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Personal experience with ankle/clavicle fracture recovery times?
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By Chris D
From the couch
Oct 12, 2010
Sign near the Third Flatiron

A month ago I managed to take a very bad fall while returning from scouting a cross-country route up the west face of San Bernardino Peak just a few miles from my house. Falling about 80 feet down a steep, unconsolidated slope, I managed to sustain lots of bruises and very bad lacerations, two broken ribs, a right clavicle broken into four pieces, a broken right tibia and fibula, dislocated ankle, severe concussion and a subdural hematoma. I don't remember the fall at all. I spent the night in the mountains with SAR volunteers and got my first helicopter ride the next morning. All in all very humbling and somewhat embarrassing. Don't underestimate the hazards in second and third class terrain!

Since then, I've had three surgeries; three weeks ago, an open reduction internal fixation and syndesmodic fixation (screw and plates) of the right ankle, and last week an open reduction internal fixation of the right clavicle and a minor procedure to remove the syndesmodic screw from the right leg. Here's some x-rays from a week before the clavicle surgery.

My recovery so far has been laying around, exercising what's not broken, and weaning myself from the pain meds (done!).

I meet with my orthopedic surgeon tomorrow. One thing I haven't screwed up the courage to do yet is ask about time-lines/prognosis for recovery. I know it's dependent on the individual, diet, activity, adherence to physical therapy regimens, etc. Still, I'd really like to hear some first hand accounts of recovery experiences and time-lines for similar injuries. I'm not so worried about the clavicle, as I expect that to be better well in advance of the ankle. The ankle concerns me. I've read anywhere up to two YEARS for full recovery, and haven't found a thing about outlooks for climbers. Looking at my rack hanging in the corner makes me want to cry. I wonder if I'll ever be able to boulder again? When, if ever, can I risk a fall onto the mended ankle? I'm pretty sure what the surgeon will say...

Please share your experiences!

Thanks.


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By Cpt. E
Oct 12, 2010

i sustained a tib\fib fracture about 4" above the left ankle when i was 25.

it took about 6 months to heal then, and never an issue with any of the erector-set items that were installed.

that being said, i would not want to do it over at age 40.

i remember stretching and bending the crap out of the ankle region until it hurt. alot.


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By Chris D
From the couch
Oct 12, 2010
Sign near the Third Flatiron

Cpt. E wrote:
that being said, i would not want to do it over at age 40. i remember stretching and bending the crap out of the ankle region until it hurt. alot.


Luckily, I'm only 38, so I guess I'm good to go!

I foresee a lot of that sort of pain. after the first surgery, going from a splint to a cast, I saw my swollen foot for the first time in a while and did some half-hearted motions which were, well, very painful. Too bad there's no good way to turn the pain off without narcotics...I mean, I know something's wrong, already, body!

Thanks!


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By JWong
From Los Angeles, California
Oct 12, 2010

I broke my talus bone in my ankle a year ago last week. Three screws and no weight bearing for three months.

After one month of physical therapy, I started climbing again. I was lucky and the bone healed very nicely and the blood flow remained. My physical therapist said my recovery was surprisingly quick given the injury.

As for your concerns about falling, my doctor actually told me that the ankle was now stronger than before. The screws support the bone and the ligaments come back tighter than before, hence the need for all the PT. He said getting rotation and range of motion back was the bigger concern over possibly re-breaking it.

I wore a brace for about a month when starting back into climbing until the ankle felt supportive enough and toproped initially. It was probably three months if not longer before I started feeling comfortable dropping down on it while bouldering.

On a side note, when the weather changes, I can feel my scar tingle like I was Harry Potter. Ankle aches too...


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By Jasmine Kall
Oct 12, 2010
Getting ready to climb!

And my climbing partners wonder why I hike so slow down anything that isn't a flat smooth trail and won't let them be right behind me.... Scary! Hope you heal up well!


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By Chris D
From the couch
Oct 12, 2010
Sign near the Third Flatiron

JWong wrote:
As for your concerns about falling, my doctor actually told me that the ankle was now stronger than before.


