(Poll) Modified brostrom surgery: orthopedic surgeon or ankle specialist?
November 19, 2008 by mhueter
Filed under Health, Polls, Uncategorized, injuries
Today, I’m posing a question to readers:
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Here’s some background:
Last November, in a championship rec basketball game, I landed on my opponent’s foot and felt a pop.
“Nothing unusual,” I thought, since I had sprained this particular ankle about twelve times in my basketball career. So I laced my sneakers a bit tighter and continued to play – and win 
Turns out, however, that this was not such a simple injury. It was the turning point – at least as far as the stability of the lateral ligaments in my right ankle is concerned.
The next week, I could barely walk.
A few more weeks past, and still – considerable pain. Two different orthopedic surgeon visits and two four-month sessions with physical therapy later, I still feel considerable intermittent pain, particularly after exercise and with long periods of standing or walking.
Finally, I made an appointment to go see Dr. Paul Cooper at Georgetown Foot and Ankle Clinic. He immediately recommended a procedure called “modified brostrom.”
Apparently, when you sprain your ankle enough times, the ligaments loosen and it creates instability, which results in pain. If you look at the pictures in this post (yes, they’re my actual x-rays) you’ll notice that there is some considerable space between my ankle bones. (that’s not supposed to happen)
Modified brostrom surgery essentially tightens everything up and “makes you feel like you have a new ankle,” or so Dr. Cooper says.
He told me it would require a month in a cast and at least another month of physical therapy. But this would be a simple procedure that he could do in about half an hour.
The next day, Dr. Cooper’s surgeon scheduler called. She proceeded to tell me that Dr. Cooper is booked for surgeries until March of 2009.
“Uhh… that’s a little ridiculous,” I replied.
She told me the operating room is jam packed and Dr. Cooper is booked solid. This really sucks for someone who loves to play rec sports in the spring.
So I made an appointment with another well-respected sports medicine orthopedic surgeon, Dr. Weimi Douoguih at Washington Hospital Center. Impressed by Dr. Wouoguih’s contribution to Insider Medicine and his e-mail address present on his business card, I was hopeful that he would be right for me.
I was immediately impressed by his personality and ability to talk to me.
Dr. Douoguih said he thinks I do, in fact, need the surgery. He mentioned that he doesn’t do a lot of this type of surgery, but he’s trained in it and feels comfortable performing it. And – even better – he can work around my schedule.
So here’s what I need help with – do I wait until March for the specialist (Dr. Cooper)? Or, do I get it done sooner with Dr. Douguih? Does anyone have any experience with this?
Appreciate your opinions.
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I’d say see the sports ortho – for two reasons. #1 – he can see you sooner. #2 He is more apt to put you on a plan that will allow you to return to sports quicker.
Yo Meg, what’s up?! Long time no talk, sad to be in contact again for such a bummer situation.
Just a little food for thought from my own experiences with surgery as well as my sister. As you well know I had two ACL reconstructions, both with Dr. Bartolozzi in Philly who is famous for doing ACLs. Both my knees have been fine (better than old, actually!). Now my sister Jamie blew out her knee in a summer soccer league in July before she was supposed to head off to Wake Forest for her freshman year of college. We contacted Bartolozzi and even though he likes the family, there was no way he was going to squeeze her in before she had to leave for school. So my parents took her to see Dr. Deluca, the Flyers doctor, who doesn’t do as many ACLs as Bartolozzi but is a skilled surgeon none the less. She got the surgery about a week before heading off to school, and her knee has been absolutely fine as well.
So I guess the moral of the story is that while a specialist in the surgery might be ideal, another reputable surgeon can give you the same results. Based on what I know of your drive and work ethic, I think you’ll attack rehab with enough gusto that no matter what surgeon you pick you’ll be back in no time. But if you can jump start the process 2 months ahead by picking one guy over the other, I say go for it.
I would definitely go with the specialist because even though the other guy will probably do a fine job you want the best chances of succesful operation without later complications. I know it sucks being unable to do anything (I severed my acl in september and still haven’t yet gotten surgery) but you’ve gotta think long term. But I wish you luck with it, and if you are waiting until march you’ll still be cleared to play before I am (if that makes you feel better).
I’m trying to vote, but I can’t.. I would wait and go with the specialist.
Giving up one season is worth a lifetime of problems. Good luck. 
Check out Health Insurance, employer approval of the dates and how you will be getting help while on the crutches!!! Might want to put this off until later but your call.
Dad,
you figured out how to comment! Yay! I’m going with whatever the group says. Better start voting!!
Meg
Hey cuz… I think that your blog is rad! That is a bummer about your ankle… I would definitely wait for the specialist… Hope all is well. ALOHA
Hey Sobo! Great to see you on here!
Love the advice. Because there really is no sense of urgency for my surgery, I might as well wait for the specialist. Great to hear from you.
I heard you did great in crew at Notre Dame? Excited to hear about it – I’d love for you to blog if you’re interested. We should all catch up sometime soon.
