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Broken fibula and other trauma

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2weeks ago I was thrown in a boat going thru a wake-I spent 10 days on crutches figuring I was just bruised. Went to doctor 4 days ago.
Have a torn mcl on my left leg, my right leg fibula has 2 breaks-top and close to bottom, and I have Compressed fracture of my L4 vertebrae. I have a groin to ankle removable brace for my left leg. Have nothing on my right and am wondering why my doctor believes it best not to cast it.There is supposedly not a lot of displacement.
I am told to be I a wheel chair for 4-5 weeks. I live in a townhouse, no elevator, and have been using crutches to get from bed to bathroom. Sitting in a wheel chair cause too much pain in my back.q
What would advice be to treat these issues simultaneously?should I be stretching?
No cast really?
Looking for guidance.
Many thanks
Rolling Eyes
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replied January 2nd, 2012
Especially eHealthy

What was the reason (which injury) for the wheelchair? None of the injuries, on their own would require a wheelchair rather than crutches/cane/walker. Maybe, the surgeon felt you would be more comfortable in a wheelchair and it would be easier to get around.

One thing is, you have had a "trial of life", when you did not go to the doctor immediately. If any of the fractures were going to displace or cause problems, that was the time frame when it most likely would have occurred.

Well, let's go through your injuries one at a time.

Your L4 compression fracture must be of a stable construct, otherwise surgery would have been done. Sometimes, patients are placed in a spinal orthosis for comfort, mainly for the first month or so. But, since you have been getting around without one, the surgeon probably didn't think you needed to be tied down. The lumbar compression fracture will heal on its own. Usually, they, themselves, do not cause any problems. If, however, you managed to damage a disc or two in the area, that might show up later as a problem with DDD (degenerative disc disease). Also, occasionally, the resulting ligamentous laxity, due to the compression (compression of the bone makes the ligament looser), may cause some problems later.

The knee MCL (medial collateral ligament) injury will actually heal on its own also. Usually, in isolated MCL injuries, the treatment of choice is a long leg hinged ROM (range of motion) brace. This is can be cut down to a regular sized hinged brace in a few weeks. The purpose of the brace is mostly for comfort, but also to provide some support to the knee when subjected to valgus stresses.

Since the MCL will heal on its own, why are we concerned about ROM? This is the idea behind this treatment. When the MCL first starts to heal, the collagen (scar) that is laid down in the ligament is haphazard. It's just a big ball of scar. But, with range of motion, the stresses applied to the ligament will cause the collagen fibers to line up properly as they mature.

So, again, for the MCL, just time and doing range of motion will get the ligament to heal properly. But, you still have to rehabilitate the limb.

Now, the fibula. It sounds like the fractures are within the shaft of the fibula. This are most commonly caused by direct trauma, a direct blow to the area. These fractures are very different animals from the distal fibular fractures involving the ankle joint. And, they are also different from the proximal fibular fractures involved in Maisonneuve Fractures.

Fibular shaft fractures are just treated for comfort. In a patient with just a fibular shaft fracture, he/she might be placed in a fracture brace and on crutches, till they feel comfortable going without them. There is usually no need to treat fibular shaft fractures.

In fact, the fibular shaft is considered an expendable bone. The fibular shaft can be harvested as a vascularized bone graft, for use somewhere else in the body.

So, with all of your injuries, the surgeon probably did not want to encumber you more immobilization.

Again, I'm not sure as to why you have to be in a wheelchair all the time. Have you spoken to the surgeon about your weight bearing status? With your injuries, you should be able to advance it fairly quickly, especially since you have had a trial of life.

Good luck. Hope you feel better soon.
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