Surgery day and learning about the Arthrex InternalBrace
This article is third in a series that chronicles my experience following Lisfranc injury.
Part 1: Learning about the scary life-altering potential of a Lisfranc fracture
Part 2: Setting goals for Lisfranc recovery gives optimism, determination and purpose
Part 3: Surgery day and learning about the Arthrex InternalBrace
Part 4: Lisfranc recovery is slower and tougher than imagined
Part 5: Relearning to walk and ride a bike after Lisfranc surgery
Part 6: The 215-mile Lisfranc recovery test puts my foot through its paces
Part 7: Looking back a year later. What’s fixed and what isn’t.
Part 8: Did the iWalk crutch speed my recovery?
I woke up scared the morning of my surgery.
What if my surgeon goofed? What if my anesthesiologist gave me too much juice? What if I never walked well again? What if I never skied again?
What if?
The nerves caught me off guard. I’d gone under for three surgeries in my life: removal of my wisdom teeth, removal of a ganglion cyst from my ankle and removal of my tonsils. This time they weren’t taking anything out, just adding to it. And the thing they were adding to was one of only two appendages that support and balance the entire top-heavy human body.
Prepped and ready to go under the knife.
We get so used to seeing people stand, walk, jump and run that it’s easy to take our feet for granted. If you tried to stand an inanimate object shaped like a human up on end you’d probably have a tough time getting it to stay still. If you succeeded you’d still have a heck of a time getting it to withstand a soft breeze or gentle bump from a passing cat. The human body is complex, and everything from our hands to our toes work in tandem to keep us upright. But a significant portion of it has to do with our feet.
Our feet are amazing and complex. Each has 26 bones and 33 joints, of which 20 actively articulate. A foot has more than a hundred muscles, tendons and ligaments. With all those mechanics built to support 200 or more pounds, how could something not go wrong once you’ve broken it, drilled through it or added hardware to it?
In this sense, my nerves the morning of my surgery were justified.
My pre-surgery foot, shaved and ready, with a little bit of flip-flop tan.
It was Tuesday, June 19. I woke, had a final round of one-foot-on-the-floor push-ups--the last, I assumed, for at least a week or two--and my wife came home from work to take me to the hospital, which was less than a mile from our house. We joked on the way there that I could ride my bike to my surgery, but might have some trouble getting home.
We went into the orthopedic surgery center, filled out some paperwork and sat. After a few minutes, I was led to a room where I donned a gown and hair net. Then I was led to a hospital bed where they stuck me with EKG nodes, inserted an IV and shaved my leg. Then my wife came to sit with me while I waited in pre-op.
In our idle chitchat, we both realized we still didn’t know exactly what the surgeon was about to do. The surgeon had explained it well enough that I easily chose her method using a tool called the InternalBrace, a system using a small screw, oblong button and flexible FiberTape that would replace the missing ligament, but she’d said there was a video we could reference.
An x-ray of my foot with the Arthrex Internal Brace in place.
I probably wouldn’t recommend doing so right before surgery, but we looked it up and watched as a surgeon drilled a cadaver’s foot with a scary-long 1.6-millimeter-wide drill bit, pulled a strand of collagen-coated FiberTape through, which required a bit of force, and then hammered a screw into place before tightening it. “Hearing the appropriate squeaking noise, you have confidence you’ve achieved solid fixation,” the surgeon in the video said.
It didn’t turn my stomach, but it was an eye-opening moment in which I understood the pain I’d soon be in.
It bears some further discussion, though. What is this system? How long has it been around. What’s it promise to accomplish.
The InternalBrace is made by a Florida-based company called Arthrex and seems to be at least near the forefront of ligament repair for a range of joints all over the body, but particularly for joints in the foot and ankle. I’m a complete layperson, but it seems to have a few distinct benefits over traditional hardware. First, because it’s basically a strong, pliable string, it does more than a screw to emulate a ligament, allowing a joint to articulate and heal more naturally. Second, it’s a permanent addition to the joint, which means it will always be there to back up a part of your body that has been permanently compromised.
In fact, while Lisfranc fractures appear to have ended the careers of numerous professional athletes, my surgeon later told me that some professional soccer players have returned to to professional play using InternalBrace by Arthrex.
Not long after the anesthesiologist arrived and performed a nerve block on my leg from the knee down, they wheeled me into the operating room. An hour or so later, I woke with my foot in a splint, which looked a lot like a cast but was pliable in order to accommodate swelling. They showed me an x-ray of my foot with the internal brace in it, and not long after, my wife drove me home.
My post-surgery normal: laying on my back and movies. At least for a few days.
There’s not much else to it. The doctor said the surgery went well. I had prescriptions for an array of pain killers, but the nerve block wouldn’t wear off until the middle of the night, or perhaps even the next day. My only job for that day, and for most of the ensuing two weeks, was to lay on my back as much as possible and keep my foot elevated above my heart.
Some of my reasons for concern, like dealing with anesthesia, had passed without incident, but it would be weeks before I'd know about others, and months before I'd have answers to the biggest question of all: how will my repaired foot work?
Disclaimer: I am not a medical or mental health professional. I'm not even current on my CPR or first aid certifications. Do not substitute any information found here for a visit with a knowledgeable doctor, preferably one who specializes in foot and ankle problems.