Hiking/Mountaineering after a serious tib/fib fracture

[eastcoastski93]

I had a compound tib/fib fracture with compartment syndrome December of 2023. I was caught in a slide while skiing and the pin binding on my left leg did not release. I watched my leg fully twist in slow motion and my shin was punctured by my tibia. Since Dec of 2023 I've had 5 surgeries (2 fasciotomies - compartment syndrome) (tibia nail #1 and allograft - donor bone graft, which failed and ended up being non-union 8 months in) (surgery #5 was an exchange nail 12mm diameter, plating of my non-union fibula and an autograft which was bone from my femur - September of 2024)
I was on a mountain guiding track and have essentially shelved that for good.
Has anyone else had a similar, serious injury like this? How long did it take you to get back into climbing/mountaineering? I just miss getting out there.
I've been walking, albeit with aches and pains, pretty well for the past few months. I'm hoping this is the last surgery I'll need (aside from removing some hardware down the road)

[Gore Girl]

Wow, eastcoastski93, I'm momentarily speechless at the magnitude of what has happened to you. But I wanted to weigh in and give you some hope. Full disclaimer: I've not personally had that degree of physical injury, ever. I'm lucky to say I've made it into my 60s and kept everything connected thus far. And I can also say that hearing about your accident will remind me to continue to stay the course on being ever so conservative and cautious with skis on. I live to hike and climb, so I don't want to wreck myself skiing. The only reason I do anything on skis in the winter is to stay in shape for hiking, frankly.

I will share this with you: I did, however, battle a serious illness in 2016 as a complication from a serious case of shingles that I thought would end my hiking forever. I could not stand up without my heart rate going to 150 and any physical activity was out of the question. I went overnight from being an ultrarunner and distance hiker to basically having to master walking again. I battled depression as a result, and I despaired of ever being out on my beloved peaks again. It was the most devastating, lonely, and isolating experience I'd ever gone through. And I fought my way to resolving it on my own - but I did resolve it! So I can imagine to some degree what you are feeling. One of the mental keys for me is that after I got sick of feeling despair all the time, I got righteously angry and told myself that I was NOT going to let it all stop me. I WAS NOT DONE. And that anger channeled my thinking into finding resolution, which had many crucial elements and time involved - but I would not have gotten there without refusing to give up.

Now some practical thoughts regarding your specific situation: I also hope you are done with surgery. What are you doing to strengthen the muscles around the knee/in the calf? Because quite likely that will be the key to supporting the ravaged bone structure underneath. Also, some of that hardware may be causing nerve pain - so when you finally can get that taken out - it might be helpful. The fact that you suffered compartment syndrome leads me to suspect that your calf muscles had taken quite a beating. What nerve impingements are a factor for you, and can they be addressed with treatments? I'd imagine they gave you gabapentin or pregabalin for that, but that's not a great long term therapy for nerve pain. I was on that for a while for the nerve damage on the right side of my face due to what I went through but the drug made me stupid and uncoordinated - plus you build up a tolerance to it. So I chose daily pain over stupid and clumsy any day!

[jrbren_vt]

I am very sorry to hear about your serious injury.

I broke my left fibula above 13K' on Horn Peak in the Sangres on June 19, 2023. A week later I sprained my right knee getting off the couch while watching TV. So summer of 2023 was a complete wipe out for me for hiking. But I was very lucky, my Tibia was unaffected, so I was able to hobble out in about 6.5 hours (normally that descent and distance would take me 3 hours or less). I was lucky no surgery was required. I started going for walks on paved sidewalks in August (with a boot). I was hiking again by mid September. Limited to class 1 trails. Some folks on this site helped me out by steering me to some good starter trails coming off injury (Mt Flora, Sniktau, etc...). This is why I object so strongly to the useless definition for a class one trail on this site. I have read from other sources it meant lots of flat places to place your feet, relatively few roots and rocks to deal with, which is a big deal coming off an injury. The injury occured when my left foot got lodged between two rocks, my next stride with my right foot hit a pile of typical Colorado Rockies kitty litter scree, and down I went. I heard the snap. I don't know what happened with my right knee a week later.

Fast forward to February of 2024, where I was starting to mix some jogging in with my walks around town. My left knee started acting up, and has been flakey ever since. It's getting stronger, but very slowly for my taste. It eliminated any running or jogging, but fortunately I could still hike and bike without bothering it, which got me through the summer of 2024. In June of 2024 I dropped a big rock on my right toe while climbing an off route slope of Square Top mountain near Guanella pass. It was non displaced and did not require surgery. I started jogging again in October, where my knee tells me to cut it out of I try to push too hard or too long. I have not had that one diagnosed, still trying to see if it gets better on its own. I think the left knee issue was due to a stretch I have always done, that may not be doable any more after the broken fibula. All these joints are connected I learned .