I was actually planning to ask my surgeon if I could expect this, as I'd hear it before. I hadn't thought much about long-term sensations like the tingling you mention, but with all the slicing from the surgery I suspect there'll be some of that in store for me.

When I stopped taking the Norco a few days ago, I had the MOST disquieting sensation of a large bug scurrying the length of the incision from my sternum to my shoulder. That was really weird. I still half expect to see a big dead centipede in there tomorrow when the dressings come off.

Thanks!


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By Chris D
From the couch
Oct 12, 2010
Sign near the Third Flatiron

Jasmine Kall wrote:
And my climbing partners wonder why I hike so slow down anything that isn't a flat smooth trail and won't let them be right behind me.... Scary! Hope you heal up well!


Thanks! I hoping to heal well and quickly!

I've had a month to reflect on the accident, and by far the most troublesome thing about it is that I never saw the danger. We were in terrain that was steep and loose enough that I was on my guard the entire time (both for myself and the friend I'd convinced to accompany me), yet I have no recollection of embarking on anything risky that led to the fall. The way my partner described the start of the fall, I had some tremendous bad luck, but still...it's not something I should let happen again, yet I don't know how it happened. Could have ended much worse. Really going to re-evaluate my judgment skills when I return to the rock.


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By Brent Apgar
From Out of the Loop
Oct 14, 2010
Me and Spearhead

C-
Sorry to hear about the accident, sounds like you really beat the crap out of yourself.
Like you mentioned, recovery time lines for people are so very different. I've worked on rehabbing the same shoulder injury in different people and had one person back to climbing close to pre injury intensity in a few months and then had another person take a full year to get back up to speed...

I guess that I'm suggesting to just take it a day at a time and push your body as it will allow. I know this is going to sound stupid but trying to stay psyched and not be frustrated w/ the process is the biggest benefit you can give yourself.

Chris D wrote:
I was actually planning to ask my surgeon if I could expect this, as I'd hear it before.

I wanted to throw this one in here because Jwong is talking about a different injury altogether. Yes, the Tib/Fib Fx site should heal as strong/stronger than what was there pre-injury. But you dislocated your ankle where J. Fx his talus, you're looking at a different set of variables for rehab.
You're going to have to focus on regaining a lot of muscle strength and proprioceptive control (in rehab this is accomplished by doing exercises standing on just the injured foot. the final evolution of this would be something like one legged squats or lunges standing on a BOSU)to create a stable Talo-Crural joint. I'm not sure if the surgeon did any work on the disrupted ligaments during the repair? If so then you'll be more in the boat Jwong is talking about where re-gaining the full ROM is going to be more difficult because of the tightness in the soft tissue following the repair.
Hopefully that wasn't too scattered. If dropping me a message would be helpful just get in touch.
good luck w/ the healing process,
BA


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By JWong
From Los Angeles, California
Oct 14, 2010

Good points Brent. I didn't look at his Xrays before I posted. But I figured his surgeon would advise accordingly. Everyone's recovery is very individualized, so it's always best to follow the Dr.

I did forget to point out that I dislocated my ankle as well. So badly in fact that he couldn't get it back into place without prying the bones wider while he fixed the talus...

Thanks for the clarification.

Jason


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By James Arnold
From Chattanooga
Oct 14, 2010
Chew toyed

Man, that sounds really bad! I had a broken ankle this summer...make sure you get the best PT you can and do your exercises religiously. Cost quite a bit even with copay but having machine tests and an hour of intense work 2x a week for 2 months really paid off for getting back in the game.

I took it one step further and was really investigative about what was going on inside...when he said something like mitochondria I'd go look it up in anatomy/exercise phys books and visualize my ankle getting stronger during those burning "endless" sets of home exercise.

Meanwhile, I did all I could for upper body without stressing ankle...hangboard, etc. It sounds like you are on the right plan--might be limited to grip strength for a while, get started on the gripboard.com, get yourself a few toys like powerballs and start building from there.

When I boulder, it's limited to lowballs and high (as I can go) numbers...still a billion problems to do...the most painful for me is foot jamming, so I try to stay away from the real intense stuff there...good luck!


