UKC

I received a Hawkins II fracture of the left talar neck (bone in the ankle) after taking a solo fall last weekend.

I reckon that this must be a common injury amongst climbers, so has anyone else had one of these? How quickly were you climbing again? Did you receive any lasting complications?

Thanks for your help,

tizer

In reply to tizer:

My best mate and former climbing partner suffered that in Mar 2005. (Fall on Ben Udlaidh.) He's still not 100%. Able to hillwalk but not for any more than 4 or 5 hours.

It wasn't diagnosed as a fracture at first, so he walked round on it for a while, which couldn't have helped.

In reply to tizer:

Also known as snowboarders ankle I think. Apparently its quite hard to diagnose as doesn't show up on normal x-rays. My friend suffered it, seems to be just like a sprained ankle, but doesn't heal for a few months. Quite easy to re-injure as well or so I'm told.

In reply to Valley Ninja: The talus has a very poor vascular supply so healing can be slow. You should expect reduced range of motion of ankle. i've done mine (5 years ago) and five years later still climb but can't run any more.

In reply to Nez:

Thanks to everyone for the feed back. The prognosis does not look great.

Nez - What was the severity of your break? I had the operation Tuesday and they put in 6 pins. How is your foot in the cold? Has it affected any other sports? I'm a diver as well, so am concerned about the effect this injury will have on this. What do you think?

Thanks

tizer

In reply to tizer:
I had this fracture in my right ankle in 2000.
No pins, just a cast.
Following the injury I had 6 months of doing nothing except hopping on crutches (and I mean nothing...not so much as getting out of a chair without assistance), followed by 6 months of physio before I started walking, running, then eventually climbing again.
The physio started gradually then built up to 2 sessions a day, 5 days a week for the last 2 months or so.
All in all about 18 months bfore I was "fit" again.

At the time of the break the Doc said the fracture wouldn’t cause me too much trouble, but the associated tissue damage might.
I don’t have any lasting complications: It aches a little in the cold and I have to pay scrupulous attention to warming up and stretching if I’m going to do anything intense on it.

I’m sure there are people on here far more qualified to comment than me, but if I could offer any advice, it would be to give it complete rest until healed then don’t scrimp on the physio.
I remember it being very frustrating at the time, but in the long run it means I’m now back to full fitness (bar the minor issues I mentioned above).

Although it feels like it at the time, it doesn’t necessarily mean the end of your climbing activities.

Good luck.

In reply to tizer:

I've had it. It takes a while, but will get better. Don't worry. Hurts like hell!

Still feel it in the cold/damp but perhaps it's coz I'm looking for something! If my right ankle ever hurts, i think nothing of it, but if it's my left then I think it was coz of my injury!

Take care.

In reply to tizer: I fractured my talus about 3 months ago - higher up than yours - mine was an osteochondral fracture to the head of the talus (no op required, just plaster) so I don't know how relevant this'll be.

I'm still having trouble walking properly on it, and can't run yet, but climbing is ok in general and I was able to start again (gently!) about 6 weeks after injury. The main problem that I have is lack of mobility and pain at the extremes of movement - this makes rockovers and slabby stuff difficult, but overhanging stuff is ok and seems to be quite good therapy, i guess because the movements required in climbing are so varied. Walking downhill or over uneven ground is a pain in the arse though.

I'm hoping that physio and execise will continue to help with this - cycling and swimming are good and have helped a lot - plus they'll help you hold some fitness. Your physio should give you some exercises that are specific for you, but more general ones that I've found helpful are contrast baths (foot in ice water for one minute, then hot water for one minute, repeat for 10 mins) to help get more blood to the injury and sort out the trauma, and variations on standing on one leg to get all the proprioceptors woken up again once you get out of plaster.

I've been told that my ankle will most likely be less stable as a result of the injury, but this can be improved by wobble boarding etc.

Hope that's of some help and that you heal quickly. Best of luck.

Nic

In reply to tizer:
Looks like its a popular one! did mine about 18 months ago, 13 weeks in a cast, but no operation. Went ice climbing the week after the cast came off - not very clever really. Managed to rock climb from about 2 or 3 weeks after, but I ended up tearing a muscle near my knee, beacause the whole leg had got so weak. So give it plenty of rest, and take everything really slow. I still can't run and scree is a nightmare but cycling is good, - avoid clip in pedals. Rock climbing I'm OK in the peak & wales all day, but long days in Scotland this winter & I could hardly walk for 2 days afterwards - but I suppose this is different for everyone.
Biggest difference for me was a good physio - NHS physio told me I would never get full movment back, private physio managed it in about 30 mins.

In reply to JamesA:


Sounds very like my mate's experience. He went private, and things began to improve from then on.

In reply to DougG:
Its unfortunate, but seems to be common around here - just not enough NHS physios. Its easy to think that doctor's etc. word is gospel, but I learnt its worth challenging them, & be prepared to make a fuss if you don't like what you hear.

Thanks again to everyone for you help and advice. After reading the posts I do feel much more positive about the whole thing. It does seem to be a common injury amongst climbers. Also, no one has mentioned circulation problems, which I was particularly concerned about, so that's a bonus. I'll rest up, get a good private physio and take it slow.

tizer

In reply to tizer:

I had exactly that same injury (fracture to the neck of the talus and Hawkins type II subluxation (that's 'partial dislocation' in English!) last May. Two 5cm stainless steel screws (permanently) inserted into the talus.

