high ankle fracture

[rugby18]

I recently fractured my fibula and ruptured the AFTL and the syndesmosis. I went to hospital on the day that i was injured (15th of November) and was told to return on the 17th, on that day i was diagnosed with a weber c3 ankle fracture had surgery to fix a syndesmosis screw through the tibia and fibula and a plate fixed onto the break. After the ORIF surgery i was put into a back slab cast on the 17th untill the 1st of December.. I have since been since been in a non weight bearing cast. I was firstly wondering what the long term ramifications would be if any and also how soon would i be fit to play rugby(the doctors seem to stray away from answering this question when asked). Also would a patient normally be put into another cast after having the non weight bearing cast removed or would they be given some sort of support brace. Finally how long is a patient typically on crutches for after sustaining a pretty severe ligament damage injury such as mine. thanks very much.

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[alinguyen]

It will be assumed that your tendon healing will occur meanwhile your fibular is healing. With a Weber C fracture, you've pretty much ruptured both major ligaments of the ankle (ATFL and deltoid ligament), virtually disrupting the syndesmosis and dislocating the ankle. This is a pretty serious injury.

If you're playing rugby, I'd assume that you're young and quite active. Usually, it takes about 4-6 weeks for a ligament to heal, although this is not guaranteed if there have been complete ruptures. Usually they have to be surgically attached to ensure the best chance of healing. Bone on the other hand, would take you 6-12 weeks to develop enough strength for you to moderately weight bear through, where you're looking for the bony parts to form what they call a soft callus to hold the bones together. In the meanwhile, you'll be pretty much non-weight bearing.

Thus, while you're waiting for your bone to heal, your ligament should heal over too. Unfortunately, you're at the mercy of your own natural healing with regards to bone and ligament, and you'll have to wait for the green light before you can start weight bearing in any matter. The best thing for you to do is try not to aggravate or refracture yourself doing anything rash. There's nothing really to accelerate healing except good nutrition.

The long term ramifications of non-weight bearing for so long is muscle wasting, especially of your gastrocnemius (calf), quadriceps, hamstrings and gluteal muscles. Not only is muscle wasting an issue, but ankle stiffness and swelling especially will be your main enemy once you begin your rehabilitation once you can start weightbearing and applying more pressure to your ankle. Expect yourself to be quite tender to weight bear once you're allowed to. This is normal, and if your bone is healed on X-Ray, don't be afraid of putting weight through your foot (within reason). Co-ordination, learning how to walk well and eventually run will follow with rehab.

At the moment, you'll be looking at about 4-6 weeks after you're allowed weight bearing before you can walk without your crutches, 2-3 months after weight bearing before you've got the strength to be walking 30 minutes a day, and 4-6 months after weight bearing before you're thinking of running again. Results vary, and I'll tell you, a good physio will improve your outcomes.

I can foresee that you may have issues with ankle stability considering the extent of your injury, although fingers crossed, your ligaments are healing along with your bone. Good luck, hope this helps.

[physiobob]

Firstly, thanks for the great reply above. Pretty much says it all. With such a significant injury you need to give it time to try and get a good result. You might be back for winter rugby but probably this season might be one of rehabilitating the co-ordination, power and speed rather than playing a game. Work with the team but rugby is a tough sport and you could easily re-fracture if the bone and ligament strength isn't there yet. Full ossification usually continues to at least the 12 month mark post injury.

You might try to find a physio with some magnetic bone healing modalities to assist the fracture healing along the way however the comment above are most likely the way forward this year

Also here's a bit of bunf on your type of fracture for those reading. This came from Wheeless' Textbook of Orthopaedics. I have also attached a few images typical of this type of fracture.

Weber C Fractures

Weber C ankle fractures occur above the the syndesmosis and are similar to PER injuries in the Lauge Hansen classification:

classification:
- C fibula fracture above syndesmosis
- C1 diaphyseal fracture of the fibula, simple
- C2 diaphyseal fracture of the fibula, complex
- C3 proximal fracture of the fibula
- frx above the syndesmotic result from external rotation or abduction forces that also disrupt the syndesmosis and are usually associated with an injury to medial side

[broken101]

Hi,

I have a very similar injury to this. I don't know the medical terms as well as you guys but i know it was a "high ankle sprain" (syndesmotic). I underwent ORIF and had two screws placed in my ankle oct 20th. I was just taken out of my cast 3 weeks ago and just over a week ago was told by my ortho to begin putting weight on my ankle slowly.
He also told me to use a stationary bike and do the alphabets with my ankle. I haven't been scheduled for rehab just yet, they are taking the screws out in 2 months so i would imagine rehab comes after that ? I would have thought rehab would be part of the re-learning how to walk process.... Should i ask for rehab regardless ? On a side note my ankle is super stiff. It was immobilized for 3 months so i guess that's normal...
And my foot is swollen. I do the exercises and i see some progress with moving my foot in a downward angle and the side to side or circular movement is pretty good but i feel like i'm getting nowhere with upward movement. I can't move my leg forward past a 90 degree angle - it's stiff completely. I've started to try toe raises but am a little nervouse going forward without some sort of advice. I had one of those fractures on my fibula also and you guys seemed pretty knowledgeable on this so i was hoping i could share from your insight

Thanks guys!

[Jomider]

Thanks for this thread - I have found it very helpful a year on - I seem to have a very similar injury from an exorotation during a skiing fall. 11th Jan 2010... Syndesmotic rupture, Weber C - ORIF, ligament rupture etc. Hard to tell exactly what else, as the operation report is in German ), but overall I don't believe there are any other complications. I have a couple of questions:

Given that I have been given an Aircast, and can wiggle my toes with abandon when I have the cast off and wheel myself around the house "quite safely" (?) in my chair, how do I draw the line as to what I can and can't do with and without the Aircast on - I have been given varying pieces of conflicting advice about weightbearing and so on.

Can I start some sorts of physio already or must I wait? - I worry about my calf wasting away. Can I accelerate the ligament healing with masage or something?

When can I get back to Tae Kwon Do (stretching, push ups and patterns rather than breaking or sparring)?

I'm quite nervous I will push it too far by just returning to normal too quickly as with the Aircast off it creates an illusion that all is well, although I know the ligaments must all be damaged and the bone is held together by the plate and screws.

any advice would be very welcome - thanks

[Josephine]

Broken, swelling needs treating with ice and elevation. It will act just like the cast and prevent good ROM.

Jomider, that sounds like a really nasty do! As a mere nurse, I would venture to suggest that recovery should be of the 'nice and easy does it' variety. But you can keep on top of the muscle condition with passive exercises but I'll leave the physios to fill you in on that!

[Jomider]

Thanks Josephine - I will check out passive exercise - 'nice and easy' is quite a challenge, but i have managed to avoid weightbearing mostly for now - I'd hate to rip those screws out... ouch!