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baffled by the doctors diagnosis

i recently fractured my upper fibula and my ankle in a bike accident, i was in a cast for a week, an the doctor told me it was ok to remove it, ive had it removed an a air cast put on instead, the pain is extremely high, has the doctor possibly made a mistake, an should it still be in a proper cast, anybody know the answer
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replied June 27th, 2013
Especially eHealthy

It sounds like you have a Maisonneuve fracture. This is a fracture of the proximal fibula (usually up by the knee, but it can be anywhere along the shaft) along with a disruption of the syndesmosis ligament (the long broad ligament which attaches the tibia to the fibula) and the distal tibiofibular ligaments at the ankle, along with a fracture of the medial malleolus (the inside ankle bone). In some cases, instead of a medial malleoulus fracture, the deltoid ligament will rupture, but this acts the same as the fracture. As a result of the ligament injuries, there is usually widening of the mortise of the ankle joint. The widening of the ankle mortise can lead to traumatic arthritis later on down the road, if not managed properly.

This is a very significant injury, which is often mistaken for the more benign fibular shaft fracture.

A Maisonneuve fracture usually occurs when there is a significant twisting of the ankle, such that the talus acts as a wedge, pushing the tibia and fibula apart. Midshaft fibular fractures usually occur from a direct blow to the lateral aspect of the leg (the outside of the leg), and there is no ankle injury associated with it.

Thus, whenever there is a fracture in the midshaft to proximal fibula, it is very important to find out the mechanism of injury from the patient and then examine the ankle for an associated injury. In this injury, the ankle must also be x-rayed.

So, if you were not taking care of by an orthopedic surgeon, you may have been mismanaged. Often, if there is widening of the ankle joint, surgery needs to be done to place a couple of screws across the syndesmosis. If the medial malleoulus is displaced, it too should be treated surgically. But, even in nondisplaced fractures, usually the syndesmosis screws are placed, and the patient is kept nonweight bearing for 6-12 weeks.

If you are having problems, see an orthopedic surgeon as soon as possible.

Good luck.
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