I was in a cast for 7 weeks..walked (with difficulty and some pain) using two crutches for about 4-5 weeks after that and was then able to walk using a single crutch before starting to walk completely unaided 16-18 weeks after the accident. I started hill-walking five months after the injury (with some pain and using trekking poles constantly: this was, shall we say, not exactly following the Orthopod's advice to the letter!). Gradually since then I have got to the stage where I can hillwalk (for 6-7 hours) without too much swelling occuring afterwards (usually!).

I'm going indoor climbing later this week (first time in nearly 13 months). I hope to get climbing outdoors later in the summer. I might have started climbing sooner but am balancing one of my Orthopaedic Consulants' advice (I've seen a few: I keep going back for regular check-ups because of the risk of avascular necrosis) not to climb at all until at least 2 years after the accident, when the bopne should be fully re-generated (which would be May next year!) with my own wish to get back into it asap.

The main long-term risk, as they should have told you by now, is avascular necrosis (30-50% risk for type II displacements like what we've had). It doesn't appear to have happened in my case (they should be able to give you a rough idea of the risk 6-8 weeks after the fracture: immediately after the fracture is too soon to tell) but there's still a risk which is the reason for my Orthopod's concern at my climbing ambitions: even a small fall (say, on a ground move before the rope starts to protect!) could, in some cases, jar the bone sufficiently to cause this to occur. I have to be aware of this as, if avascular necrosis does develop, it would most likely have to be treated by fusing the ankle (which might disrupt my mountain ambitions just a tad!)

I was lucky with Physio (compared to some of the stories I've seen here). I was seen within a few days of having the cast removed (be prepared to spend some time on the phone ensuring that the various departments (i.e. Ortho and Physio) talk to each other!) and continued to see them regularly until December (i.e. 7 months post-injury) by which time I could walk around town with absolutely no problems.

Since then, to get my ankle strong enough to climb, I've concentrated on going to the gym (have stopped running: would still be too painfull to run regularly anyway!) and occasionally seeing a sports therapist such that the range of motion in my injured left ankle is now about 90-95% of the right ankle (even though it's still noticably swollen!)

I also, shortly after I started Physio last year, bought a wobble board, wobble cushion and cryo-cuff (iced water to reduce swelling!) so I could do alot of physio myself at home every day

On a more positive note, I had no problems with the cold in my ankle last winter (or when I was in -15deg temperatures in Nepal earlier this year)

It's not a nice injury but every individual injury is subtly different and how soon you get back to climbing really depends on how much ligament damage you did (If it's a type II fracture, you're unfortunately bound to have some ligament damage, but hopefully not as much as I did!). Hopefully you'll be able to get back to it sooner than me!

I attach one link but would warn you that it didn't make for cheerful reading for me when I read it shortly after my injury: you just have to remind yourself that not everyone suffers the worst case!

http://www.wheelessonline.com/ortho/hawkins_type_ii_talar_frx

One thing one of my consultants acknowledged is that avascular necrosis is very poorly understood: they really don't know why it occurs with some type II fractures and not others; this is, I suppose, why advice I've received from different Orthopods I've seen recently has ranged from " don't worry, get on with your life: if it was going to happen, it would have happened by now" to the more pessimistic advice of another telling me not to climb before May 2008!

Good luck and mail me if you want any more info!

In reply to all:

just out of interest how did you all sustain this injury? Was it from falls at climbing walls, leading, running/walking, bouldering?

In reply to tizer: I broke my talus (non-climbing industrial type accident) but was initially told I had just torn some ligaments. Eventually got it xrayed and was in plaster for 5 weeks. The doctor actually thought hobbling about on it for a while helped as it reduced the inflamation and improved the circulation.
After it was out of the cast it was weak for a while but now is fine. Using a wobble board really helped me recover some strength and balance. No long term negative effects (yet!).

Cheers,

FT.

In reply to SFM:

In my case, scrambling: fell 3m and landed on my toe onto a small rock ledge, forcing the ankle to dorsiflex to an ever so slighly greater extent than normal!

As far as I'm aware, it's less common than what most people think of as an ankle fracture (i.e. involving the fibula or tibia). Neither of my two Physios (one got transferred to another hospital during my treatment) had ever dealt with that specific injury before (although I reckon they still did a good job with my treatment)

In reply to tizer:

Hi Tizer,

Keep positive, all injuires are different and heal at different rates.

I'm another talus breaker. Unidentified for c. 8 weeks with an initial diagonsis as badly sprained. Thus tried walking cycling and swimming on it, as well as physio to try and remobilise. The ankle then developed a guarding response and the whole foot siezed to protect the break site. Eventually healed with no pins or casts, and so far no sign of necrosis. So I'm lucky.

I lost nearly all inversion in the ankle but:

14months on I can-
Walk for two days on it with poles and care, over multiple munro's. It has poor shock absorbtion so I take trainers for tracks. Rock climbing was hard at first, but now on multi-pitch (just), I am slowly building up the grades, and foot jamming is a big No!. On the plus side I'm re-visiting and enjoying old classics I first climbed over ten to fifteen years ago. Currently winter walking or snow and ice climbing would be hard, due to lack of inversion and poor strength to support the extra leverage of front pointing. Running, no hope at present, but I have just started trotting.

Lessons learned (apart from telling the doctors that they surely must be mistaken)

1) Don't do too much.
2) Get a good physio and follow thier instruction as best you can (drive and personality took me out too soon). Note that many ankle rehabilitation excercises may not be appropriate in your case, so ask your physio.

To give credit the physio's suspected the break before the ortho's found it (they missed it twice).

For the voyuers, how did I do it? - 250ft fall in 50ft bounces, when both my crampons popped while rigging a belay c. 600ft up a winter route - cue alot of one legged abseiling, some crawling and then alot of pride swallowing to ask for assistance.