Fractured lateral malleolus

[hedgeofthehog]

Hello,
I fractured my left lateral malleolus almost 5 weeks ago. The fracture is at the tip, and the tip is still attached, I jumped over a fence landing on a rock and my ankle twisted and I was told the ligament attached to the tip is so strong that is what causes the fracture. I have had a non-weightbearing cast on since then and am due for a review on the 18th Sept when I hope to get the cast removed. Can you tell me do these types of fractures heal well as I am a big skier and want to be able to ski sometime in December and also what kind of physiotherapy will I need to get back on my feet? Will I be able to walk as soon as the cast comes off or not??
Many thanks,
Nigel

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[alophysio]

hi

It is hard to say based on not being able to see the fracture.

Non-weight bearing (NWB) cast seems REALLY conservative for 5 weeks so it is either bad or you have an old fashioned doc.

When you say "the tip is still attached", that it is only a crack? If it is, some docs don't even bother with a cast let alone a NWB cast!

From the sounds of it, you'll be fine. I think you will take more time to recover from being NWB than from the fracture!!

See how you go - often i don't even bother to give exercises to my patients because usually they are young (softer bones) and they run around like maniacs anyway.

You'll be skiing in December - but that is a complete guess (for legal reasons!! )Good luck!

[hedgeofthehog]

Hi alophysio,
Thanks for your reply.
The fracture is at the distal end of the bone and is fractured all the way thru they told me but is it is not displaced at all. I have no idea why they said NWB. I had booked a sesh with a private physio but if you think thats not needed any advice on what I should do once the cast is taken off? Obviously I'll be a bit ginger on the foot so how would you recommend I proceed putting weight on it, waking etc after next thursday???
Many thanks.
Nige

[alophysio]

Hi Nige,

The session with the physio would be best because they can tell you what to do and how to do it better than any written advice can.

I would be a bit sus if they want you to go 3 times a week for 6 weeks or something. I think for an uncomplicated injury like yours, i would say 1 or 2 is all i spend on them with a phone call in a month's time to make sure all is well (and it usually is).

Good luck and let us know how it goes!

[hedgeofthehog]

Cheers for that!
Had the cast off today and apart from it looking horrible...wasted, dry skin, bruised they reckoned it had healed well and I shouldnt have any problems with it. I can fully weightbear standing on both feet but walking will out of the question for some time I think. The fact of being totally NWB is going to slow me down more than the fracture. So am off to see the physio tomorrow for some exercises etc but was told it could be weeks and weeks before I am back to full normality and even then I may need a stick to help for maybe 6 weeks.

[Canuck Physio]

Cheers for that!
Had the cast off today and apart from it looking horrible...wasted, dry skin, bruised they reckoned it had healed well and I shouldnt have any problems with it. I can fully weightbear standing on both feet but walking will out of the question for some time I think. The fact of being totally NWB is going to slow me down more than the fracture. So am off to see the physio tomorrow for some exercises etc but was told it could be weeks and weeks before I am back to full normality and even then I may need a stick to help for maybe 6 weeks.

Hmmm... wasted (maximal muscle wasting occurs within 2 weeks of immobilization, this is not simply strength loss, this is muscular atrophy, loss of muscle protein, and is unrecoverable even with rehabilitation for a short period $ A long term strengthening and muscle hypertrophy program will be needed for this... BUT)

Considering you can not walk, you need to assess your ankle, knee mobility and stability. If you can not stand on one leg, big problem, I would highly recommend you progress the stability of that ankle else what will happen is limited mobilty, increased chance of reinjury (sprain - not necessarily fracture), and so much more. Why? Because almost always in cases like this people think no pain = full function. Far from the Truth, the deficits in my experience can remain for up to 6 months without appropriate rehabilitation.

