Any doctors in the house? Opinion about a crooked leg

[holliscx]

March 2017 I had an MRI that discovered a bone tumor (giant cell tumor) in my knee.

After initially saying no sports due to possibility of a fracture, my doctor permitted me to cycle up until surgery 6-9 months away but 2 weeks later I crashed and broke my leg with a direct impact to my knee.

I felt the bone break when the paramedics lifted me off the ground to put me on a bed in the ambulance. So I cradled my leg in the position I fell.

The ER doc in a small town about 30 mins outside of Barcelona was a brute.

I received no pain killer or medication or anything so was nervous with a lot of bodies around my bed in the ER plus throw in that this was happening in my second language, Spanish, while my buddy was shouting to stay strong in English.

The ER doc touched my leg and I started screaming because it wasn't stable. He stormed out of the room and said he wasn't returning until I calmed down.

About 3 minutes later he returned and told me bedside for the first time that he needed to put my leg straight. I gave no resistance and he yanked my knee straight in one swift motion.

Immediately they put a cast on my leg; I was transferred by ambulance to my hospital in Barcelona.

In Barcelona there were 2 incidents moving me that caused trauma because my leg wasn't stable so they cut off the original cast (because they thought my kneecap might have been trapped due to inflammation) and replaced it with a second full leg cast this time covering my ankle as well.

When they put the second cast on I thought it had an odd curvature so I called the nurse out to the hallway and she looked and said it was fine. The whole time I was in my cast I always thought it was quite curved especially the lower portion of the leg. I was with a full leg plaster cast from April 29 to first week of June.

Fast forward and I've been doing PT for about 9 months. I will have surgery next month.

I'm writing because my leg was straight before the accident but now it isn't.

I went to the ER once out of precaution for some pain I had and the doctor who reviewed my x-ray noticed in person examining me on the trauma bed that my leg wasn't straight.

So I asked my doctor about it and he said it was off a couple degrees but he wasn't too worried about it. I could tell his focus is on the next step which is surgery to remove the tumor. My doctor who was bedside after the break is also my surgeon.

I can't get the first ER doc out of my head. He was a real dick. Even my buddy who was with me when I crashed said he backs me fully that this guy was a jerk. So I'm just wondering is it possible that he could have set my leg badly and that's why it's not straight? He didn't do me any favors that's for sure so if someone could have mucked me up he's the logical candidate.

Or the second full leg cast was set badly and/or a combination I don't know. The only thing I know for certain is that my leg was straight before the accident and now it isn't.

When I'm at physio I look in the mirror and my bad leg is bowed terribly. I walk like a gimp and still use one crutch but I can't shake a severe limp nor put my full weight down and the crash was April 26, 2017.

I would appreciate any opinions about what might have caused my leg to go off straight.

I started at 25 degrees ROM in my knee. I'm only at 90 but I'm optimistic simply because my knee doesn't feel strong or normal yet at all so figure that's promising considering.

Thanks for reading. Not a fan of doctor of internet but curious because not knowing is the hardest part.

[Paul Jacobs]

I am a UK based Consultant Surgeon. I am an eye surgeon so I do not want to discuss the specifics of your case which is outside my field. In the UK in the National Health Service (NHS) there is a Patient Advice and Liaison Service (PALS) which is available to all patients. What is PALS? - Health questions - NHS Choices

They act as independent advocates for the patient and can help facilitate a discussion between a patient and doctors or other health care professionals whenever a patient has concerns about the quality of care. This can be helpful for all parties and may help resolve any issues without the need for litigation but also does not prevent litigation where that is justified and appropriate.

My impression is that, at this stage, a full explanation of what happened during your care would be helpful to you. I do not know whether there is an equivalent patient support system where you are but it would be worth enquiring.

[MarkC]

Were it me I 'd be looking for a top notch orthopedic physician and proper consultation in person.

Depending on all factors after careful consideration, there are methods available to correct these types of issues. Not trivial but quite remarkable what can be done with current tools.

[holliscx]

Thanks Paul. Although I'm American I'm not the suing type. I'm not thinking lawsuit but just want to have an inkling why my leg isn't straight.

I guess doctors and lawyers are always so careful to point liability somewhere I simply, innocently wish to know why which is why I tried to spell out all of the facts for some context even though it's a doctor's best guess.

[holliscx]

Were it me I 'd be looking for a top notch orthopedic physician and proper consultation in person.

Depending on all factors after careful consideration, there are methods available to correct these types of issues. Not trivial but quite remarkable what can be done with current tools.

