The Team Ilizarov story

5000 Miles UK to Siberia Cycle - The Accident

Cycle from the UK to Siberia 2003

Follow my progress as I cycle from the UK to the Ilizarov Scientific Center in Kurgan, Siberia during 2003. This cycling expedition is to raise money for orthopaedic research and those that saved my life and prevented amputation of my leg following a near fatal road accident in 1999. Departure date was January 20th 2003 at 12.30 pm from Broomfield Hospital, Chelmsford, Essex, England.

 


Here are a couple of pictures of myself before the accident. On the left I've just finished a training session at my local gym and the other is touring in Spain on my old FJ 1200. As you can see I'm in pretty good shape and in fact doctor's told me that this is probably why I survived the impact.


I decided to go shopping locally. I was approximately twenty minutes from home - just a few miles - when the accident happened. I don't remember anything about the accident. (It was later explained to me that four vehicles were involved. I had hit the back of a car hard enough to literally leave the outline of my body on the car.) The next thing I remember is waking up in a side room at Broomfield Hospital, Chelmsford. I was only vaguely aware at that time that I had injuries to my left arm and leg.

My Injuries:
Head Injury-Lacerated liver-Ruptured kidney-Abdominal haematoma-Disintegrated left wrist Disintegrated left tibia-Broken left ankle-Broken ribs-Pancreatitis developed while in hospital.

I had also sustained internal injuries which were life-threatening. It was in A & E that internal bleeding was discovered. Vital organs had been damaged. I survived only because I had a strong mid-section. The fact that I survived at all was due largely to my general fitness and weight training regime spanning many years.

Decisions had to be made regarding amputation at this stage. Fortunately for me the Consultant in charge decided that due to my good physical condition it was worthwhile trying to save the leg. He called in his team, and the long procedure to put me back together had begun. Following initial operations, I was closely monitored in intensive care.


The internal injuries were left to see if they could possibly resolve themselves to avoid more surgery. The external injuries were initially treated with a plate fixing my ankle - an external hybrid fixator on my leg and another external fixator on my left arm to pin the wrist.
As I recall, I had many operations in those first weeks and some of the pictures on this page show my 'gradual' recovery in those early weeks. From complete bed rest - where I had no comprehension of what was going on - to being helped to sit out in a chair for a few minutes each day. Finally - I was allowed outside for the first time in two and a half months. I still had a long way to go but my recovery had begun.

I will never forget the overwhelming feeling of how lucky I was to be alive

During this time in hospital I developed methicillin-resistant Staphylococcus aureus M.R.S.A and it was decided to give me an injectible anti - biotic called Vancomycin. The anti - biotic was administered very slowly. Then, after a few moments, I felt severe burning sensations in my hands and feet. The injection was stopped immediately because I had developed an anaphylactic reaction to the drug. Several nurses came into the room to assist and a doctor was called to administer adrenaline injections. Eventually I recovered, but was then given oral anti - biotics. That regime was to continue for the next eighteen months.
Prior to my eventual discharge after three months - the fixator on my left wrist was removed. The bone had mended but my wrist and hand were left badly shaped and with little movement or feeling. (Further treatment would not be attempted until 2002.)


Following discharge from hospital the plan was for me to return in a few weeks to have a bone graft operation. This should encourage new bone growth. The 'healing' process was going to take a long time and to illustrate just how serious my leg had been damaged - one of the Registrar's told me that it was as if a grenade had gone off inside my leg.

I went back to hospital for the operation. Some bone was taken from my left hip and transplanted into the damaged area of the left leg. This was a routine operation and in theory should promote growth in my damaged leg. I returned home and visited the consultant on a weekly basis.

I did have problems with persistent infections and periodically went back into hospital so that my progress could be monitored. Infections slow down or halt the healing process and so continuing with the anti-biotics was crucial. I had to have weekly blood tests due to the strength of the drugs which could, if not monitored, exacerbate the kidney damage I had already sustained.

Many weeks later it was decided that the external fixator could be replaced with a full length cast-brace. The brace is joined at the knee joint with external hinges to allow 'normal' movement. This allows weight bearing to begin whilst at the same time supporting the leg.

It was at this time that serious problems began to develope with my leg.

Continuous infections in the bone itself meant that I had to undergo operations to remove infected areas. One such procedure was to remove the earlier bone graft material because it had 'died'. The infected ends of the tibia bone had to be 'tidied' up. This would mean the loss of about 25mm to the overall length of the leg. The next procedure was to have another external fixator fitted. This time it was to be an 'Orthofix' (see picture above),and an internal fixing plate. This was because the cast brace wasn't able to support my leg sufficiently and when I tried to bear weight, the leg moved sideways at the injury site. This had the effect of 'shearing' away any bone that was trying to form.

Next Operation

In the ongoing process of trying to prevent amputation of my leg, a decision was made to try a second bone graft operation.

This was somewhat different to the first bone graft where 'granules' of bone were inserted - this time a complete section of bone would be used. Another important difference would be that this 'complete' section of bone would be transplanted with its own blood supply.

The procedure was to take a section of bone from my right fibula - complete with an integral blood supply, and this would be grafted into my damaged leg. The body should incorporate this material into the damaged area and begin the process of regeneration at the injury site.

