Hi there just after a bit of advice.

4 weeks ago today I suffered a fall and the initial x-ray showed that I have fractured my Calcaneus in 3 places and that I may have to have an OP to put in a metal plate depending on how it heals within a cast.

Now today I went for my appointment and had my cast removed and immediately could see that the swelling had gone down to a minimum and that the only strange thing noticeable is a bruised bulge on the right side of the foot, the doctor looked it over and didn't want another x-ray and said that I can keep the cast off and wait another 4 weeks before partial weight-bearing and physio therapy.

To me this seems a little strange as through reading many other peoples experiences with a similar fracture they have had to wait for a long time before having the cast removed as well as the physio.

Now I understand the reason they probably didn't want to do surgery is because I regularly smoke but I am just after an opinion as too whether I have simply gotten lucky and my foot is starting to heal-up well or whether a mistake has been made.

Ta

Greg Smile
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replied May 26th, 2013
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Scagrat,

It also depends upon where the fractures are located and whether or not they are displaced.

If the fractures are not displaced (sometimes called "hairline" fractures by nonorthopedic surgeons), then there is not a whole lot to, but wait for the bone to unite. Casting is basically for patient comfort in these cases.


If the fracture is displaced, but can be reduced (put back in place) and then held with a cast, that is all that is needed. The cast only needs to be in place till there is some osteoid formation (the soft tissue matrix of bone, which "glues" the fractures back together). Then, the body will calcify the osteoid, to make callus (new bone).


Also, as you stated, you may have just gotten lucky, and the bone has healed up well. But, more likely, the surgeon has just decided that you will be treated nonoperative and what you get is what you get. That if you develop problems down the road, that elective corrective osteotomies could be done (or a subtalar fusion). At this point, you could be asked to stop smoking during the post-op recovery time period.


It would be rare for a calcaneous fracture to be completely healed in four weeks, but since it has a lot of cancellous bone surface, they do heal quite a bit faster than fracture such as a tibia shaft fracture (where there is little cancellous bone). But, it is quite possible for the fracture to be in the first stages of healing ("glued" together). And, if you are careful (and not a knucklehead) you could get by without having a cast for for another month. As long as you are comfortable.


Good luck.
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