Hi; I don’t know you, I just ran upon your blog as I was searching for Brostrom. I am currently recovering from my second brostrom (both ankles done). Long story short, I have seen both orthos and podiatrists and the podiatrist was the BEST surgeon. He was the only one willing to help my badly damaged ankles. The ortho was aloof and did not even give me PT after my first ankle surgery (1992). Good luck, it is four weeks in a hard cast – its crazy but really worth it. I can already tell a difference in stability (in the ankle done in July)
I would do as much research as possible re surgeons in other areas — i.e., Baltimore (Johns Hopkins — for example) or New York. If a surgeon is booked so far in advance it could also mean he has so many patients and is spreading himself too thin; he may not have enough time to devote to everyone’s case. If, the day you are scheduled for your surgery, there are patients with more serious problems who are having surgery, or if the surgeon considers the surgeries to be more complicated than yours, you may not get his complete attention no matter how skilled the surgeon may be. After all, he is human, not a machine. It seems rather strange that in the metropolitan dc area, there is only one or perhaps two surgeons who have the expertise to do your surgery.
Actually, I know nothing about this website; I just happened here when googling the name Paul Cooper. I would probably suggest going to Dr. Cooper, although you’d probably be OK with the guy at Washington Hospital Center.
Here’s why: Dr. Cooper is so busy. That means he does a lot of surgery. Tons of it. In fact, he’s a surgery machine. When you go to the foot and ankle clinic, sometimes it’s like a busy factory.
I went to see Dr. Cooper rather than have a podiatrist do my surgery because my podiatrist does a couple of surgeries a month; Dr. Cooper probably does many more in a day. I think you’re better off going with the guy who does a certain procedure a lot. Dr. Cooper’s a foot and ankle guy, and he probably does a lot more than the guy at WHC who does not concentrate on foot and ankle. My surgery is not until April, and it’s only January I think he’s worth the wait I was also impressed about his certainty about the type of bunion surgery that he could do on me. Others, a podiatrist and ortho foot guy, waffled and were not sure. I hate to say this–and I hope I’m not wrong since it’s an exaggeration–but Dr. Cooper could probably do some of these in his sleep! I hope I’ve given you good advice, though you’d most likely come out OK with either guy.
I just noticed the date of your post–November. Maybe you’ve already had it done! Oh well.
I just noticed Frankie’s post. Yes, Cooper is busy, but I see that as something of an advantage because he should be so skilled in these procedures. It’s also true his office is very busy and he doesn’t have as much time in appointments as some other docs. Still, I have confidence in him. I won’t know more until after my surgery. There are other foot guys in the D.C. area, and I don’t think this surgery is so unusual that a lot of general orthos and sports medicine guys couldn’t do it well. Still, if it were me, I’d have a foot and ankle guy do it.
There’s a famous foot guy, Myerson at Mercy Hospital in Baltimore. He treats many big athletes. He was the guy who did Terrell Owens before that SuperBowl some time back. See http://footandankle.mdmercy.com/
There are guys at the Hospital for Special Surgery in NY. I think she can get good surgery in D.C.,though. It looks like the one picture is a stress film. They try to see how far the ligaments will permit the foot to tilt. When I had it, after a severe sprain many years ago, it was very painful. I had an acute and severe injury. I had the stress film some time later and it didn’t hurt as much. That group of ligaments on the outside are called the lateral collateral ligaments. The usual sprain is of the anterior talo-fibular ligament, which I believe holds your talus to your fibula. Read up on your own, I’m not a doc. Good luck.
i broke my ankle when i was 6 and was spraining my ankle after it over and over again. my ligaments loosend and when i was 8 i had this modified brostrom. it worked well to start with but eventually i ended up worse than before! so when i was 10 i had the chrisman snook to re-stablise my ankle. again it worked well at first, infact for a good few years. when i was 17 the pain in my ankle stated to get noticably worse so i went back to my gp. he referred me to a different hospital from which i had my operations and they sent me for x-rays, scans, physiotherapy and still couldnt tell me what was wrong. eventually i got referred back to my original consultant who straight away told me my ‘ankle had gone again’. i again got referred as this problem had never occured before. my consultant had to research around the country to find out what he had to do as it is so un common for the second chrisman snook to fail. after 2 years of messing about, here i am age 19 with my leg in plaster again!! they decided to take a tendon from behind my knee an up my thigh and reconstruct my ankle with it. its just a good job im not a sporty person!! even tho i had to give all that up when i was younger due to my ankle problems.
Hi there-i came across your posts, and see at this point they are old, but, if you are still reading i thought i’d add to the advice. I had the brostrom repair, and i did it with Myerson whom i loved from day one. He gave me the time of day, and seemed to know what he was doing (i’d seen several dr’s to decide who i wanted). Both my ankles are shot. I’m a runner, but have been twisting my ankles since i was 8. I had two surgeries on the left, but the right was more severe, and about two years ago started to simply roll out of the socket at inopportune times. Myerson promised me running again would be no problem.
I had the surgery last march. I’ve not run since. Something was not done right, or put back too tight, and now my peronial tendon snaps across my ankle bone. It’s a terrible feeling, and hurts. When i went back to Myerson, his attitude changed. He told me that maybe i had something wrong with the tendon before the surgery, that perhaps it was abnormal before he did anything. He also said, he’s ‘never had this problem with anyone else before.’ He said he’d have to go back in , and instead of going back into the same three inch incision, he would have to cut from the incision, up the side of my calf where the tendon runs, so he can “see the entire thing.”
I’ve not yet done the surgery again, and am at this point unsure what to do, but am too young and active to live with this like this. My point here is, I heard about Myerson, and thought he too was the best. Would the other surgeon i saw have done a better job? I agree there’s something to be said for the experts, but, the experts too make misstakes. Hopefully, the expert you choose at least admits them and wants to fix them. I haven’t found that expert yet….
Good luck with whatever you decide…