Orthopedist Questions Amputation

ā€œBroken tibia, fibula and hole in ankle, surgeon suggesting amputationā€

I fell 20 feet two years ago and broke my tibia, fibula and have a hole in my ankle. I have had 2 surgeries to repair with no success and am in extreme pain constantly. My doctor is suggestion a fusion and a spinal nerve stimulator, but is not confident it would work. He said amputation may be the only way to not live in pain anymore. How long is the recovery time with an amputation until I would be able to move around well on my prosthesis and not be in pain?

15 Answers

Iā€™m afraid that by now, even amputation may not stop this pain. See a pain doc who can determine the source of pain, do trial a stimulator, and discuss other interventions for pain control.
FOR A HEALING OF FRACTURE - PORTABLE NERVE STIMULATOR CAN BE TRIED. FUSION OF BONE IS DONE AND CAN HELP TOO. YOU CAN TRY DIFFERENT CONSERVATIVE TREATMENT SO PAIN IS LESS, PLUS USE ANALGESICS, NARCOTICS UNDER CONTROL, SMOKE MARIJUANA AS IT RELAXES REDUCES PAIN TOO. AMPUTATION IS LAST RESORT IF HEALTHY - YOUNGER THAN 3-4 MONTHS. YOU CAN BE WALKING OK NO PAIN EITHER. DECIDE BUT AMPUATAION IS AMPUTATION... GOOD BLOOD SUPPLY TO AREA, SO HEAL BETTER FAST, NO INFECTION, PLUS GOOD GEN HEALTH. ALL IS VERY IMPORTANT. IMPORTANT IS SECOND OPINION.
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3-6 months
This is tricky. From what I can gather regarding your injuries and surgeries (without having all the details) a fusion would be the first option. This will hopefully relieve the pain but may not take it all away. I've had both ankles done myself and still have some pain, mainly in one, but not enough to stop me doing things. There will be other consequences though - such as losing movement in your ankle to some degree (depending on the number of joints in the ankle fused). You should be able to walk easily with orthotics or custom made shoes. Running would be very difficult so it would limits some sports. A spinal cord stimulator is purely for pain and could be used in conjunction with either operation. The leads are inserted in an operating theatre and the current is tested and adjusted over a week in a trial. If it works the neurostimulator (a small computer in effect) is implanted. If not, the worse are removed. It a last resort in pain management and only works for some people with specific types of pain. An amputation should be an absolutely final resort. Unfortunately amputees can get 2 types of pain - phantom limb pain, and stump pain - as well as phantom limb "sensation" which is not painful but can be uncomfortable. For a trans tibial (below knee amputation) you are looking at at least 3-6 months to get your final prosthesis (leg) and to be fully functional with it. Amputees can get pain at various times after the surgery and during the rehabilitation phase. If all went perfectly well and there were no pain issues careful maintenance of the stump is needed to ensure no skin breaks down. There is a newer option called osseointegration, where the attachment for the prosthesis is cemented into the bone that has been amputated so you "click" the leg on. That is still a very specialised procedure. Amputation is a complicated and involved process and you'd be best to get your surgeon to introduce you to people who have been through it learn as much from them as you can before you decide to go through with it. You can't go back. Personally, I'd consider less the invasive options first.
A fusion is better than an amputation. A fusion, when successful is great. The results are long-lasting and you are able to do more with less pain.
The prosthetics today are excellent. I have patients that participate in a number of sports including climbing, skiing, tennis, and running. The down time is usually about 6 weeks to get the incision to heal and then prosthetic placement starts to shape the stump for the prosthesis. Hope this helps.
Recovery from an amputation can be as fast as 6-10 wks. The clear difference btw an amputation and a fusion is the absence of the leg and not requiring bony healing to be effective. Although there are the drawbacks of requiring a prosthetic and need for fitting/ maintenance, healthy individuals can continue an active lifestyle with an amputation.
Golly. Amputation sounds terribly extreme. I think you should see a physiatrist for pain control and a second and even third opinion before any surgery is contemplated. Pain control is the first line of management. Today we have such sophisticated pain control measures a physiatrist can use nerve blocks etc etc.
I specialize in limb salvaging procedures. I may be able to save your foot
This may be a good option for you. Amputation that is performed by an experienced surgeon can result in a good functional outcome. You may walking in 3-6 weeks.
While an amputation is obviously a serious life changing event, it is not a life ending event. The recovery following a below knee amputation is relatively short given the duration of your symptoms and prior surgeries. Most surgical wounds, if you are healthy and don't have chronic complicating medical conditions, heal in a matter of weeks. The "stump" is treated following surgery by swelling reduction and shaping with various compressive dressings are shaping socks. Usually by 6-8 weeks, prosthesis fitting can be initiated.
Prosthetics for below knee amputations have evolved extraordinarily and many amputates are able to resume various pre-injury activities with appropriate prosthetic styles and designs.
Light weight materials and specialized designs have permitted many athletes to resume or even begin all types of sporting activities with modifications or specialty prosthetics.
I am not sure what the hole in your heel is, but if it is an open non-healing wound or your have an infection in the bone; an amputation may be life saving depending on your health and age.
I wish you the best.
Sounds like a terrible problem, sorry. If all else has failed, an amputation would relieve pain. People with a below-the-knee amputation do very well. They walk normally with a prosthesis, and most people don't even realize it. It takes a few months for the amputation wound to heal and mature enough to fit it with a prosthesis.
Amputations, if done by a surgeon experienced in them, can give long-lasting relief of pain. Technology has evolved a lot over the last decade. The ultimate success of the surgery will depend, in part, on how well you do your physical therapy and more importantly, your home exercises to build up the leg motion, endurance, strength, flexibility, and condition. Pop-doc.com has these exercise program suggestions. Finally, what your expectations are will also affect how well you do going forward, over the next several decades.
Amputation is a choice, if the infection is not controllable and/or the fracture has not united. Prosthesis can be fitted at the end of the operation and you can be walking with crutches the next day.
Easy to try the stimulator. They can work miracles. Where do you live? I'd avoid the amputation. Fusion (of the leg) not an unreasonable solution. Stim first for certain. Try Boston scientific or abbot-DRG stimulation, avoid Medtronic. They make great stuff, just way behind on stimulators.