential nerve damage, etc.
The downsides of surgery seemed too high, and the downsides of cast-only approach manageably low, so it was an easy decision. We liked the surgeon a lot, though we'll probably just switch to a local ortho doc (the drive into boston is just too long), besides, there's no "high tech" involved in putting on and removing casts. The challenge will be getting care locally when the staff seems booked out months in advance...
Kathy will have about four weeks between the first cast being applied and the next checkup, and with luck will spend the time (late Jan to late Feb) in the Florida Keys from whence we recently returned for this adventure. Conveniently, Southwest Airlines just today set their Manchester-Fort Lauderdale fares at $59 each way.... Scott will make a modified version of our original trip to Thailand, with a stop in the south for about a week of SCUBA diving.
Epilog
May, 2007. Kathy's "fixed", mostly. Still sore, a bit swollen, and she hobbles a little.
Kathy spent a chunk of the winter with her folks down in Florida, while Scott gallivanted around southeast asia. It turned out that it would be the last time she'd see her Mom, who passed away on May 22nd, 2007. So while Kathy would much prefer not to have smashed up her foot, it proved a major "silver lining" for both of them.
Photos