I guess that would come after surgery. I'm just antsy to know and don't want to pester my doc about it even though I'm wearing shorts to our appt next week for I want him to touch the outside of both of my legs for you can feel the difference or I think so anyway.

But his priority is the next step which is to remove the tumor and the operation is a fair bit of work. I asked him once and he said he isn't worried so I feel like asking a second time is potentially bothering him, but I'll probably ask again.

[MarkC]

You should definitely ask. You won't be troubling or pestering or bothering anyone.

Would expect your doc to be 99% focused on the tumor as that is the immediate problem. But point out the other issues and ask what can be done down the road.

Sounds like you are in good frame of mind to be thinking about successful treatment of the acute problem then quality of life after.

Hope it goes well for you.

[bironi]

I too would recommend voicing your concern again. The doctor should respect your concern. It is your body. Good luck.

[Britishbane]

Hollis, this whole experience sucks and on the whole your attitude is commendable. I'm with Mark, you should definitely ask. My limited experience has shown me that those who are vocal self advocates when navigating the (US) medical system have the best outcomes. If your surgeon dismisses your concerns in favor of concentrating on the tumor I'd definitely get another consultation, preferably from someone with some experience working with people interested in remaining active.

As to the bend: could it not be a result of muscle atrophy? I have to assume that after the better part of a year of disuse the leg will look different simply due to the loss of muscle mass. Any chance of posting a picture?

P.S. Not a medical doctor.

[holliscx]

As to the bend: could it not be a result of muscle atrophy? I have to assume that after the better part of a year of disuse the leg will look different simply due to the loss of muscle mass. Any chance of posting a picture?

I definitely still have muscle atrophy. That's what I thought initially like it would fill in and pop back in place but earlier this week on Thursday I felt with my hand both my bad and good leg and they felt structurally different so I want my doctor to touch the bone too to see what he thinks.

Hold on let me take a pic ...

IMG-6349.jpg

Bad leg is my right so left looking at the pic.

Everything on the outside where you see that bulge feels night and day.

The tumor is on the inside; I'm not sure exactly where the fracture was but it's the inside where the bone was compromised / most fragile.

Here's an older pic of my leg. This was taken in September but it's much harder to tell a difference here because of the angle I'm standing. Plus around my sock line my blood was almost clotty and my sock would eat into my leg it was weird but I think it was just poor circulation until I started walking better and used my leg more. But that's why my leg in the pic below looks so puffy and swollen.

[dennis]

Agree completely with the others regarding communicating with your doc.

The angle of your leg is made up of multiple variables including possible changes the tumor may be having as well changes when the leg fractured and was reset. The setting may not have been optimal, but the focus now is to optimize the outcome.

I would bet you are more aware of visual differences between the right and left leg than anyone else.

Make sure your doc understands your level of concern about the function as well the appearance of the knee. How it was set will be less important to him than what he will need to do moving forward to optimize function.
I rewrote this about 83 times, still not sure I answered the question.

[dennis]

Another thing to consider. Where the bones healed you may have some scar formation that you can feel. Think of a steel pipe breaking and being welded back together except you can't grind down any extra material like the wizards in the forums here can.

[rabo]

Not a doc, but a weight bearing X-ray (bilateral) would give much info.
That is a varus angle on the right.
The beach picture has you weight shifting to the left and is not helpfull , although it almost looks as if the varus angle is present there too.
Long term it can lead to medial compartment cartilage wear in the knee.
It sounds you got to get your other issue straightened out first (no pun).

[j44ke]

You are still pre-op on the tumor right? Has the doctor told you what to expect from the surgery? If he is going to remove the tumor from the bone, then what is going to fill in the space left by the removal of the tumor? And how are they going to manage your leg post-op in order for it to heal?

I am going to guess that the surgery will be a lot like breaking your leg again. And that there might be bone reconstruction that will require hardware to hold the leg at proper length as it heals. And that may be why the surgeon isn't focused on what your leg looked like now, because it may be different after the tumor surgery. Your leg may never be the same, but it will hopefully be just as usable as it was before all of this happened.

Obviously I am a poet (see below) and not a doctor, but I saw my dad's leg through its recovery. In his lower leg, he broke one bone in two places and another in one place and cracked an ankle bone. The surgeon did a great job, but it is not the same shape as it was before. He still has a little limp, but he's mostly healed.