The operation was a very long process - approximately 10 hours. The operation was carried out jointly by orthopaedics and plastics.

I had an internal fixation plate fitted during this process and another plaster cast brace fitted shortly afterwards. It was felt that this combination would support my leg sufficiently enough for healing to take place.

As the weeks passed things didn't really improve. I continued to have problems with various infections and so maintained a high dosage of anti - biotics. My leg unfortunately, continued to move laterally under slight pressure and thus prevented any chance of new bone forming.

During Christmas 2000 I developed a high temperature and became feverish. I went back into the Broomfield Hospital. My condition was considered serious and so intravenous anti - biotics were administered. After a week of this and after many swabs had been taken - the result was that I had M.R.S.A again.

Once I had stabilised and my temperature began to return to normal, it was time for hard decisions to be made.

The consultant who had worked so hard for over a year now had to tell me that the leg wasn't healing and that there was nothing else that he could do - I must now consider losing the leg and prepare for an artificial limb. Obviously this was devastating news and something that I just hadn't contemplated during the past year. We decided that I should go home and return the following Monday for a full and frank discussion.

Monday came and the consultant repeated what was said before. But he had been condsidering all the options and told me that there was a surgeon at the Norfolk and Norwich hospital who specialised in this type of trauma and used a technique known as the 'Ilizarov Method'. This is a special type of fixator which holds the limb in line laterally but is designed to allow longitudinal compression - allowing weight bearing to take place which is fundamental to bone healing. I couldn't wait. He would contact the other consultant immediately.

I was overwhelmed when later that same afternoon I received a telephone call from the Norfolk & Norwich Hospital. It had been arranged for me to see him at 9:00 am the next morning.

I was examined by the consultant following x-rays and removal of the plaster cast. I was nervous because I knew that this was my last chance. Everything hinged on the consultant's assessment of my injury and how I would respond to an Ilizarov being fitted to my leg.

After a long and detailed consultation the result was that he would attempt to fit a frame. But, I had to agree that if the operation wasn't sucessful, I would have to agree to an amputation. I agreed without hesitation and travelled home to await the call to go in for the operation.

The operation to fit the Ilizarov frame was sucessful as you can see by the pictures above - please click to enlarge. There were several 'stages' to go through before the work on my leg would be completed.

The 25 degree tilt of the tibial bone above the injury had to be corrected.
The gap between the bone ends would have to be compressed together to 'fuse' the bone ends together and stimulate new bone material to grow filling out the damaged area.
In 2002 the frame will be reinstated to correct the curvature of the lower leg. This is pronounced and causes hyperextension of my knee joint. (The joint tries to bend the wrong way when weight is applied.)
In 2002 the final procedure will be to lengthen the leg.

The adjustments are carried out by turning adjusters on the frame 1.0 mm each day (4x 0.25). This allows the body to gradually adapt to the changes until the completion of each procedure.
This is a painful experience but worth tolerating to achieve the necessary amount of djustments at each stage of the corrective procedure.

I returned to the Norfolk & Norwich Hospital each week so that a progress assessment could be made. Any necessary changes to the geometry of the frame were carried out during these visits - the daily 1.0 mm adjustments I did at home each day.

I made good progress with the adjustments and maintained strict hygiene of the frame and the pinsites. I even began to walk with the aid of crutches and do gentle cycling on my indoor trainer. I adapted the left pedal to accommodate the width of the Ilizarov frame and the 50 mm difference between the length of my two legs. (25mm following a 'tidy up' of the bone ends and 25 mm following compression with the Ilizarov.)

The previous 14 months of inactivity had resulted in a substantial loss of lean body mass. X rays showed also that my other bones were decalcifying through lack of weight bearing exercise.

Having the Ilizarov fitted was like giving me my life back again. As I said above - I could now begin walking again - with the use of crutches - do some gentle indoor cycling and some weight training exercises for my upper body. This was a real turnaround!

I did still have M.R.S.A and the pin sites were painful, but slowly the bone did begin to form new 'callous' and I could at last begin to feel positive about my leg and my future, thanks to the Ilizarov frame.

In the summer I took part in the orthopaedic walk which is organised nationally and raises money for orthopaedic research and the hospitals.

In September after wearing the frame for nine months - it was removed to 'rest' my leg. Another Ilizarov will be fitted early in 2002 to begin the lengthening procedure.

Update 20 July 2002.

Unfortunately my optimism regarding the planning and execution of the work to my leg was unfounded. Time has now run out for the frame to fitted and the leg lengthening process to be completed in time for my departure to Siberia scheduled to begin in January 2003.

The frame will need to be on for at least five months so even if the frame was to be fitted today it will still be on until the end of December this year. I couldn't then set off in January to cycle 10,000 miles to Siberia and back and expect my leg to survive. I have therefore decided to complete my preparations this year and leave as planned in January 2003 wearing the shoe that I have developed to make up the difference between the length of my two legs which is more than 2 inches.

This is disappointing because the challenge is hard enough anyway without any additional complications. Still, looking at the bigger picture, the main task is to complete the challenge and raise lots of money for orthopaedic research and that is what I am focusing on.
Treatments and Operations Update 2002

 

 

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