Gary Gough is a 39-year-old technology manager in the investment banking sector. He describes his experience of suffering a severe ankle fracture in Japan, which required urgent surgery in order to be able to walk normally again. Gary describes flying back to the UK and finding the best treatment at London Bridge Hospital.
I was in Tokyo when I slipped on the wet surface of a manhole cover. I was wearing shoes with a leather sole, lost my grip and went down very hard. I knew straight away that it was serious and at the Accident and Emergency department, it was confirmed that I had fractured my right ankle.
It was a particularly bad break of the fibula, the bone that runs down from the knee joint and connects with the ankle. I had a spiral fracture, which means the lower part of this bone had been twisted as I fell on it. The doctor in Japan advised me that I would need surgery immediately to pin my bone back into the correct place or I wouldn’t ever be able to walk normally again.
It could not have happened at a worse time. Together with my wife and two young children, we were preparing to leave Japan, where we had lived for three years, and relocate to the UK. My accident happened just five days before our flight; I felt terrible that I wasn’t able to help with the packing and preparations.
I made the decision to wait to have my surgery when I came back to the UK and recover here. We were able to bring forward our flight so I could reach the UK and organize surgery as quickly as possible. But it was quite unnerving, because it meant I would be flying just 48 hours after my accident. My foot was very swollen and I started to panic about what would happen if the swelling increased during the flight. My foot was in a fiberglass cast, so I would not have been able to break it on board the plane, to release the pressure.
I was concerned about getting on the flight so managed to contact an out of hours doctor from a local clinic. I was very fortunate because the doctor I found was the medical adviser for Lufthansa in Japan. He told me it was absolutely essential to split the cast before I got on the flight. So, three hours before the plane took off, he split the cast and I made the flight.
Just prior to leaving Japan I had started to look for a surgeon in the UK. There was one surgeon a family member had seen previously, but he couldn’t offer me an appointment quickly enough. Then, through friends of friends I was given a recommendation to see Martin Klinke at London Bridge Hospital. It was very impressive – I met with Mr Klinke on Monday morning, the day after I arrived, and he operated that same evening.
I had my operation at the end of October 2012. It was my first ever operation, so I did feel a little nervous about it. When I came round, I found there was no nausea or discomfort – the pain was very well controlled. I spent four nights in London Bridge Hospital and was very impressed with everything – the food and the nursing, the organisation; I was very comfortable.
I needed to keep my foot elevated for three weeks and for six weeks, avoid weight bearing of any kind. This of course presented some challenges, but I was fortunate that my mother came to stay for the first week, which was helpful in the practical sense and also for company.
During the early weeks, my advice would be to take the help that is offered to you, because you are very limited in terms of what you can do yourself. You can’t carry anything, so it is useful to have a backpack to hand to move essentials around.
I did the exercises my physiotherapist had given me with great care. It was very helpful and my physiotherapist showed me the safest way of getting up and down stairs on crutches. By Christmas, about eight weeks after surgery, I was able to put a little weight on my right foot. I still kept my crutches with me as back up and stopped using them all together on a gradual basis. At this time, the UK was having a particularly long and snowy winter, so it was challenging getting around while still recovering from surgery.
Early in February, I started to cycle again and was able to do rides of 40 kilometers. I fact, I found my foot felt better as I became more active – the swelling tended to be worse after a day sitting at my desk at work. Cycling was a good activity for me, with less impact on my foot than running which I am hoping to start again soon.
Now, in June, I have pretty much fully recovered – I rarely have any pain and my range of movement is much better. I can run around with my children without any problems, or go for a long bike ride. Martin Klinke was brilliant – I cannot speak too highly of him and I feel very fortunate, given that my injury took place in Japan, that I was able to quickly find the best treatment so soon after arriving back in the UK.
Martin Klinke, consultant orthopaedic surgeon of the London Foot and Ankle Centre at London Bridge Hospital, explains Gary’s injury and the innovative ‘tightrope’ device he used.
Ankle fractures are assessed by a system called Weber classification and Gary had a type C fracture, the most unstable of the three types. This means that as soon as possible after the injury, we need to operate, reduce the fracture to its original (anatomical) position to give the ankle sufficient support again. In Mr Gough’s case, we also had to reposition the fibula in relation to the tibia and allow the ligament between the two bones (syndesmosis) to heal properly as this is crucial for this unstable fracture. If this is not achieved one suffers from chronic pain and early osteoarthritis.
For the fracture we used a special plate and screws but for the stabilisation of the syndesmosis we applied a ‘tightrope’ device. Instead of using a stiff screw this implant has multiple benefits. It does not need to be removed at a later stage and allows for minimal physiological movement of the bones which speeds up recovery.
One of the many strengths of the service we offer, is that we can see patients and if necessary operate very quickly. We also help patients who are returning from overseas, or based abroad for some of their time. We use the most modern surgical techniques and newest implants and have on site physiotherapy and a podiatrist to allow the patient to return to normal life as quickly as possible.