Stick to the Physio programme, but also make sure that you cover the basis: joint mobility, strengthening, proprioceptive and balance work! gait retraining - GOOD LUCK

[pistol]

My brother recently fractured his lateral malleolus as well. The ortho is saying that it is a spiral fracture as well as a facture at the distal end. He has been in a WB cast since he got it on. He is also using an EBI bone stimulator 10 hours/day. After 2 weeks the fracture at the distal shows complete union but the spiral shows some calcification but not much. He is wanting to come back and play football with in the next week. He has an appointment on Tuesday to get the cast off. What is your opinion on the healing time and playing of football? Also what is your opinion on use of bone stimulator and their effect on fracture healing time?

[alophysio]

forget playing football on the fracture for 6-8 weeks after injury.

Bone stim? not sure about how it works but i doubt it would improve the fracture to the point of being able to play contact sports in half the time.

Professional athletes dont' come back from leg fractures that quickly...

[ryankurosaki]

Hello,
Just recently, I broke my left foot, the doctor's diagnosis indicates that I have a mallelous lateral fracture and they are suspicious that I have an OS talus fracture and an OS navicular, Please tell me what that means.

And also the doctor said that I will be able to walk again in 3 weeks, is there any possibility that I can walk before the 3 weeks?

thank you

[Josephine]

Quite often they will cast a small fracture in a foot for pain relief as much as for healing. I had a small avulsion fracture off my 5th metatarsal a few years back. Walked - or should I say hobbled - on it for about 6 weeks before I finally sort advice from one of the surgeons at work. He had a cast put on it Friday afternoon but the plaster tech botched it and I had a crease on the inside which was mega painful! That baby was off by Saturday noon and didn't go back on! It healed just fine.

As for the OS talar and navicular - OS is just a term for bone. It's not uncommon for doctors to prefix the names of small bones of the foot with it. As in Os Calcis or calcaneum, the heel bone.

Also, I would have thought that 3 weeks was being optimistic. 6 would be nearer the mark, especially if you're still walking on it. Lateral malleolus fractures also mean the ankle joint is potentially unstable. If it's not been internally fixed, that will need time to heal as well.

[alophysio]

hi ryankurosaki,

whilst what josephine said is correct, i would say that lateral mallelous fractures can be walked on quite soon depending on the type of fracture. So 3 weeks is not uncommon.

Often i don't plaster my patients but get them into an aircast walking boot or even an aircast ankle support depending on the fracture and keep them walking.

Hope that helps

Cheers

[ashish_itbhu]

Hi all,

I fractured my lateral malleolus in a motorcycle accident. Its was a undisplaced fracture. Docs has put on the temporary cast to reduce swelling.
and on second visit(a week after first visit and the accident)they told me, looks like that tallus is shifting outwards towards fibula, and hence its better for me to go for ORIF. I underwent the surgery, as told by the doc.

Here are my questions :
1. Can someone examine the xrays attached(accident day and a week after) and tell me what were the chances of getting healed without surgery?
2. How many weeks after operation does it looks like from my injury, that i will be able to drive again ?

Thanks,

First Day :
=======================



A Week after :
===================================



Post op :
=====================

[alophysio]

Hi

Not orthopods here so wrong people to ask for a medical question like that...but i would say that you could have healed without surgery but the shift in a week is pretty substantial so i would have listened to the guy too...

IMy rule is pretty simple - if you can stand on one foot and do a 1/4 squat, then you can drive - the thing is that you need to be able to work the brake in an emergency. I also get them to sit in a stationary car with the engine off and hit the brakes hard - if you can do it without pain, you are ok. If you have any doubts about how much it will hurt, you aren't ready!!

Of course, ask the drs about their opinion - they know much more than us, especially since we only have the information you have given us (which is VERY limited).

THanks

[ashish_itbhu]

It has been 3 weeks since Op.
Stiches and Splint removed. No pain in the Fractured area. Docs told me to keep moving ankle, to regain some motion, along with recovery(only up/down motion and no rotational motion).

I can move my ankle a bit(10-15 degree) without pain, but feel a little pain due to stiffening. No pain in fracture point though.

Should i stress my limit a bit to achieve more movement or let it move only whatever i m moving till now ? I fear hurting the recovery as now its only 4th week post op.