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By Adam Winters
Administrator
From the Shire
Oct 14, 2010
Red-tail Hawk, Buttermilks

Wow Chris that's a proud x-ray.

Last summer I broke my ankle on a rope swing of all things. 25 feet to a 45-degree slope in 2 feet of water. I broke my tibia in two places, fibula, talus, and severley dislocated my ankle. On top of this I crushed the main ligament that runs between my tib and fib, and damaged lots of soft tissue. My injury is known as a Pilon Fracture in the medical world.

I had three surgeries all in all, and no weight bearing for 4.5 months. Then I used one crutch while I learned how to walk again. Only then was I able to start my 3 months of physical therapy. Coming off the oxycontin was terrible, glad to hear you got thru it ok...

I'm 1 year and 2 months past my break and still not 100%. I'm coming to the realization that I never will be, but 90- 95% isn't holding me back too much.

Note: My surgeon treats the US ski team when they're in Mammoth and he said my break was one of the top 5 worst of his career. That being said I am back to my usual routine, including highball bouldering. You'll be back in action soon, just stay motivated and determined.

Best of luck to you, and you other guys.


before...
before...


after...
after...


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By EMT
Oct 14, 2010
me bouldering in MT

Man I don't know shit about recovery time(everybody is different) ...but I want to say I'm glad you're alive. Few will ever understand what you are going through. Be sure to stand up from your self and get the best dam doctors that you can find no matter what, even if you have to fire one. Get the best people you can find to get you back to 100%. No one's going to care about your recovery as much as you, so who better to find the best people to help you get there?

Sending all the quick healing vibes I can muster your way!


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By Chris D
From the couch
Oct 15, 2010
Sign near the Third Flatiron

brentapgar wrote:
I know this is going to sound stupid but trying to stay psyched and not be frustrated w/ the process is the biggest benefit you can give yourself.


Doesn't sound stupid at all. I totally believe that. I know that I'll get back to 100%, and I know that it is going to be sort of slow, but I'm prepared to do what it takes, and have a high tolerance for pain, so I'm hoping that helps me through the rehab.



brentapgar wrote:
I'm not sure if the surgeon did any work on the disrupted ligaments during the repair?


The only thing the surgeon mentioned about the ligaments was that he had added the syndesmotic screw to hold the tib and fib together for a couple of weeks to aid in their repair. That screw came out last week.

I asked the surgeon a lot of questions the day before yesterday, and his primary concern now is the condition of the cartilage in my ankle. He says that is the real unknown, and will determine not so much short-term health, but future pains and arthritis. I asked him very pointedly about my return to climbing. He says the clavicle will be 100% in two months, the ankle in four! I was very surprised!

Now I have a goal!


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By Chris D
From the couch
Oct 15, 2010
Sign near the Third Flatiron

James Arnold wrote:
...get started on the gripboard.com, get yourself a few toys like powerballs and start building from there. When I boulder, it's limited to lowballs and high (as I can go) numbers...still a billion problems to do...the most painful for me is foot jamming, so I try to stay away from the real intense stuff there...good luck!


Thank you!

I've been doing all I can with rubber rings and putty and light dumbells right now, but still taking it easy, as the surgeon says I'll be able to go full-bore with the arm in three weeks, and with PT be back to 100% in two months.

The ankle's a different story, but not too bad...just gonna be more work.

I actually mentioned bouldering to the surgeon, and made sure he understood what I meant when I talked about leader falls and the potential impact from a bouldering fall. He understood (he's a sports-medicine guy who is the US Figure-skating team doctor, or something like that) and said that in four months I'd be able to withstand any impact on the ankle that I could have pre-accident. What a great surprise!


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By Chris D
From the couch
Oct 15, 2010
Sign near the Third Flatiron

Adam Winters wrote:
Wow Chris that's a proud x-ray.


Holy cow... Nothing compared to that "pre-surgery" picture! Gads!

Here's a picture from the day before yesterday of my newly repaired clavicle.