If you've ever seen the champion skier Hermann Maier's leg, it is markedly different after his motorcycle accident. At the time, he talked about having to relearn how to use this "new" leg, because it didn't work the same way as the "old" leg.

My wife developed a bad disc while we lived in Prague. The doctor there did not have a terrific bedside manner - basically do as I say - and my wife reached a point where she didn't know what to do. So we made some phone calls, found a top notch doctor in the US, and flew to the US for a consult. The doctor was terrific, and at the end of the session, my wife had a much better understanding of her situation and actually had more confidence in the Czech doctor's prognosis. The big difference was the medical culture in the US which is much more patient centered and responsive to patient questions.

Doesn't mean Spanish medicine is bad, but if you aren't getting the information you need, get a second opinion, perhaps from outside your particular medical culture.

[rabo]

Like they sometimes say:" what do you want?: " "A good surgeon with terrible bedside manners, or the opposite?"

[SeanEasley]

I definitely still have muscle atrophy. That's what I thought initially like it would fill in and pop back in place but earlier this week on Thursday I felt with my hand both my bad and good leg and they felt structurally different so I want my doctor to touch the bone too to see what he thinks.

Hold on let me take a pic ...

IMG-6349.jpg

Bad leg is my right so left looking at the pic.

Everything on the outside where you see that bulge feels night and day.

The tumor is on the inside; I'm not sure exactly where the fracture was but it's the inside where the bone was compromised / most fragile.

Here's an older pic of my leg. This was taken in September but it's much harder to tell a difference here because of the angle I'm standing. Plus around my sock line my blood was almost clotty and my sock would eat into my leg it was weird but I think it was just poor circulation until I started walking better and used my leg more. But that's why my leg in the pic below looks so puffy and swollen.

Your right leg looks like it already had developed a varus deformity (bow-legged) prior to the fracture. Can be congenital, or a result of a tumor growing in the structure of the bone somewhere and changing it slightly over time. I'm no surgeon, but I'm a physio of 20+ years. I have observed a lot of bodies with a lot of different ailments and pre/post surgical appearances. And yes, often alignment is changed anywhere from a couple degrees up to several after a surgery or fracture and the resulting healing. Can be considered within the 'normal range' after its all healed up. The surgeon has to ask themselves if there is potential to do more harm than good in addressing a cosmetic or even slight functional loss. I would suspect in the case of addressing a giant cell tumor that may be compromising or about to compromise a major joint (your knee) that preserving that joint's function is more important than a minor cosmetic concern. Apologies if you've probably already heard all this...

[holliscx]

Another thing to consider. Where the bones healed you may have some scar formation that you can feel. Think of a steel pipe breaking and being welded back together except you can't grind down any extra material like the wizards in the forums here can.

My physio thinks I have scar tissue which is preventing him from working through my limited ROM. He says I've plateaued at 90 degrees and he can't work through it. He believes the surgeon, who is my doctor, will scrape away any scar tissue and that I will gain flexibility quickly following a successful surgery. Nice analogy btw.

Not a doc, but a weight bearing X-ray (bilateral) would give much info.
That is a varus angle on the right.
The beach picture has you weight shifting to the left and is not helpfull , although it almost looks as if the varus angle is present there too.
Long term it can lead to medial compartment cartilage wear in the knee.
It sounds you got to get your other issue straightened out first (no pun).

You're correct. At this point I couldn't put a ton of weight on my bad leg. My crutches are just out of frame and I was putting most of my weight on my good (left) leg. I thought the pic might be helpful for it does show the leg; you never know what someone might or might not see.

You are still pre-op on the tumor right? Has the doctor told you what to expect from the surgery? If he is going to remove the tumor from the bone, then what is going to fill in the space left by the removal of the tumor? And how are they going to manage your leg post-op in order for it to heal?

I am going to guess that the surgery will be a lot like breaking your leg again. And that there might be bone reconstruction that will require hardware to hold the leg at proper length as it heals. And that may be why the surgeon isn't focused on what your leg looked like now, because it may be different after the tumor surgery. Your leg may never be the same, but it will hopefully be just as usable as it was before all of this happened.

Obviously I am a poet (see below) and not a doctor, but I saw my dad's leg through its recovery. In his lower leg, he broke one bone in two places and another in one place and cracked an ankle bone. The surgeon did a great job, but it is not the same shape as it was before. He still has a little limp, but he's mostly healed.

If you've ever seen the champion skier Hermann Maier's leg, it is markedly different after his motorcycle accident. At the time, he talked about having to relearn how to use this "new" leg, because it didn't work the same way as the "old" leg.