The moral of this story is be real careful about coming back to soon. Definitely don't give up your guiding ambitions "for good". Maybe "for now". Maybe talk to a guide service on what other opportunities there may be in that business. Administrative work, working with client to find the right trip for them ? I have been a client on several guided trips, and often talk to the office staff ahead of time on these issues. There is a lot of project management that goes on here. In time you will heal, and you would be well positioned to perhaps get an in the field role. How long it takes has numerous variables. Just speculating. But don't give up. Fine some other interests that your body will allow. Kayaking ? Boating ? For me it was biking, that didn't bother my injuries.

One more note, I strongly recommend physical therapy if you can swing it.

Best wishes for a full recovery.

[Ebenton]

I have a thoughts you will not like. I am not a doctor. If you Google the statical end point for these modalities. I believe they end at a total knee replacement. Consider what you've been thru and how much time you have invested. You need a competent surgeon. The various systems all their froibles , peccadillos, and on occasion failure. Your age, and other health concerns will play a role in your decision. Life after I can't tell you that. Long distance running perhaps not. I am a now almost old man. I was born in Colorado, and did some of the 14ers. Attempting to condition myself led to trying to run. Some folks are gifted mechanically, some are not. Attempting to run led various issues for me. Resulting osteoarthritis and a total knee replacement two years ago .. I had another total knee today.. My job has not been kind to my joints. After my leave of absence expires. I don't think I'll be returning

[cvbuffs]

Similar story to the OP with nearly identical injury roughly 12 years ago - tib/fib (tibial nail; 2x fib fractures high and low) + compartment syndrome (2x fasciotomies) + ACL on my right leg results in a lengthy hospital stay and 6 surgeries to get pulled back together. Compartment syndrome resulted in foot drop for about 4-6 months before I got back to ~75% ankle flexion; currently would say I'm at 90%+ on mobility. Road to recovery definitely had ups and downs between pain management, rehab and additional surgeries. Probably a good two years before I could hike 6+ miles without significant pain during or after.

Started my 14er journey about 2 years post-accident and kept it simple with easier class 1 peaks in the Front Range area and summited 13 peaks within a couple of years (nothing higher than class 2). Fast forward to the summer of 2020 where climbing all the 14ers became an obsession resulting in completing them all summer 2023.

In between there was another ACL surgery (left leg, 2016) and a left foot surgery in early 2023. Yes, I'm accident prone.

Biggest hurdles were always staying in shape when your fitness level drops significantly during the periods of inactivity before and after surgery. Maintaining a good body weight has always been an issue so that was exacerbated during these times. But I was able to find some activities that I now really enjoy (ie. distance biking) to help in staying in relatively decent shape. Included was a ton of weight and resistance rehab to strengthen my quads, hamstrings and lower leg muscles to help with stability (particularly for the ACLs and the loss of mobility/stabilization in my right foot). Lots of body weight time on the bosu ball to help with building the muscles that had to be used in lieu of my regular muscles working; in particular my tibialis anterior muscle, quads and hamstrings on my legs have gotten significantly larger in the time since my accident(s). From there it was getting back to my regularly scheduled programing with sports and outdoor activities to work the non-gym muscles.

Second hurdle was pain management and the ability to understand what was bearable, how long is it bearable, and what usually causes pain. In my particular experience, I had a ton of pain in my lower leg at seemingly random times to the point where I’ve had x-rays take to make sure I didn’t have a stress fracture or something wrong with the tibial nail; this pain still exists but at less frequent intervals. Feedback from the docs was that it was just latent pain and that they would never remove my tibial since that was now the strongest part of my body and removal would have a high probability of rebreaking my leg. That will be different for everyone but for me, taking a couple of ibuprofen before a long hike or at the summit was pretty standard fare (typically going down was always more painful than going up) and giving myself time to warmup at the start of a longer hike was needed. Poles were also very helpful in lessening impact going up/down and can be used in a pitch to help roll out muscles. I also found at times that trail running downhill helped to save my legs since it was engaging my upper legs more and reduced the overall time on trail.

The last thing is just realizing that you will probably never be back to 100%. Even 12 years later I still have some nerve pain/dead nerves and lack of muscle mobility and stabilization in my right leg. That leg is also slightly shorter which has an impact on my hip and general bodily balance so things like distance running are not enjoyable. I've also cut way back on skiing and the types of terrain I will go on, along with scaling back my participation in rec sports, not because of capabilities or pain but more just lowering the risk of another catastrophic incident.

That’s a novel already, but would be happy to chat if you have questions or want more info. Hopefully, at the very least, you can see that it is possible to come back from an injury like this and get back to climbing/doing the things you like. It will be a long and sometimes frustrating journey but I found that walking long distances in the mountains was great rehab both mentally and physically. Good luck!