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

[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]

Originally Posted by 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.

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...