Sciencemadness Discussion Board

Any doctors here?

Nixie - 15-5-2007 at 22:08

I broke my ankle last month--stable spiral fracture of the distal fibula. After six weeks, during four of which I wore an Aircast, there's pain throughout my ankle and foot area every time I step, and both still get swollen during the day when I'm upright. Today's X-ray showed that the fracture is not aligned, as I've sketched in the image below (exaggerated; the actual misalignment is about 20%). I couldn't tell if it has actually fused, though a couple weeks ago the doctor told me it would have (without an X-ray at that time), and to take the cast off and start putting some weight on the leg and exercising it a bit.

When I saw the doctor after the X-ray (it would take several days for the radiology lab to get them to him), and mentioned that I saw this misalignment, he said it doesn't matter and would over time be fine, but that doesn't sound right to me. If it fully heals that way, it would seem weaker at this point, and the bone sticking out more likely to cause damage of the soft tissue above it if I get hit around that area, especially sine I'm very thin. Wouldn't it be best if they surgically break it again and affix with a pin or something like that it so it's aligned properly? And I'm still concerned about walking around without the cast since the X-ray didn't convince me it had actually fused. Pushing with my finger on the spot of the fracture is definitely painful. I really don't know what to do here... :(


[Edited on 15-5-2007 by Nixie]

solo - 16-5-2007 at 00:21

Most of this type of fractures are pinned(for alignment) and /or screwed to resolve the alignment and reduction. all this to avoid problems with soft tissue , ligament attachment and ROM (range of motion ) problems.......follow the advice in your signature...get a second opinion....meanwhile here is an article with exemplatory problems associated with this type of fractures.........solo

Note: this is not exactly organic chemistry type of inquiry , this should be in the micellaneous forum or try the many orthopaedic medical forums....

Fibula Fractures in Athletes
by Marc S. Fineberg, M.D.
........see page 3

[Edited on 16-5-2007 by solo]

[Edited on 16-5-2007 by solo]

Attachment: update 10-04.pdf (248kB)
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Nixie - 16-5-2007 at 01:06

Sorry, I didn't even know the word 'orhthopaedic', and I'm not a member of any medical forum. The reason I posted here is that it's the forum where I'm a member that gets closest to medicine.

The idea of having metal permanently embedded in my body bothers me... are these pins/screws at least non-magnetic?

[Edited on 16-5-2007 by Nixie]

solo - 16-5-2007 at 01:25

Surgery can be done later to remove the pins and screws but with each trauma to the bone over healing occurs and the pain noted in the area during cold wheather....here is a forum where you can ask .......solo

http://www.topix.net/forum/med/orthopaedic-surgery

Nixie - 16-5-2007 at 02:25

That's just terrible. I'm pretty much freaking out now...I assume my whole summer is gone as well from this. If there's cartilage damage, could be much longer that I have problems (I guess the chances of finding out are low, it's unlikely they'd divert MRI time on something like this, fucking public health care... I guess you get what you pay for).

Is there any way to force alignment externally? It looks like it should move in place if I simply push it in with my finger, but how to provide such a force well. Maybe a real cast as opposed to the soft Aircast could do the trick, assuming the bone's not fused yet (I don't even know what the chances of that are after six weeks, but the Aircast wasn't all that immobilizing, especially with respect to twisting motions). I hate my life

[Edited on 16-5-2007 by Nixie]

froot - 16-5-2007 at 06:46

Fused bones still look broken on x-rays for some time after they are functional. 20% misalignment for that particular bone is not a trainsmash but still, not ideal. Here in Africa I've seen many x-rays of misaligned bones fuse from breaks which occurred years before. The body seems to have a way to protect itself from sharp bone protrusions by depositing a hard mass around the fused break.
I would get more opinions from other doctors.

Nixie - 16-5-2007 at 13:28

I went to urgent care at the same hospital where the radiology lab is. The attending GP looked at it and said the misalignment was too small to bother with screws. So same opinion as my family GP, and no referral to an orthopedist. The fracture is misaligned the 1-2 mm offset that the article solo posted says is the borderline between no worry and need for surgical intervention... though my fracture is a bit higher in the bone, and so angular displacement at the ankle join is thus a bit less. Still, the mention at the article of restricted ankle mobility and potential for post traumatic arthritis scares the shit out of me...
They said I can get my X-rays on computer disk for $60. Maybe if I post them online I can get a comment from an actual orthopedist.

The_Davster - 16-5-2007 at 19:49

Orthopedists arent covered by healthcare here(or at least mine was not), so chances are you will have to pay for an opinion.

Nixie - 16-5-2007 at 20:27

It's why I said I'll post them online, and get a recommendation hopefully for free.

Worst case scenario would be one telling me I'd benefit from the surgery, and then being refused here, saying it's elective... I certainly wouldn't be able to afford something like this at this time.

I assume the bone can be rebroken at any time in the future when I am able to save money to have it aligned perfectly?

