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Comminuted Distal Fibula Fracture

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Dear Doctors,
I have a few concerns regarding my current injury that I would like some feed back on.

Here is some back ground information regarding my injury...

Back on June 13th, I slipped and was unable to gain my footing before I fractured my lower right fibula. I believe the fracture is just a little above my ankle bone … and the fracture when looking at the frontal view of my x-ray appears to be running at a downward diagonal across the bone. My fibula is a little displaced at the fracture site. I have seen my orthopedic surgeon twice since my initial injury and on my last visit on June 25th he left my hard cast on and said he would see me in four weeks and then take a look at how well the bone was healing. Sounds reasonable enough, but then he made a comment … “we will then determine if you need surgery or not.”

When I questioned him about his comment he dismissed my concerns. If he was concerned that the bone would not heal correctly, should he be seeing me before August 8th? Is it typical to allow a bone to heal 6 weeks before intervening with surgery? From what I have ready it is better not have surgery if possible, but seeing how I live independently, I cannot be on crutches for another 6 to 8 weeks. Luckily I am not teaching at the university this summer and have been able to stay at home. How concerned should I be about this prospect?

I asked my doctor… “When should I begin putting some weight on my injured leg?” His response was “well, you can. I will re-enforce the bottom part of your cast.” (Now my current cast is not a walking boot / walking cast; it is just a hard cast that begins below my knee and extends to my toes.) I thought are you kidding me; that is your response?

So, I said: “I can do a lot of things, but seeing how you are the bone specialist what I really would like to know is that with the injury I have will putting weight on my leg cause my displacement to increase and prevent my bone from healing correctly.” To this question I received the response “we will look at it in 4 weeks and see where we are.” Needless to say, I have contacted my primary care physician who has referred me to another orthopedic surgeon (my appointment is scheduled for July 23rd.)

My last concern pertains to my lack of mobility due to my need for crutches. Although I am athletic, I am pretty clumsy on the crutches and have fallen several times. My confinement has been frustrating because I need to perform normal activities, like carrying a plate / bowl of food across my kitchen, and getting up to my second floor. So, I have researched some alternative crutches on the web and recently in my despair I purchased an “I Walk Free Knee Crutch”…
The manufacture said it was suitable for lower leg casts. Is this device safe to use with my injury?

I asked my doctor and faxed him some information on it, his nurse called me and said that Dr. X is not familiar with the equipment and pretty much that it is his policy not to research patient’s requests… this was the final straw for me… Dr. X is out.

Any advice you can offer would be greatly appreciated. Likewise, if anyone has had a similar injury and purchased the I walk free crutch, please share your experiences. Thanks!
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replied July 16th, 2009
Community Volunteer
When my Mother fractured her upper leg years ago she was put in traction in the hospital for a few weeks...This was done before they did surgery...I guess each physician handles it differently...If you have questions, ask around...It is your body...You have to feel confident in your doctor...Good luck...

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replied September 1st, 2009
It is my understanding that long term casting is old school, with new research supporting progressive bracing even for severe fractures, with strengthening beginning within three-four weeks, a walking boot when union is seen, or if not, splint and strap (adjustable, firm, tight) bracing then slight weight bearing within six.

With a comminuted fracture or a displacement, external fixation with wires is now generally preferred over open surgery with pins and plates, although a combination is generally thought to be a more successful approach.

None of the procedures are guaranteed success and all have secondary issues to contend with, some long term, some short term, some possibly disfiguring. There are many variables, including the severity of the fracture and injury to surrounding tissue and nerves. If you smoke or have pets you may be more subject to infection or poor healing. If you have other injuries, past or present, this may also affect the outcome, as will your diet and other life habits.

The best advice I have heard is to avoid ibuprofen as it blocks the body from building new bone as fast as it needs to. If you don't absolutely need surgery, avoid it. There will inevitably have to be another and another. Even if it takes three years to heal on it's own, that is a drop in the bucket (100) when you consider how much time and pain is involved with the surgeries. Not to mention complications, on and off the table.

There are newer casting styles for class II & III breaks which hug the ankle/fib more tightly in a toe up position, assisting with re-alignment. I am concerned about a walking cast with that displacement tho and hope you have seen another doc by now. Consider a neurosurgeon in addition to the orthopedic. An osteopath may be helpful in making the decision as to what to do next and a physiatrist help if you have other injuries (past or present) to contend with. Keep the blood flow and nerves intact: eat oysters (ick) instead of taking ibuprofen, lift and lower without weight bearing as often as you think about it (hold the lift til your muscles quiver, a minute or so, then lower) and be patient with yourself.
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replied September 6th, 2009
Oh boy I'm feeling the pain to! I was in a car wreck July 24th and it crushed my Talus bone and broke my fibula too, sounds like around the same place as you broke yours. I can't believe your Doc is doing you that way! I had to wait 1 1/2 weeks to have my surgery because of the swelling but I did have to have it. Of course mine was a very complicated surgery because of all the damage but I still had it.I had to have 3 screws and cadavar bone along with lots of reconstruction. It kind of just sounds like your doc doesn't care! Don't get me wrong if you don't have to surgery by all means don't!!! This is pain that I am having an extremely hard time dealing with. And yes I am probably looking at more surgeries down the road. Sad But I have a friend that had one of those walkers you are talking about and she loved it! It gave her so much more freedom! Unfortunately I can't use one because of my injuries but I recommend one if your doc says ok. And by all means please find another Doctor!! I would hate to see you go through more pain and aggravation if there isn't a need to! I will be in a wheelchair and crutches until around November then if things look ok they will let me start partial weight bearing and physical therepy. For now its just sit sit sit with my leg elevated. Best of luck to you and hope you heal quickly!!
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replied August 13th, 2013
Dealing with ankle (fibula) fracture
I am 7 weeks into a "comminutive distal fibular fracture" (ankle break in several places) with no displacement. My doctor put me in a boot from day one, with instructions to not put weight on it. Today I was told it is healing but not there, give it four more weeks in the boot. I understand what you mean about the crutches! You can't even carry a cup of coffee! I've found that my office chair with wheels works much better than crutches to scoot around the house, and I've pulled a lightweight handcart designed for luggage out of the garage to carry things. I tried the "knee walker" scooter for awhile, which had some pluses, but the pulled ligaments in my knee were irritated by it and I turned it back in. I hope you find a doctor that gives you some confidence! And, let friends know that you need rides to get out of the house. Be prepared for the healing to take some time -- I guess that part can't be hurried.
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