[h-man]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif 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.

I don't think the wire is an option, the usual method of fixing bad ankle fractures is with a plate and screws; however, that is at the TIME OF THE FRACTURE, not when the fracture has united. Any orthopedic procedure involving pins and plates has complications, the main one being infection of the bone (osteomyelitis), although this is uncommon. However, we don't know how bad the OP's fracture was or what his original or current Xrays actually look like, so it is difficult to comment accurately. I do agree however that in most cases, bone remodelling occurs quite nicely, especially in young folk. Mind you, it has been a long while since I last did orthopedics, so I'm not the best source of advice. I think the important thing is, if you are still worried, or if the pain and swelling is bothering you, go back and see your doctor and ask for a fuller explanation, and if you are still not happy, a second opinion.

 

[Crowbar]

LOL, I'm not young any more. I'll be 27 in early June.

 

[Jon L]

Quote:

Originally Posted by Crowbar /img/forum/go_quote.gif LOL, I'm not young any more. I'll be 27 in early June.

Luckily for you, the fibula is one of the less important bones in your body b/c the tibia does most of the weight-bearing.

Fractures healing satisfactorily does NOT mean you won't have intermittent swelling or pain around the area, even in soft tissue/ligaments. In fact one of my fractures still hurt and feel stiff after many years from time to time, and this one got the pinning surgery done!

From what you describe, the only alternative is for an ortho surgeon to put you under anesthesia, cut it open, actually re-break the bone at the fracture, re-align, put plates/pins in, then re-cast, hoping it will heal better this time. No surgeon will do this especially with the bone healing acceptably.

 

[milkpowder]

Quote:

Originally Posted by h-man /img/forum/go_quote.gif I don't think the wire is an option, the usual method of fixing bad ankle fractures is with a plate and screws; however, that is at the TIME OF THE FRACTURE, not when the fracture has united. Any orthopedic procedure involving pins and plates has complications, the main one being infection of the bone (osteomyelitis), although this is uncommon. However, we don't know how bad the OP's fracture was or what his original or current Xrays actually look like, so it is difficult to comment accurately. I do agree however that in most cases, bone remodelling occurs quite nicely, especially in young folk. Mind you, it has been a long while since I last did orthopedics, so I'm not the best source of advice. I think the important thing is, if you are still worried, or if the pain and swelling is bothering you, go back and see your doctor and ask for a fuller explanation, and if you are still not happy, a second opinion.

A bit OT, but in what circumstance or type of fracture does one thread a wire through the bone as a reduction method? Thanks.

 

[jules650]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif A bit OT, but in what circumstance or type of fracture does one thread a wire through the bone as a reduction method? Thanks.

All sorts. I've seen it used commonly in distal radius fractures, fractures of the digits, patellar fractures, and in some nasty periprosthetic fractures. I was unfortunate enough to do 4 months of orthopaedics this year. They use intermedullary nails (in effect big 'wires') in fractures of the femur.

To be pedantic, wires are a form of fixation and not reduction. Reduction is when you correct the angle and alignment using brute force. If that comes out for your exams you owe me a drink.

Q: What is the difference between an orthopaedic surgeon and a carpenter.
A: An orthopaedic surgeon can give you antibiotics.

 

[milkpowder]

I see. Thanks

So iirc, you would reduce, than fix right? We were told that you use brute force all the time in orthopaedics eg fixing a massive scaffold thing into someone's fractured pelvic girdle via metal rods where apparently you literally screw the rods in with bare hands

Beforehand you jab the guy with the biggest needle you can find and load him up with analgesics or anaesthetics.

No joke! Surgeons used to be the carpenters aboard ships (or is that just a myth?)

 

[h-man]

I think that is definitely a myth, milkpowder. However, we used to be barbers initially, hence the reason in the UK why we preserve the title "Mr".

 

[Hardwired]

I broke the tibia and fibula in my right leg about 4" above the ankle in too many places to count. The first doctor to see my x-rays told me I would never walk again without a cane. His superior chucked him into the hallway and I never saw him again. The bone was so shattered there was nowhere to attach screws to set the plates, so the doc shish-ka-bobbed the tibia parts together with a metal rod and hoped for the best on the fibula.

I was told putting weight on the break, starting with very little at first and then increasing as the bone knits, is the best way to build bone tissue and help the bone knit solidly. As with most scar tissue, the new tissue is generally stronger than the surrounding tissue, so exercise is key to mending broken bones.

My fibula fused just about like what you show in your drawing. I had it looked at a few years back and was told once the bone heals the only fix is to rebreak and set the bone. I lost almost an inch of bone matter in the original break which is causing back and hip problems from imbalance, and rebreaking the leg would only make the bone loss worse, so I decided not to.