My wife developed a bad disc while we lived in Prague. The doctor there did not have a terrific bedside manner - basically do as I say - and my wife reached a point where she didn't know what to do. So we made some phone calls, found a top notch doctor in the US, and flew to the US for a consult. The doctor was terrific, and at the end of the session, my wife had a much better understanding of her situation and actually had more confidence in the Czech doctor's prognosis. The big difference was the medical culture in the US which is much more patient centered and responsive to patient questions.

Doesn't mean Spanish medicine is bad, but if you aren't getting the information you need, get a second opinion, perhaps from outside your particular medical culture.

Yes, I'm still pre-op. Tumor treatment was 9 mos followed buy 2 mos rest. This Thursday we're reviewing my most recent MRI from last week and they will tell me a surgery date on this day.

My doctor showed me where he will go into my knee. He said he will remove the tumor, pack the hole with bone from a cadaver, insert metal rods for support, and close me up. I guess there's a curettage component to removing the tumor in which he scrapes it out doing his best to prevent recurrence. He didn't go into specifics there but in his last 110 cases like mine he said they've had 20% recurrence which is promising.

Management post-op is 3 months no weight on bad leg. I'll begin physio immediately. They will check for recurrence every 6 mos (I believe) and after 3 years if the tumor hasn't recurred you're in the clear.

Spanish medicine has been great. My hospital is a reference hospital. I have public healthcare but my care has been outstanding. I truly don't believe I would receive better care in the states which has been a pleasant surprise. I am receiving outstanding care.

The trickiest part for me is my Spanish is intermediate. I'm self-taught and definitely in over my head but if I can march through the hoops to receive the diagnosis that I have a bone tumor and talk to medical professionals in Spanish for years then it's approaching fluent. Technical terms and the like are over my head as many would be in English and when I don't understand I ask questions. I make sure I get the big picture first and miss some details and I'm a lot shyer in Spanish but that's fine. I'm usually doing so as a courtesy to my doctor who has an excellent game plan.

I was really just curious what causes a leg to go off straight and I have some idea now from this thread which has been helpful. I appreciate the replies.

Like they sometimes say:" what do you want?: " "A good surgeon with terrible bedside manners, or the opposite?"

My doctor was bedside after my break. He's been a savior. While my tumor is benign, I've met many cancer patients of his at physio and every one of his patients, including current and former colleagues, have nothing but the highest praise for my doctor. Plus he's in his 50s which is probably a surgeon's wheelhouse.

I can't emphasize enough how excellent the care is that I'm receiving. In fact this whole situation has really opened my eyes to the vital role hospitals play in day-to-day life and I'm so appreciative of everyone who plays a supporting role.

Your right leg looks like it already had developed a varus deformity (bow-legged) prior to the fracture. Can be congenital, or a result of a tumor growing in the structure of the bone somewhere and changing it slightly over time. I'm no surgeon, but I'm a physio of 20+ years. I have observed a lot of bodies with a lot of different ailments and pre/post surgical appearances. And yes, often alignment is changed anywhere from a couple degrees up to several after a surgery or fracture and the resulting healing. Can be considered within the 'normal range' after its all healed up. The surgeon has to ask themselves if there is potential to do more harm than good in addressing a cosmetic or even slight functional loss. I would suspect in the case of addressing a giant cell tumor that may be compromising or about to compromise a major joint (your knee) that preserving that joint's function is more important than a minor cosmetic concern. Apologies if you've probably already heard all this...

The beach pic above is 4-5 months after the break so no pic prior to the fracture. I can dig up something to show my leg was straight previously probably.

The tumor was a non-factor prior which is why I was permitted to continue riding. The only risk was fracture but since cycling was a non-impact activity my doctor reneged on initially telling me I couldn't cycle and the crash was an accident.

Thanks for your comments. No I haven't heard this especially in English it's refreshing to read. Really appreciate it. I have a newfound respect for physios too. I hope you agree, I've concluded that physios are part physical guru part therapist for mine works my head as much as my leg. Especially early on my fear was debilitating but as our relationship has grown stronger so has my leg.

This might sound silly but I broke out in a full sweat whenever my physio touched my leg simply because he was pushing the living daylights out of my knee which is scary. When my doctor ensured me that he wouldn't break anything, I relaxed and let him have total control of my leg. I seriously thought for awhile that he could break something for he was using so much force. Personally I've found females more gentle and delicate which I prefer and all of the males are the same. They grin and get really physical.

