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View Full Version : Where a leg might break & pain - A question for medical or unfortunate experiential expertise



Perks
03-05-2016, 12:02 AM
I'm curious for opinion here. If someone coming down a ladder bungled it and fell, feet first the way he was pointed, the last eight feet or so, is there any part of the leg that would be most likely to break?

I mean, it doesn't seem likely that a femur would give out with an impact like that, but is tib/fib more likely than, say, ankle or heel, or is it all too speculative and it doesn't really matter where I break this poor guy's leg?

Also, I'd welcome any description of broken leg pain. I have been terribly fortunate not to have broken any bones, so any eloquence you guys have on the wretchedness of broken legs, I'd be happy (er, sad?) to hear the story of your pain.

Silva
03-05-2016, 12:51 AM
From eight feet, I wouldn't expect that the leg would break unless it got tangled in the rungs on the way down or the person was rather fragile (old bones, previous breaks, low bone density, and such). Falling feet first, though, it'd be likely that the ankle might roll and/or sprain, especially if the person isn't trained in falling (like, say, a gymnast, or someone who grew up riding horses, might be).

Cred: lots of jumping off of six foot bunkbeds as a child, only one mild sprain, but children's bones tend to be more "green"/flexible

Perks
03-05-2016, 01:06 AM
Hmmm. Okay. Have any feeling about how high the shortest leg-breaker of a drop would be? :)

Silva
03-05-2016, 01:21 AM
Haha. Beyond 12 feet I'd stop worrying about sprains and worry more about breaks, but I lack the necessary expertise as I have yet to jump off my roof. :tongue I hope someone who works in an ER or something can chime in on that.

Edit: (Also, I'm sure there are people who have broken limbs falling from lesser heights, but there are a lot of factors to take in to account.)

Perks
03-05-2016, 01:27 AM
Edit: (Also, I'm sure there are people who have broken limbs falling from lesser heights, but there are a lot of factors to take in to account.)Sure. Thanks for the input, though!

mirandashell
03-05-2016, 02:07 AM
People quite often break a heel falling like that. Not sure about the height though.

MDSchafer
03-05-2016, 05:19 AM
It can be most any part, and it depends on the force, the strength of the material and whatnot. Save any doctor coming by with a more technical answer, I'd say, if they land on their heels, typically the Calcaneus breaks, it's the large bone in the back of your heel. Honestly though, injuries are such a variable thing there's no "One" answer, like you said, there's a lot of variables.

Beachgirl
03-06-2016, 05:14 AM
I'm curious for opinion here. If someone coming down a ladder bungled it and fell, feet first the way he was pointed, the last eight feet or so, is there any part of the leg that would be most likely to break?

I mean, it doesn't seem likely that a femur would give out with an impact like that, but is tib/fib more likely than, say, ankle or heel, or is it all too speculative and it doesn't really matter where I break this poor guy's leg?

Also, I'd welcome any description of broken leg pain. I have been terribly fortunate not to have broken any bones, so any eloquence you guys have on the wretchedness of broken legs, I'd be happy (er, sad?) to hear the story of your pain.

I'm sorry to say that I had this exact experience last July. I was painting a wall in our new home and somehow forgot I was at the top of the ladder, rather than the bottom. I literally just stepped right off, thinking I was on the bottom step. My husband still shakes his head over that, but anyway...I came down hard on tile floor with my left foot and broke the very bottom tip of my tibia, which is called the medial malleolus (the inside ankle area). Sharp, blinding pain shot up my leg, followed by me crumpling to the floor and screaming, during which there may or may not have been less-than-adult-like crying and possibly some cursing.

I ended up in an orthopedic boot for several months. That was a real pleasant experience, especially during August. Did I mention I live in South Florida? The heat and humidity, combined with a heavy black boot made of materials that seemed to hold the heat in, made me a little... um... let's just go with grouchy. Then there's the whole problem with walking around with only one shoe, which is invariably a different sole thickness than the boot. I swear I thought I was going to need physical therapy for the hip pain that caused.

I've been out of the boot for a few months now, but I still have frequent pain from the bone break. I've been told I might always have some pain, since bones don't heal as well as they do in younger people (I'm 49). It throbs and I have sharp pain when I put weight on it whenever we have a cold front come in (which for us means dropping from 80F down to 55F, but still...).

