Ankle Fusion and Leg Lengthening
April 16, 2002. I remember it like it was yesterday.
It was a hot spring afternoon. The smell of fresh cut grass and the mountain air hit my face as I was driving to work. I was 18 years old, a senior at Pine Bush High School getting ready to graduate, had recently been accepted into my top picks for college, and was just asked to the Senior Ball by one of the head football players. I was wearing a cute sundress and feeling like I was on cloud nine. How quickly life can change – in the blink of an eye.
I was on my way to work. Living in the Hudson Valley (NY) region, roads were curvy. I was coming around a turn and lost control of my car and smashed into a tree. All I can remember is my head on the floor of the passenger seat, my body shivering, I was so cold! Blood dripping off my head and I was just screaming, “help, someone please help me!” What was minutes felt like an eternity. I heard someone in the distance tell me everything would be okay. My life was black – shut off – I did not exist until I woke up in the hospital with tubes in my mouth, wires all around me, and this massive metal contraption that in the medical world is known as an Ilizarov apparatus. I had no idea where I was, what had happened, or what was going on. I was told that I was in a car accident, and that my car had caught fire. I was airlifted to Westchester Medical Center, as this was a trauma situation. My mom told me that my right foot had been shattered, and my talus bone had been extruded and was not salvageable; leaving my foot quite literally dangling off my leg. The doctors informed my mom to prepare herself and that the only option we had was to amputate my leg. She begged and pleaded for them to do everything they could to save my leg. Aside from my foot injury, I also sustained a broken nose, lacerations to my spleen and liver, a concussion, and a few bruised ribs. The Chief of Orthopedic Surgery, Dr. David Aspirino was the doctor on call when I arrived. Never having seen anything like this before, and respecting my mother’s wishes of saving my leg, he placed a piece of cement in place where my talus once was, while he came up with a game plan. He reached out to foot and ankle surgeon, Dr. David S. Levine at Hospital for Special Surgery, and asked if he would be willing to take on an experimental procedure. The idea of constructing a talus out of titanium was presented and a miracle was made. A talus was formed from dimensions taken from my left ankle. I was about to undergo one of the first total talus replacements. On December 20, 2012 – I arrived at Hospital for Special Surgery – (I call it my Christmas Miracle) for my procedure.
Fast forward almost 14-years-later and I’m still a patient of Dr. Levine’s, even though I now live in Florida. In October of 2014 I was faced with yet another decision. I was told that the titanium was starting to wear away and weakening the surrounding bones. I had lost all my cartilage and there was no surrounding cushion to support my talus, causing a severe amount of pain, inflammation, and arthritis. I was told this day would ultimately come, that although it was a highly functional outcome, it was also a clinical failure. I held on for 14 years with the hope that there would be some advancements in technology, that there was a cure or solution to this. I was told that ultimately my only two options was amputation or a total ankle fusion with simultaneously limb lengthening. I was put in contact with a patient of Dr. Levine’s who was an amputee. We spoke and she was an inspiration to me! I educated myself and even reached out to the National Coalition for Amputees. I also researched everything and anything I could find on ankle fusions. Unfortunately, there was not much in terms of an ankle fusion with someone who did not have a talus. So there I was, an active 32-year-old woman faced with two decisions. I was certain of the one I chose, and I went back to Dr. Levine and told him I was ready to do this! He explained to me that normal ankle fusions are performed by fusing your tibia to your talus, however, I do not have a talus! In my case, they would need to remove the titanium implant, causing me to lose a significant amount of length in my right leg.
It was then that Dr. Levine referred me to Dr. S. Robert Rozbruch, who is Chief of the Limb Lengthening and Complex Reconstruction Service at Hospital for Special Surgery. The next several months were spent trying to find time to take off from work so that I could undergo surgery. I’m now officially scheduled for surgery on April 15th of this year. Exactly one day shy of the anniversary of my car accident. Emotions are currently at an all-time high. I honestly cannot believe how quickly time has passed since the day I ultimately made my decision to move forward with my fusion. Being a little shy of a week away, I am feeling anxious, nervous, and scared; all the while eager to start the next chapter of my life. I do not do well with the unknown, but I am learning to let go a little and realize that I cannot be in control everything. I have to let go a bit. It helps to know that I am in the best hands at the number one ranked hospital for orthopedics.
If I have learned anything from all of this, it is to always believe in yourself, because there will come a day when others will have no choice but to believe with you!
Follow Gabrielle’s progress through surgery, post-surgery physical therapy, pin care and more, by reading her weekly blog on the HSS website: Gabrielle’s Story