But my leg is driving the bus. My physio says it shouldn't be this hard and I don't know so much that he's given up on me as much as he's tired of seeing no improvement. That said I have improved. When I started I could only bend 25 degrees but now I'm at 90 which is the beginning of good and my knee doesn't feel anywhere close to normal which is promising for when it does (hopefully) then I'm sure I will see gains.

One question I've been scared to ask that everyone has hinted at from day one that going into surgery with limited ROM is bad but no one has said how bad. Well I'm definitely going into surgery with 90 degrees ROM. I don't know what that will mean on the other side. 140 is the goal. I hope I get back there one day.

[holliscx]

Apologize for these pictures but I don't have a lot where I'm standing facing a camera as I'm usually on the opposite side of the lens.

But the skinsuit shots below were for a cyclocross skinsuit I designed that went AWOL in production. The design is a wolf's mouth from an illustration of an artist in Brooklyn anyway there were groin issues for the placement was too low and the manufacturer was clueless.

But if you look at my knee I think you can tell pre-accident my right leg is night and day from what it is today.

Interestingly the last photo was right after my cast came off so about 6 weeks after the crash on April 26, 2017 or first week of June I believe.

What's curious to my eyes is obviously I had muscle atrophy after the cast but the outside of my knee in that pic doesn't look as bad as the pic I shared a few posts above which I took Friday.

Sean do you agree? Can you tell? I know this is crude and I don't wish to waste anyone's time but just thought I would share.

I may print these and show them to my doctor on Thursday.

IMG_0573.jpg

IMG_0577.jpg

IMG_7937.jpg

[j44ke]

The trickiest part for me is my Spanish is intermediate. I'm self-taught and definitely in over my head but if I can march through the hoops to receive the diagnosis that I have a bone tumor and talk to medical professionals in Spanish for years then it's approaching fluent. Technical terms and the like are over my head as many would be in English and when I don't understand I ask questions. I make sure I get the big picture first and miss some details and I'm a lot shyer in Spanish but that's fine. I'm usually doing so as a courtesy to my doctor who has an excellent game plan.

With my wife, it was never about the quality of care. Czech doctors and medical care in general, especially for foreigners who pay cash, is excellent. What was missing was exactly what you describe - the detail that comes from understanding all the technical terms and their explanation, plus the ability to ask questions as an integral part of the medical process and not feel as if she was imposing upon the doctor by asking them.

BTW, here is Hermann Maier's leg after his recovery. Pretty amazing what he did with it afterwards on the ski slopes.

[jumphigher]

I'm not a doctor either. Just wanted to add that your leg doesnt look bad from an aesthetic point of view, imo. I agree with the person that said YOU probably notice it more than anyone else, OP.

Good luck to you though, hoping for the best outcome for you.

[fastupslowdown]

so i'm bow legged, been this way as long as i can recall. mom brought me to a doctor during my early teens. doctor asked me if it bothers me, i said no. the doctor turns around to my mom and says any the cure isn't worth it. to this day i can run bike etc

oh and this thread made me recall this...


So this man wants a new suit, and he goes to a tailor. The tailor puts him up on the platform surrounded by all those mirrors, takes his measurements, and says “OK, come beck in a veek, I'll heve de suit ready.”

In a week the man returns to the tailor shop. “Here’s your suit,” says the tailor.

“Well, I’d like to try it on,” says the customer. So he goes in the dressing room, takes his clothes off, and starts putting on the suit. It’s all but impossible to get into the thing! Finally, he has it on, comes out, and gets up on the platform again.

He looks at himself, frowns, and says to the tailor, “This suit is terrible! Look at this! The jacket sleeves are so long they’re flopping! But the shoulders are so narrow I can’t even breathe! The pants legs are baggy! But at the same time, the pants squeeze my hips!” On and on he complains.

“Vait a minute,” says the tailor, interrupting him. “Here’s vut you’ll do. You’ll go like dis…” And the tailor shows him how to hold in his sleeves, hunch up his shoulders, tuck in the baggy pants with one hand, all at the same time, to “make it fit”.

A few minutes later the man emerges from the shop onto the street. He’s hobbling down the sidewalk, trying to walk while still holding his sleeve, hunching his shoulders, tucking the pants, etc, etc.

Two old ladies waiting for a bus across the street notice him as he struggles along.

“Oy!” says one of the ladies, shaking her head in pity. “Look at that poor man!”

“Yes,” says her companion, also shaking her head. “But doesn’t his suit fit nice!” -mike g