I have to wonder if putting ten screws in a bone that small might have the long-term effect of making it like a piece of perforated paper! I hope not.

My ankle fracture was nothing as bad as yours. That looks really close to compound. How long did it take for the swelling to reduce enough for them to operate? Then again, I suppose they may not wait if it's that bad!

Your surgeon sounds like mine...it wasn't Dr. Yu, was it?


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By Chris D
From the couch
Oct 15, 2010
Sign near the Third Flatiron

EMT wrote:
Be sure to stand up from your self and get the best dam doctors that you can find no matter what


Thanks a ton!

You're advice is spot-on, and I concur. The helicopter dropped me off at what is the "county hospital" here, i.e. where the people with no money go. I don't mean to disparage them or say that they didn't do right by me, because they did. The emergency doctors were great. I felt that I got exactly the treatment I needed. But when I tried to call to set up my appointment for the first surgery with an unknown doctor, I got bounced from phone to phone for two hours, then finally gave up. I called all the folks I could who I knew had had orthopedic work done, and all of them recommended the surgeon I ended up going with, and I couldn't be happier. The guy is amazing.

I hate to think that I was about to trust the surgical repair of my broken ankle to just anyone. My idea was "hey, they're all surgeons, right?" but in retrospect, they were going to let my clavicle heal on it's own, which my current surgeon says my never have happened, and would have taken three to four months even if it did. Ugh.

EMT wrote:
Few will ever understand what you are going through.


Again, I agree. I'd never have guessed what dealing with this would be like. One outcome of this is a re-assessment of the risks I'm willing to take vs. the reward. I can't wait to get back to climbing. It brings me such happiness, I can't imagine giving it up. But as soon as I'm ambulatory again, the motorcycle goes on Craig's list. I enjoy it, but not nearly enough to go through this (or worse) again.

That said, every time I start to think I can't stand another minute stuck in the house, or after the surgeries when trying to cope with the pain through a haze of dilaudid and morphine, I quickly think "Hey, I didn't die!"

That usually perks me right up. I'd advise anyone in a spot like this to think about that a lot. Always cheers me right up!

And it really isn't that long from sleeping 20 hours a day and barely being aware of your surroundings to being ready to get back to work. For me it took five weeks. Back to the office on Monday, albeit in a wheelchair for another month...


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By Aerili
From Salt Lake City, UT
Oct 15, 2010
Get down from there! <br /> <br />May 2013 <br />Photo by Duc

Chris D wrote:
I have to wonder if putting ten screws in a bone that small might have the long-term effect of making it like a piece of perforated paper! I hope not.


Bone heals back as strong as before the fracture. Unlike soft tissue, there is no such thing as bone scar tissue. It comes back exactly the same (which soft tissue does not do). It will repair around and with the hardware and be like "one operating piece" as far as the musculoskeletal mechanics of your body are concerned.

My brother broke his clavicle years ago in a snowboarding accident and had a plate and screws put in (although it did not break as many times as yours), and he has never had any real problems since in any athletic endeavor (including climbing).


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By Adam Winters
Administrator
From the Shire
Oct 15, 2010
Red-tail Hawk, Buttermilks

Chris D wrote:
My ankle fracture was nothing as bad as yours. That looks really close to compound. How long did it take for the swelling to reduce enough for them to operate? Then again, I suppose they may not wait if it's that bad! Your surgeon sounds like mine...it wasn't Dr. Yu, was it?


I was taken to the hospital in Bishop where they took one look at it and said "all we can do is set/straighten it for you", which they did. I was then transported to Mammoth hospital that same night where they got 8 of 10 screws in before swelling set in and had to stop. I was on a morphine drip for five days, then released. One month later they installed the last two on my inside lower tibia (that sharp inside ankle bone), which was much worse than the first surgery. And 3 months after that they removed the long tib/fib screw.

The only lingering pain is on the inside of my ankle, which had been sheared off completely. I'm hoping with more time it'll subside.

My Doc was Mike Karch in Mammoth, friggin genius. I never had a cast.

Your clavicle is going to be indestructable now!