I do have some painful days when the weather does strange things to my leg, but I do yardwork, go on short hikes, etc, with no problems. Considering how bad it was and how relatively well it turned out I don't complain. I also use it as an excuse to cut short my wife's shopping trips. "Sorry, my leg is hurting, can we go?"

I would think if you want to straighten the bone, the earlier you do it the better. If you haven't lost a lot of bone matter it shouldn't make things worse, other than increasing your recovery time. I can say that a crooked bone doesn't mean you'll be a cripple. And maybe you'll have a 'weather leg' and can amaze your friends by predicting the weather better than your TV weatherman.

 

[Crowbar]

What can I do about joints? All the joints in my foot were injured in the accident. My toes bent so far back the joints still hurt when I touch them. Te worst is that I cannot at all bend the foot forward, the ankle seems to be blocked at 90 degrees. There's been no improvement over the last two weeks of trying to do this. When I try to force it, there's a pull backwards at the top of sorts.

 

[Davesrose]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif A bit OT, but in what circumstance or type of fracture does one thread a wire through the bone as a reduction method? Thanks.

I've been involved with medicine in military applications recently....rather funny to see how their procedures/tools can differ quite widely from clinical medicine. Since they need quick and general methods, a K-wire is almost always used for immobilizing a bone. It's rather shocking to see some of the instruments they'll use for burr hole procedures

As for the OT, I agree with those who say it's up to you to decide if you want to go through surgery. Your doctor probably was advising against it because of the costs/complications of having it. If you do more reading of sports injury, you'll just get more worried

Since your fibula is not much of a weight bearing bone, I personally wouldn't worry about it. I have a slight underbite: I have thought about surgery for it, but decided against it. I hear people who have such surgery (breaking your jaw bone then resetting) always wind up with pain and complications. No doubt if I tried corrective surgery, it probably would leave me with pain and an overbite.

 

[milkpowder]

Quote:

Originally Posted by Crowbar /img/forum/go_quote.gif What can I do about joints? All the joints in my foot were injured in the accident. My toes bent so far back the joints still hurt when I touch them. Te worst is that I cannot at all bend the foot forward, the ankle seems to be blocked at 90 degrees. There's been no improvement over the last two weeks of trying to do this. When I try to force it, there's a pull backwards at the top of sorts.

Sounds to me like you tore a lot of tendons on the bottom of your foot. It's probably not the joints' fault. That said, I haven't done specific foot-related stuff yet so I'll let someone who actually knows their stuff speak

Quote:

Originally Posted by Davesrose /img/forum/go_quote.gif I've been involved with medicine in military applications recently....rather funny to see how their procedures/tools can differ quite widely from clinical medicine. Since they need quick and general methods, a K-wire is almost always used for immobilizing a bone. It's rather shocking to see some of the instruments they'll use for burr hole procedures

Got any pictures?

 

[Davesrose]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif Got any pictures?

Confidential....Those NDA agreements. But lets just say you can find stuff at your local hardware store

and RE: foots and tendons: I do know that rehabilitation takes a long time to go through. Your doctor should have seen if you tore any tendons. Swelling can take a lot of time to calm down, and is probably giving you the pain/immobility. A physical therapist should help you improve with exercise and will help you gauge the time it will take to improve.

 

[Crowbar]

Can't be tendons. I don't really have pain on the bottom of the foot. When I said I couldn't bend it forward, I'm not talking about my muscles being unable to pull it that way; I meant that the ankle simply won't allow that motion, even if I try to force it with my hands.

 

[jules650]

Quote:

Originally Posted by milkpowder /img/forum/go_quote.gif I see. Thanks So iirc, you would reduce, than fix right? We were told that you use brute force all the time in orthopaedics eg fixing a massive scaffold thing into someone's fractured pelvic girdle via metal rods where apparently you literally screw the rods in with bare hands

Correct. Resuscitate, reduce, fix(i think another R goes here but I can't remember) then rehabilitate. They do use a lot of brute force in orthopaedics. It's very much like woodwork or ironwork with all the saws, hammers and drills.

The coolest thing in orthopaedic surgery is the cement. It takes about 10 minutes to set during which it undergoes an exothermic reaction. It goes from putty to rock solid, during which it's so hot you can barely hold it between your fingers.

 

[jules650]

Quote:

Originally Posted by Crowbar /img/forum/go_quote.gif Can't be tendons. I don't really have pain on the bottom of the foot. When I said I couldn't bend it forward, I'm not talking about my muscles being unable to pull it that way; I meant that the ankle simply won't allow that motion, even if I try to force it with my hands.

Unfortunately one of the potential complications of bony/joint injuries is osteoarthritis. Only time will tell if this will be a long term side effect.