[Edited on 16-5-2007 by Nixie]

Maya - 18-5-2007 at 05:50

I wouldn't worry about any permanent pins or screws in the ankles...........both my Mother/ Fatther-in-laws broke their ankles ( coincidence! ) and had permanent pins / screws put in............good as new now; now they just set off aiport detectors whenever they go on a trip

tumadre - 18-5-2007 at 07:52

I would not be too worried about the misalignment.

I twisted and broke my Tibia in three places, and the misalignment was about the same as yours.


I was off my leg for 14 weeks, and walked on an air cast for 6 weeks with one crutch.

Stay off your leg until pushing on the break causes a dull, moderate pain.

DrP - 18-5-2007 at 08:06

Quote:
Originally posted by Nixie
That's just terrible. I'm pretty much freaking out now...I assume my whole summer is gone as well from this. .............I hate my life

[Edited on 16-5-2007 by Nixie]


This is not uncommon with broken bones. I broke my wrist a few years ago and was quite down about it. At the hospital over here it is now common practice for the doctors to get you to fill out a 'suicide assessment form' if you have broken a bone. The form asks questions like 'are you single/married' 'are you unemployed' 'do you suffer from depression' 'do you have any hobbies' 'will the injury stop you from enjoying your hobbies' 'have you ever tried to kill yourself' 'have you ever been to canada:P' ... etc.. This is to assess the risk of you doing yourself in from being so depressed about breaking yourself - apparently it happens alot - breaking a bone can be quite depressing.

Cheer up - you'll be allright in the end. I'm sure you'll get plenty of volenteers to rebreak you leg if you need it in the future! ;) :P :D

Elawr - 18-5-2007 at 20:02

Not to worry, Nixie. Fractures of the distal fibula such as yours generally heal without complication. Even badly aligned breaks do well, because the injury is stabilized by the larger, intact tibia. Also the bone will remodel itself, an amazing process that continues long after the broken ends have fused. Living bone is in constant turnover, with new bone being laid down while other places are actually eaten away by specialized bone cells. In this way, the signs of a misaligned fracture gradually disappear over time. See this especially with clavicles (collarbone) also with fibulae.

So don't worry, from what you say, your injury should heal just fine.

Nixie - 19-5-2007 at 08:48

What about soft tissure recovery? All the joints in my foot hurt, especially the bases of the toes, which hurt at the slightest touch. Everything got bent too much in the accident.

The worst thing right now is I cannot at all bend my foot forward at the least. It's like the ankle is blocked at 90 degrees. I can bend it backwards towards the leg, however, which is the motion during a fall that caused the injury in the first place. If the cartilage or ligaments are busted, that wouldn't show on an X-ray. I cannot walk normally mainly because of this inability to angle my foot forward for a proper strike on the forward step.

[Edited on 19-5-2007 by Nixie]

DrP - 25-6-2007 at 06:02

You only broke your foot about 8 weeks ago? It can take 3 to 6 months sometimes for a break to heal - I not overly suprised you cant bend it yet. I still get nasty aches in my wrist from years ago. Rest it completely for another 6 weeks or so - without poking it arround.

unionised - 25-6-2007 at 09:52

I'm not a doctor, but I do know something about the history of science.
200 years ago you wouldn't have an Xray to tell you it was slightly misaligned. Your bone would still have healed up fine, it might have taken a bit longer than if it were perfectly straight. You will know when it's fixed because it will stop hurting; just the same as a million years ago. In the meantime give thanks for telephone order pizza.

Nixie - 27-7-2007 at 13:34



[Edited on 27-7-2007 by Nixie]

Jdurg - 1-8-2007 at 08:53

Yes, be thankful that you only broke your fibula. :) About 11 years ago I had an odd slip and fall in which I suffered a complete spiral fracture of my lower left tibia about four inches above the ankle/tibia socket. The fibula remained perfectly fine. I was in a cast and on crutches for a good few months, and even when the cast came off and I started putting weight on the leg there was still a dull ache for quite a while. Whenever you break a bone, you do severe damage to the soft tissue in and around the bone area. Bone itself has zero nerve cells in it so the pain you feel is simply from all the surrounding tissue that gets severely screwed up. This tissue takes a while to heal and can cause you discomfort and stiffness for quite a long time.

Now, more then ever, is the best time to make sure that you have all the nutrients and building materials that your body needs. Ingest plenty of protein, vitamins, calcium, etc. to make sure that the raw materials you need to repair the damage are available to you.

While it sounds like you would have liked to have had surgery to repair the break, surgery isn't a walk in the park. When a doctor decides to surgically repair a broken bone, that is only done because the risks associated with the surgery are not as severe as the risks associated with no surgery. In this case, it sounds as if your doctor does not want to risk the severe bodily trauma that surgery entails. Yes, it might sound like a minor surgery, but surgery of any type requires incisions to the skin, damage to soft tissue, anasthesia, and the risk of infection.

Nixie - 1-8-2007 at 09:22

I went hiking on Saturday. Caught the same foot in an exposed root as I fell. Don't know how I didn't brake it again, but it's been painful again since.

tumadre - 1-8-2007 at 12:49

Can you get a photo of the last x-ray?

That sounds like a good sized stress fracture :(

Nixie - 1-8-2007 at 13:42

Hospital only has electronic copy, and it's like $60 to get a copy.