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By Evan S
From Erie, CO
Oct 15, 2010
Me, of course

I broke my clavicle a few years ago, in half with a number of shards in there. No surgery, no nothing, I was back at in less than 4 months, but damn if it doesn't still hurt.

I broke my ankle (talus, in half) about a year an a half ago. Had surgery, two friggin wood screws in there. I was climbing in my boot at the gym two and a half months later, and outside a couple months after that. I won't lie, it still hurts a lot and is weaker than my other foot. The doc says it can take up to two years for it to fully heal and I believe it. But, all being said and done I still climb multiple times a week, am stronger than I've ever been in some ways, and that's just life.

Try comfrey root salve over your broken bones, it can help reduce healing time. Many people drink it as a tea as well. Good luck.

Don't do this.
Don't do this.


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By no1nprtclr
From Front range Colorado
Oct 16, 2010

Chris,

I had a fall of about 30' on 1 August, 2010. Tib/fib fractures, 8 screws and plate for fibula, tib is totally healed up, looking at the x-ray showed nothing of the tib fracture. X-rays were taken the 13 October, 2010. However, the fibula still has some healing to do. I have a walking soft boot, and the doc, advised me to do some stretching as much as I can tolerate, but recommended to warm up my ankle before stretching. I can bare full weight on the right ankle without any auxiliary support ie.. soft walking boot, but still find myself using the crutches at times.

I just don't want to push it too fast. I'm pretty conservative when it comes to injuries (thankfully, haven't had many; knock on wood, lol), and feel I would rather wait and not have a re-injury, which in the end would put me out for a longer period of time and perhaps cause a more permanent damage situation.

It's still a little stiff and of course doesn't have the range of motion as the left. I know it's not ready to get out to even do 5.6 routes. Here are a few photos of pre-surgery ankle. I hope to be healed enough for the upcoming ice season, but still plan on taking it pretty easy until Totally healed up.

I wish you a speedy recovery!!! Best of luck with healing and recovery!!! Be patient, life will be better again!!

Buddhist quote: "Fall down seven times, get up eight"

Namaste,

Juan

Estes Park Medical Center, about 3.5 hours after fall.
Estes Park Medical Center, about 3.5 hours after fall.


broken fibula
broken fibula


Tibula fracture
Tibula fracture


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By Chris D
From the couch
Oct 16, 2010
Sign near the Third Flatiron

no1nprtclr wrote:
...the fibula still has some healing to do.... Best of luck with healing and recovery!!! Be patient, life will be better again!! Buddhist quote: "Fall down seven times, get up eight" Namaste, Juan


Thanks Juan,

You remind me of a couple of very interesting things I've learned since the accident. Mind you, this is from my readings on the internets, so take it with a grain of salt, but... It's my understanding that not only does the fibula provide very little structural support (it's primary function is to provide muscle attachment points) but it's also not attached to the knee! Rather, it's attached to the tibia just below the knee. Guess that's pretty fundamental stuff, but I didn't know.

Also, I have read that many doctors treat a fib fracture like a clavicle fracture...do nothing surgical, and it'll heal over time. Interesting.

The recovery from the general battering I took left me with nearly no energy at all for the first two weeks after the fall. That's when I discovered Netflix "Watch Instantly" and finally saw "180 Degrees South: Conquerors of the Useless." My favorite quote from Yvon Chouinard in that flick was "The word adventure has just gotten overused. For me, adventure is when everything goes wrong - thatís when the adventure starts"

Somehow I don't think he had tumbling 80 feet down a gully on a big chosspile in mind when he said that, but it sounds good. :)

Hope you hit 100% before you know it!


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By Chris D
From the couch
Mar 26, 2011
Sign near the Third Flatiron

Just an update and some thoughts here, a little over six months after the accident.

I ended up spending three and a half months in a wheelchair. If you haven't done it, well, I guess I wouldn't recommend it. It definitely gives you that cliche appreciation of things you take for granted, but knowing that it was temporary made it bearable. It would be foolish to say that I could imagine what it would be like to be in one of them for good. That would be tough. At the same time, you can do quite a lot in a chair, and after a few months, you get pretty good at rolling around in one. I could have been on crutches were it not for the clavicle. I think I was better off in the chair. It certainly let me return to work just five weeks after the accident, which would have been impossible without the mobility provided by the chair.