Perks
03-06-2016, 07:24 PM
Oh lordy. That's horrible. I'm sorry that happened to you, bg.

nikkidj
03-06-2016, 08:23 PM
I'm going to be a voice of dissent. An 8-foot fall is likely to cause a fracture, at least of the fibula. A person falling that far would be lucky to get away with a sprain. That's why I hate ladders. I refuse to let my husband clean gutters, hang Christmas lights, etc. I've seen people die from a fall off a 1-story home.

It's definitely possible to break the tib/fib from 8 feet-- I've treated that multiple times. I had a young, otherwise healthy person step off a 4-foot porch and end up with a fracture dislocation bad enough that I had to reduce it immediately to restore circulation. Without anesthesia. It was yank on the foot or lose it. I chose to yank. The patient did thank me later.

A calcaneus fracture is also common, especially when someone steps off of a roof or ladder at a significant height. If someone is really unlucky, they can break both calcanei and one or more vertebrae (the force of the impact gets transmitted up the axial skeleton, causing fractures of the spine, especially the lumbar area). That's why when someone comes in with a calcaneus fracture, we almost always x-ray the spine. The pain in the heel distracts from the pain in the spine, and the spine doesn't hurt as much unless someone pushes on the break.

Where I used to work, a fall from greater than the height of the individual required calling a trauma alert, just because injury was so likely. An 8-foot fall definitely qualifies. With a trauma alert, the patient is going to be roomed immediately and seen by a physician upon arrival. A FAST ultrasound of the abdomen is likely going to be completed. And multiple x-rays, especially of the spine, are going to be obtained.

HTH!

edited to change details to avoid a visit by the HIPPA police

WeaselFire
03-06-2016, 08:32 PM
Keep in mind that there are a lot of variables as well. Landing straight down versus hitting and twisting, bending, etc. Land in a small hole that traps the foot and you can get a different fracture from that of landing on concrete or brick.

Write what you need for the story and it can be believable.

Jeff

Deb Kinnard
03-06-2016, 09:18 PM
I see lots of charts (my day job is medical coding) of patients with bimalleolar fractures after falls. When you sustain a bimalleolar fracture, you basically break both lower ends of the tibia and fibula, those being the heavier and less-heavy bones of the lower leg, down where you feel your "ankle" is. Those round nubs you can feel on either side of the unbroken ankle joint are the malleoli (plural). They feel quite sturdy, but they do break. If it works for your character, this would be an easy-to-believe fracture sustained in coming off a ladder.

As I've done here before, I recommend the superb BODY TRAUMA by David Page, MD. Written by a doc/writer for writers, it gives loads of good information on how to "maim 'em right." ISBN 0-89879-741-1

talktidy
03-07-2016, 12:41 AM
Broken heels? The Welsh rugby coach did a sterling job on himself a little while ago. http://www.theguardian.com/sport/2012/apr/11/wales-warren-gatland-breaks-legs

Orianna2000
03-12-2016, 07:01 PM
My father-in-law fell off a ladder a couple years ago. As I recall, he stepped off, thinking he was on the bottom rung, but he wasn't. He broke his heel--pretty badly, too. It required surgery, and he was in a cast for a long time. I believe it still bothers him. (He's in his late 60s.) My husband actually flew out there to visit, since it was such a serious injury, what with needing surgery and all. I don't know any more specifics, unfortunately, but I thought it might help to know that you can break something falling off a short ladder, and in this case, it wasn't his leg, but his heel.

As for me, I broke my tailbone once. Slipped on the stairs and sat down very hard. Only fell about three feet, but I must've landed straight on my tailbone, because it bent into an L-shape and healed that way, so I still (twenty-odd years later) have trouble with it. They told me if I ever wanted to have a baby, my tailbone would have to be re-broken in the delivery room or else the baby would likely get stuck coming out. Yeah, there's a reason I don't have kids. . . . Well, several reasons, but that's one of them! Anyway, it HURT. A sharp ache that radiated out from the tailbone. I think they gave me Vicodin for it, but I don't recall whether it helped or not. I had to sit on an inflatable doughnut pillow for a couple months, and then afterwards, I used the pillow whenever I had to sit for long periods, like while traveling, or at church. I don't use the pillow anymore, but I do get uncomfortable when sitting on a hard chair, or if I have to sit for several hours.

Not sure if that helps you or not, but it's the only broken bone I've had.