Year 20 of this blog, which was launched on April 14 2005 has arrived! Thank you to everyone who still stops by.
Today our Real Women Real Broken Bones adventures takes us to Cedar Rapids Iowa to a 34 year old blond MILF. By day she is a chiropractic assistant and entrepreneur. She is also a mom and an amateur skier.
Day 1 - January 17th - our patient was skiing at the local ski resort in Iowa - Sun Down Mountain - and took an awkward spill.
After being driven to the ER by a family member her X-rays are reveal the truth a broken leg.
Something that I did not have 20 years ago or even 2 years ago is AI. So I asked ChatGPT to diagnose the type of fracture based on the X-ray.
This X-ray shows three different views of the tibia and ankle region. There is a visible spiral fracture of the distal tibia, which is characterized by a long, twisting break along the shaft of the bone. Spiral fractures often result from rotational forces, such as those experienced in skiing injuries when the foot is planted, and the body twists.
While spiral fractures can often be unstable and require surgical intervention, such as internal fixation with plates and screws or an intramedullary rod this one looks like it is is minimally displaced or well-aligned, making it suitable for non-surgical treatment through immobilization.
Non-Surgical Treatment Approach:
- Immobilization: A long-leg cast is typically used to keep the bone in place and allow healing.
- Non-Weight Bearing: Patient will likely need crutches or a mobility device to avoid putting weight on the injured leg for at least 6-8 weeks.
- Regular Follow-Up X-rays: To ensure the bone remains aligned as it heals.
- Pain Management: NSAIDs or prescribed pain medications can help control discomfort.
- Gradual Rehabilitation: Once the bone has sufficiently healed, physical therapy may be needed to restore strength, mobility, and function.
Healing Timeline:
- 6-12 weeks for initial bone healing.
- 3-6 months for full recovery, depending on individual factors like age, activity level, and overall health.
At the 3-4 Week Mark:
- If healing is progressing well, the doctor may allow a controlled weight-bearing transition with the walking boot.
- If there’s delayed healing or displacement, additional time in immobilization or alternative treatment might be needed.
Since spiral fractures require good bone stability for non-surgical healing, being cautious with movement and weight-bearing is key.
She was sent home with a splint:
Day 7 - January 23rd - She returned to the ortho for her non weight bearing long leg cast. You can see the impression of the splint in her swollen leg.
This isn't so bad... her leg feels more secure and stable.
She can even go to work at the chiropractor and be productive
But... at the end of her first day in a cast, our patient was struggling.
Reality is setting in.
A broken bone is the ultimate equalizer. It can bring down the most active, mobile and athletic. You can be the healthiest and still be stopped in your tracks. This is our patient kicking ass in a group fitness class before her injury.
Day 16 - February 1 - Our patient had other ideas - she was off to the beach for a vacation within a week of being placed in a full leg cast.
First come all the bathroom selfies. Love the confidence!
And the poolside selfies
And finally some pics of her getting all that attention and making friends
Day 22 - On February 7th - 3 weeks after breaking her leg, after 15 days in her first long leg cast, including 6 on the beach, the swelling had subsided and her cast was very loose.
She went into the ortho to have her cast changed, hoping that she could be moved to a short leg cast...
Here's what Dr. ChatGPT had to say about her X-ray:
Looking at this follow-up X-ray at 3 weeks, the spiral fracture of the tibia remains visible. There does not appear to have been significant progress in healing and it likely means that callus formation (new bone growth) is minimal, and the fracture is not yet stable enough for transition to a boot. The bone alignment still appears intact and stable, which is a good sign.
At this stage it is recommended to keep the patient in a
long leg cast for further immobilization.
Possible Reasons for Slow Healing:
- Tibia’s Natural Healing Tendency – The tibia has a relatively poor blood supply, especially in the lower third, making fractures in this area slower to heal.
- Fracture Type – Spiral fractures, while often stable, require good bone-to-bone contact to heal properly.
- Limited Weight-Bearing Stimulus – While non-weight-bearing is necessary early on, some fractures need mild mechanical stress to encourage healing.
- Individual Factors – Age, smoking, diabetes, poor nutrition, or low vitamin D/calcium levels can slow bone healing.
Next Steps:
- Re-evaluation in another 3-4 weeks with a new X-ray to check for bone bridging.
- Strict non-weight bearing to avoid any displacement.
What to Expect:
- If improvement is seen at the next visit, they may transition to a short leg cast or partial weight-bearing cast.
- If there is still minimal progress, further imaging (e.g., CT scan) might be needed to assess healing and rule out delayed union.
- In rare cases,
if healing remains stagnant after 3+ months, surgical intervention
(e.g., internal fixation or bone grafting) could be considered.
The Dr. seemed to agree - I would have loved to be a fly on the wall to hear him say "another full leg!".
Out with the old long leg cast...
In with the new long leg cast!
Day 43 - February 28th - 5 weeks after being placed in her first long leg cast and 6 weeks after breaking her leg, our patient went in for her follow up appointment.
Here's what Dr. ChatGPT had to say about her X-ray:
From the X-rays you provided, here are a few observations:
Fracture Alignment –
The fracture still appears to be well-aligned without significant
displacement, which is likely why doctors will continue with conservative management instead of surgery.
Minimal Callus Formation –
At six weeks, you would typically expect some visible callus formation
(new bone growth bridging the fracture). In these images, the healing
process appears slow, with only minimal signs of bridging at the
fracture site.
Cortical Edges – The
fracture lines are still fairly distinct, meaning the bone hasn’t fully
started remodeling yet. Some blurring or increased density at the
fracture site would indicate more progress in healing.
PTB Cast and Weight-Bearing –
Next treatment action should be a transition to a Patellar Tendon Bearing (PTB) cast with controlled
weight-bearing to stimulate healing
through mechanical loading, which can help bone formation in some cases.
And that is exactly what the ortho recommended for our patient. A PTB cast, which limits weight-bearing to just 33% of her body weight.
What's next for our patient? According to Dr. ChatGPT:
Estimated Timeline for Casting:
- PTB Cast Phase (Partial Weight-Bearing) – Typically, a PTB cast is used for 4–6 weeks, with gradual increases in weight-bearing. The goal is to stimulate bone healing while maintaining stability.
- Transition to a Short Leg Cast or Walking Boot – If healing progresses well, the patient may switch to a short leg cast or a CAM (controlled ankle motion) boot for another 4–6 weeks, increasing weight-bearing as tolerated.
- Full Weight-Bearing & Rehabilitation – Once sufficient healing is confirmed, the patient may begin weight-bearing without a cast, transitioning to physical therapy to restore strength and mobility.
Total Casting Duration:
- Best-case scenario: 10–12 weeks total (if healing picks up in the next few weeks).
- Delayed healing (as seen so far): Could extend to 16 weeks or more before full weight-bearing is allowed.
Since the healing has been slow, the doctor will likely continue monitoring progress with X-rays every 2–4 weeks before making further decisions.
Given the slow healing observed at the 6-week mark,
the patient will likely need an extended recovery period (6-9 months) before
returning to high-impact activities like skiing, CrossFit, and running.