[alophysio]

Simple answer is do what you can...there is a difference between pain that is hurting something and discomfort from stiffness. Please seek professional advice about your rehab...

[kacperek]

Hello,
I fractured my right lateral malleolus (another doctor said it's fibula fracture) at night from 20th to 21th march 2010 (almost 2 weeks ago). At first look it looked like a sprain, because i didn't feel too much pain. After 8 hours i did x-ray (image below) and doctor put my lower leg into the cast for 6 weeks.

After 4 days i did another x-ray (below).

In my opinion this is simple, nondisplaced fracture (but maybe i'm wrong). The worst thing is that i have non-weight bearing cast for 6 weeks. I didn't feel pain quickly after injury (one hour). At this nigt i slept in sleeping bag without any problems (without cast). Later i drove car (putting acceleration pedal). Now i'm in cast but i feel very well. I don't feel any pain or swelling. When i'm standing on this leg it's all ok. I eat lot of proteins, calcium, vit D3, vit C, drink milk and i have a lot of sleep (minimum 8h). In general i'm healthy - i ride bike a lot and run. This is my first broken bone. I'm 28 years old. My only dream is put the cast off as quick as possible. Do i have a chance to do this? It will be great if i colud be ride a bike with my friends at end of this month (from 28th april).
Thanks!
Kacper

[Swampboy]

I have a question regarding my fractured lateral malleolus. My injury happened on a Saturday. I felt it was just a bad sprain, but my wife insisted I get it checked out so I went to an urgent-care type facility the following day, Sunday. The doctor there asked me MY opinion after manipulating my ankle and leg, then said he too thought it was just a sprain. I was told to put some ice on it, do not wrap it, and if it's not better in 5-7 days come back in. I walked on it for the next 7 days and of course it wasn't getting much better. I returned to the same center but saw a different doctor this time. He seemed very surprised that no xrays were taken during my first visit. He ordered x-rays which show what looks like a type B on the Weber System:



(I have the xray on my computer but do not have it published to the internet) He stated that it had begun healing incorrectly and I would need to have it re-broken and set with a plate and screws, which I did have done by an orthopedic surgeon.

My question is this: had the original doctor ordered an x-ray the day following the accident, therefore seeing it was broken, could he have cared for it properly at that point and could the surgery have been avoided? I appreciate any opinions given, thanks.

Rob

[ashish_itbhu]

Anything above A is nowadays treated with ORIF, as it has a chance of displacing and healing improperly.

I am not a doctor to say this, but did a lot of reading during my fracture time to understand this. Mine was also a B type, u can see the xrays i posted before. and the docs were of opinion that it may or maynot heal properly. better not to take risk.

i too asked the same questions you are asking.

[alophysio]

Hi,

It is hard to say what would have happened. It is best to take that up with the Dr themselves.

There are Ottawa ankle rules to follow - did he do those?

Asking your opinion is a good thing for a Dr to do because quite often the patient actually knows what is going on and Dr's are hopefully being trained to listen to the patient more carefully.

As for not wrapping, that is what i would consider bad advice...Rest Ice Compression and Elevation - you don't wrap/compress while elevating to aid swelling reduction.

If you could walk out of there, it wasn't too bad? The Ottawa Ankle Rules are a good place to check - i think you would have had a tender fibula if you had a Weber B...

Good luck -

[Swampboy]

Thank you both for your feedback.

There are Ottawa ankle rules to follow - did he do those?

I just had to look those up, but yes he did the manipulations. I about jumped off the table in pain from the posterior edges of the two maleolus'. I was able to walk out, but with significant pain and a big limp. Still thinkig it was a sprain, I had the goal of "walking it off".

[sosassy29]

I fractured my lateral malleolus 4 weeks ago and did not know it. Went in and Dr. had it xrayed and it was fractured. What I want to know with all the pain and swelling that I am still having what is the best treatment? I have been put in a boot and prescribed physical therapy but when I saw xray there was a gap between the healing of the bones. Will this result in a nonunion healed bone and will I have problems later? At this point shouldnt it have healed on its own by now? I only went to Dr. because of the swelling, throbbing pain and difficulty walking on the affected ankle without a limp or pain. I still cannot stand on the ankle by itself without pain or instability. Your thought would be appreciated!