If you have to break something, try not to break an extremity! Well, try not to break anything, but my clavicle (which was crushed) healed very quickly after surgery due to the excellent circulation in the chest area. The ankle has taken forever to mend, the bone's healing inhibited by the naturally poorer blood circulation and the constant swelling. What a hassle.

It's amazing how quickly muscles vanish with disuse. My right leg and arm atrophied alarmingly in a short time. The muscles don't come back fast enough for me, and the recovery has to be paced or you risk complications. For me, pushing it a little too hard has resulted in a still-nagging case of peroneal tendonitis, a result of peroneal muscles overworked while compensating for other weakened muscles in my leg.

I'd never have believed the long-term potential for an injury to cause swelling and pain. I started weight-bearing exercises almost three months ago. I can now walk miles on even surfaces, mellow trails, and carefully on uneven ground and steep, rocky trails without a limp. Working my way from the chair, through the walker, onto the cane, and finally without assistance seemed to take an eternity even though it was only a few weeks.

The first couple of weeks after gaining weight-bearing status amounted to what was probably the most painful part of the whole thing, excluding the immediate post-surgery pain. In retrospect, I'm surprised that despite discovering all sorts of new kinds of pains, none of the pain, from the injury, to the surgeries, to the recovery has been unbearable. In a weird way, the pain of a hangnail or bad paper cut is just as unpleasant as the longer-term pain of injury or recovery. Hard to explain. That said, the pain starts to get discouraging when you realize that you're in pain to the point of distraction; where you really can't work, read, or think about much but the pain. A few weeks of that, steady, can be annoying.

I've since spoken to many doctors and surgeons, and the general consensus is that it's at least a year before you're "back to normal" after an ankle fracture. I'd have never guessed. While I get a lot of "hey, you're lookin' back to normal!" comments from folks, I still can't foresee a time when I can run, jump, of fall from a boulder problem without immense pain in the ankle. That, I suppose, will change as the healing continues.

I'm resigned to missing the entire main season at Joshua Tree this year, but have finally gotten back into the climbing literature in anticipation of my return. If anyone has the misfortune to sustain injuries similar to mine, I'd say that the most important thing is to keep a positive attitude! I've never for a moment considered the possibility that I'd realize anything but a 100% recovery. Closely following my physio's instructions has slowly brought me around to something closely resembling what I was before the fall. There will be discouraging moments (like my visit to the surgeon where he told me it'd be an additional six weeks before I could weight the ankle!) but know that you will recover. Six months out, there are actually times that I forget how banged up I was just a short while ago. Usually my ankle quickly reminds me, but realizing that the pain and disability wasn't at the forefront of my thoughts for a moment is solid gold.

I have the good fortune to have a very fickle memory when it comes to the bad times. I forget them quickly. I can't imagine what this would have been like if I were the sort of person who dwells on the down times and bad shakes. I'm super-fortunate; I have full range of motion in my shoulder, and have no reason to believe that my ankle won't make a full recovery too, even though it'll probably be arthritic to some extent. Teaching myself to walk again has given me the opportunity to correct old bad habits, so I may actually end up better than original! Okay, that's a stretch.

Anyway,

See you all at the crags soon!

Chris


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By aed
From Jackson, WY
Feb 1, 2012
aed

Adam Winters wrote:
My injury is known as a Pilon Fracture in the medical world.


Hi Adam,
I found myself a Pilon Fracture a couple of months ago. Not as extensive as yours, but not much fun anyway.
How's the recovery going at this point?

Well I hope.

Thanks!


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By aed
From Jackson, WY
Feb 2, 2012
aed

no1nprtclr wrote:
"Fall down seven times, get up eight" Namaste, Juan


Juan,
I'd be interested to know how your recovery went, or is still going.
Working on a recover myself right now.

Thanks!


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