Misaligned fibular fusion

[Crowbar]

I broke my ankle last month--spiral fracture of the distal fibula. After six weeks, during four of which I wore an Aircast, there's pain throughout my ankle and foot area every time I step, and both still get swollen during the day when I'm upright. Today's X-ray showed that the fracture appears to be fusing, but it's not aligned, as I've sketched in the image below (exaggerated; the actual misalignment is about 20%). The doctor said it doesn't matter, but that doesn't sound right to me. If it fully heals that way, it would seem weaker at this point, and the bone sticking out more likely to cause damage of the soft tissue above it if I get hit around that area, especially sine I'm very thin. Wouldn't it be best if they surgically break it again and affix with a pin or something like that it so it's aligned properly?

 

[lmilhan]

I would probably get a second opinion.

 

[nysulli]

get a second opinion, it doesn't seem right to me either, but i'm not a doctor

 

[Crowbar]

Well, I guess I don't know how to do that. I don't want to offend my doctor, and he's sure to find out. See, I'm in Canada, it's public health care here. They'll just send him the records; he's working within the same system. Maybe if I go to emergency and say it suddenly started hurting more...

 

[catachresis]

"Misalined fibular fusion?" - Really, I thought this was going to be a story about a problem with an experimental new energy source. (No, really.)

Get well soon.

 

[Crowbar]

LOL. Fusion simply means a union forming between two parts. It doesn't have to be nuclear fusion.

I wonder how I can get a copy of my records, so I can post the X-ray online and get a bunch of opinions. My understanding is that technically I have a legal right to see my records, but I don't know if they'll keep X-rays after some time or just written diagnosis, and they might charge a lot...

 

[mbriant]

It's your leg and your pain so I'd say too bad if the doctor's offended. A second opinion is in order. Second opinions are commonplace when it comes to medical diagnosis. I know this is a stretch, but my miniature greyhound broke his leg the first day I had him 12 years ago, and because of the tiny size of his bones, it healed misaligned as well. His x-rays looked very much like the diagram you supplied.

While he doesn't seem to feel pain (or at least doesn't show it ), most of the time he holds that leg up and walks on the other three. Unless you're into hopping on one leg as you get older, I'd do as much checking into it now while you can.

 

[jules650]

There is an acceptable angle for the fusion of all fractures, depending on the site of the fracture and the age of the patient. I have no idea what it is apart from that it is more acceptable to have a greater angle in kids because of increased remodelling in young age.

 

[Crowbar]

I hope so. I wanted to post my X-rays on an orthopedic forum to get different opinions, but the hospital said it's $60 for a copy... what the... surely it shouldn't cost that much for them to burn a CD for crying out loud.
In the meantime I find it impossible to bend the foot forward, beyond the 90* it's in, and still have swelling and pain around the foot and ankle. I wonder if there's any medication I can take to help with those.

 

[milkpowder]

Quote:

Originally Posted by jules650 /img/forum/go_quote.gif There is an acceptable angle for the fusion of all fractures, depending on the site of the fracture and the age of the patient. I have no idea what it is apart from that it is more acceptable to have a greater angle in kids because of increased remodelling in young age.

x2

Just did my bones and joints module.

I'm not exactly sure of the clinical ranges, but the bone will undergo resorption and the bits that aren't weight bearing will just literally disappear. The repaired bone should be nearly just as strong as the original bone when it is completely remodelled. Nothing to worry about IMO. That said, it will take some time for the whole bone remodelling process to finish depending on your age.

 

[jules650]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif The repaired bone should be nearly just as strong as the original bone when it is completely remodelled.

I daresay it will be stronger, but you probably know a lot more than me, Jonathan. Fractures that heal properly with good callus formation very rarely, if ever, refracture.

The bits that stick out on your diagram should remodel. They won't poke through your skin, although you may feel a bulge there if you're thin. Just my two cents, but if your picture is an accurate representation of your X-ray (as long as there is good callus formation) I wouldn't be worried. I'm a bit of a noob so take my advice with a pinch of salt (and a hundred-page-long legal disclaimer).

 

[milkpowder]

Take mine with a handful of salt. I only just scraped by first year of med school

Finished my exams today

I only got 5 hours of sleep in the last three days... so much for last minute cramming

 

[Crowbar]

Guys, look on page 3 here: http://www.sportsmed.buffalo.edu/upd...te%2010-04.pdf
At one point it says (emphasis mine):
Quote:

The indication for surgical treatment of the athlete with a distal fibula fracture is fracture displacement of greater than one to two millimeters. As little as a one millimeter shift in the ankle alignment can lead to a decrease in the contact area between the precise, smooth cartilages surfaces by as much as 42 percent. Thus, perfect or "anatomic" reduction of the fracture fragments is needed to minimize the risk of developing ankle instability and posttraumatic arthritis.

Mine is about 2 mm I think, and a bit higher in location than what's in the picture in this article, so about borderline...

 

[milkpowder]

Bear in mind they are talking about professional sportsmen getting injured. They put a heck of a lot more stress on their bones than you probably would (unless of course you're a professional sportsmen too

).

If you want surgery, I believe you have two main choices. One is to put a metal plate over the fissure and drill nails on either side. The other is to thread a long piece of metal wire along the inside of the bone, or the cancellous/spongy bone. I think the wire will have to be taken out after the bone has largely healed and will put a permanent circular scar (albeit a rather small one) on your leg. The latter is a much smaller pin-hole-like surgery whereas the former is quite a bit more significant. The metal wire one does carry its own set of risks but I can't remember what they are off the top of my head... Your best bet would be to speak to your doctor about it.

 

[Crowbar]

I'm not an athlete, but I'm an avid hiker, so ankle mobility is very important. That 1 mm -> 42% joint contact decrease is pretty scary, though since the break is higher in my case it may not be so bad. I know that the fibula doesn't carry any weight, but it does form part of the ankle joint. I guess I'll pay the $60 for a copy of my X-rays and post them on various places to get comments. Waiting list for orthopedic surgeon here averages two months or more if it's not a emergency. They'll probably say it's elective surgery since I can survive without it, and wont' be covered by public health. Dam... too bad my supplementary insurance finished when I graduated >.<