[alophysio]

Hi,

You have provided limited information so the advice will be very general...In general, a boot is the right thing to be put in so long as it is LONG - like nearly to the knee.

Walk around on it if allowed. Can't be too specific here because walking on it might be bad for it - don't know what is wrong with it!!

As for non-union - rare unless you are old or have a poor diet.

Cheers

[orthoped]

hi,
I am an orthoped myself so pls dont ignore this advice.

Firstly after seeing all these X-rays, kindly note that you may feel it as just a crack but these are pretty serious injuries.

The reason why CAST is important is
1. without the cast the fracture keeps moving slightly even if you dont step on that foot. This interferes with healing of the fracture.
2. Weightbearing on the fractured foot, can cause breaks in a partially healed fracture and impede further healing. This can result in non-union.

Time of Recovery:
Ideally it takes 6 weeks for even an undisplaced fracture to heal. So if you have a cast on then it might take 4 weeks with a cast and 2 weeks of physiotherapy to get you back on your feet.

Casting does lead to weakened muscles but it is important or else the fracture may not unite and lead to chronic pain for lifetime. (Though some fractures may heal without casting and even if the person is weightbearing, it is definitely not worth the risk.)
Additional Comment I forgot:

I have a question regarding my fractured lateral malleolus. My injury happened on a Saturday. I felt it was just a bad sprain, but my wife insisted I get it checked out so I went to an urgent-care type facility the following day, Sunday. The doctor there asked me MY opinion after manipulating my ankle and leg, then said he too thought it was just a sprain. I was told to put some ice on it, do not wrap it, and if it's not better in 5-7 days come back in. I walked on it for the next 7 days and of course it wasn't getting much better. I returned to the same center but saw a different doctor this time. He seemed very surprised that no xrays were taken during my first visit. He ordered x-rays which show what looks like a type B on the Weber System:



(I have the xray on my computer but do not have it published to the internet) He stated that it had begun healing incorrectly and I would need to have it re-broken and set with a plate and screws, which I did have done by an orthopedic surgeon.

My question is this: had the original doctor ordered an x-ray the day following the accident, therefore seeing it was broken, could he have cared for it properly at that point and could the surgery have been avoided? I appreciate any opinions given, thanks.

Rob

You are absolutely right Rob. Ideally, all sprains of the ankle should not be declared as a sprain without an X-ray of the ankle, cause its almost impossible to differentiate between them otherwise.

[Rubydog]

Fractured my lateral malleolus beginning of October and the orthopod xrayed and put me in an aircast for 2 months.
Monday I want to the doctor who told me that I could discard the aircast and resume normal activities.
The remainder of Monday, Tuesday, and Wednesday I experienced some pain in the area where the toes and sole meet.
OK. I assumed that this was because of the 2 months in aircast.
However, last night when I took off my shoes I noticed that both the inner and outer ankle were swollen. This morning the swelling has gone down. Still some discomfort when walking.
Is this in the normal (whatever that is) range of the recuperation process or should I contact my doctor again?

[dbcross]

About 12 weeks ago I injured my ankle dancing on a ship. The doctor misdiagnosed it as a Grade I sprain. I continued dancing. It became bad enough I had to go home where my GP agreed it was a sprain and sent me into rehab on it.

I decided to go to an ortho and sure enough, stress fracture. Since then I have been in a boot cast (about 6 weeks) and it went from being in pain sometimes when walking, to being in pain constantly.

My other foot is now in pain and has a burning sensation. The doctor now wants to put me in a plaster cast for 4 more weeks.

If I trusted my doctor's opinion (which I listen to but after this long, I'm questioning) a little more I may not ask anything here but...I live in South Africa and the quality of medical treatment and such isn't the greatest.

I guess the questions would be...1> what is up with the "un-hurt" foot? 2> Why would I go from occasional pain to constant pain once in a cast? 3> Any clue how much longer this should be going on?