Displaced lateral malleolus fracture surgery

[bigalrobbo]

Can anyone please give me some advice. I've recently been told I need surgery to repair a fractured lateral malleolus on my right ankle. The tip of the bone has completely "snapped off" where the ligaments attach to the bone. This is an old (about 10 years) injury, but is giving me increasing pain.

(Been giving me significant pain in the last 2 years when playing football after recovering from cruciate reconstruction surgery to the same leg!!)

My surgeon said he is going to remove the bone that is displaced rather than re-attach it to the main bone, and re-attach the ligaments from the removed bone to the fibula. I have not read anything about this procedure so can anyone tell me their experiences, recovery times - pain etc. etc. My surgeon also told me I would be in a weight baring cast for 6 weeks.

Thanks in advance of any response.

Regards,

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[pudding_bowl]

It's been about 2 months. How have you got on.
This isn't that uncommon of a surgery and your surgeon and physio should guide you.
6 weeks non weight bearing will often then be followed by a orthopaedic review to check the healing and decide wether you can start gentle range of motion exercises and start partial weight bearing.
All up the pain you'll experience will be post surgery, and inflammtion, that should slowly go away. But you'll have to start stretching post immobilisation and that is also quite painful - so lasts as long as the exercises do.
The timeline will be unique to you. But expect to be return to full sport in about 6 months and wearing protective bracing for up to year. Exercises may start at 6 weeks or possibly not till 12. Then rehab will involve full weight bearing, stretching, strengthening and proprioreception (basically balance) work.

How are you now
Pudding

[bigalrobbo]

Thanks for the response.
It is now 4 1/2 weeks since my op which the surgeon said went according to plan. I had 4 Mitek anchors placed to fix the ligament. The 2 days after the op were quite painful but nothing that the painkillers couldnt handle!
I have had no pain whatsoever since the initial 2 days. The 'back slab' plaster was removed after 2 weeks along with my stitches (7) and a new full lightweight cast put on for the remaining 4 weeks.
The only problems I am having are from moving around on crutches. I am non weight bearing (thought I was going to be weightbearing) so the strain on my shoulders and arms are taking their toll. My 'good' ankle has swelled up aswell, but is not giving me any pain.
I have this cast removed on Christmas eve, after which I have been told I will be in an air-cast (removable) for a further 6 weeks.

All in all, I am happy so far (if you take away the inconveniance of relying on lifts to get to work, not riding my motorbike and generally everything else that comes with using crutches)

I know Im only at the start of my recovery, Im expecting a fair amount of soreness/pain when I can actually start rehab, but Im sooo looking forward to getting this cast off!!

Ill update this thread in a few more weeks time to let you know how Im getting on.

Hope this thread is helpfull to anyone getting ready to go through a similar thing, and if anyone has any questions Ill be happy to reply.
I've tried (dont know if it has worked) to attach a photo of my ankle 2 weeks post op and off my pre op X-ray.

[pudding_bowl]

Brilliant. Thanks for the reply. Don't you love the big arrows on your ankle so they don't get wrong one :P

[mnob07]

If you have any updated information on your condition, can you please provide it? including information, recovery time, treatment, anything else about your initial injury.

I have recently fractured my lateral mallelous. It was an avulsion fracture (ligament tore piece of the bone off) so it sounds similar to your original injury. It came from a very bad twist of the ankle (running and jumping, landing poorly)

It's hard to keep off it completely because there is little pain and my lifestyle is filled with moving around a lot. The first x-rays (that I've seen) were one week from injury and the bone was just about where it was supposed to be. the next week, it was a bit displaced (I do not know how far but it looked a little lopsided) however "nothing to worry about" according to the doctor. It's been another two weeks since then will not see another xray until I get the cast off next week, then I have the choice of a walking boot (which I desperately want but healing comes first).

It's been 4 weeks since the injury and I've had little pain, just a little soreness at the site of fracture (and in the ligaments around it) but only occasionally do I feel any soreness there and I have full feeling and control of toes/etc.

I'm very concerned about it healing properly though, my doctor said the bone will probably "scar into place" and not cause any problems; he is more concerned about the ligament (although he did not run any tests or anything to see how the ligaments are doing or if they're injured). But what does the piece of bone scar to if not in the original spot? I feel I'll probably have problems 10 years from now and just trying to learn anything I can about this kind of injury (anyone else can chime in too!)

[bigalrobbo]

Hi there,
I originally "broke" my ankle in a very similar way to you by the sounds of it. Landing full weight with my foot not squarely planted on the floor. Ankle rolled and the ligament snapped the tip of the bone off. I couldnt possibly comment on the fact your doctor has said "the bone will probably scar into place" but I can speak of my own experience. My ligaments were intact and still attached to the piece of broken off bone and thats the way it stayed for over 10 years from the time of the original injury. I had a cast on for 6 weeks all those years ago and the bone definately did not "scar" back into position.
My surgeon recommendeed removeing this piece of loose bone due to the fact that it would be too tricky to re-attach. Ligament now held in place with bone anchors (which I can feel under my skin!!)
Its been around 7 months since my surgery. I had 2 physio sessions where I was shown stretching exercises and left to crack-on on my own. Ive been doing the exercises and the ankle was feeling fine - strong - no pain. I've been mountain biking heavily for the last 3 months and I have started to get a little soreness around the ankle but my surgeon said I should allow 6 months for full recovery. I have my last follow up consultation on Thursday, so Ill post again to let you know what is said.

I would definately ask your surgeon to make sure that the bone re-attaches itself - otherwise you will be in exactly the same situation as I was. An ankle injury not properly healed and progressively getting worse over time. Hopefully the cast will have held the bone in a position where it starts to heal itself.

I would use the walking boot. The one I had was not very restrictive and definately gave me confidence back when walking around again worrying if I was going to roll my ankle.

Let me know how you get on.

[mnob07]

It's really great to hear from someone that has been in a similar position! thank you for your reply.

My doctor did say the bone will scar in but not necessarily where it was before (he did say there would be a very low chance of it actually attaching to exactly where it was before). His aspiration for the injury was a little confusing to me because I don't know where else it would scar to... he didn't talk about prior experience seeing the type of injury and he dismissed surgery (which to me sounds inevitable).

It is a bit uncomfortable knowing that this injury is not going to heal properly. And that I will be performing physical activities such as running, weight lifting (e.g. squats), rock climbing, sports, (this list goes on), with an injured ankle. I don't really understand how the mechanics/stability of the foot is compromised but the thought of having a loose piece of bone makes me squeamish. Upon me asking, my doctor tried to explain the mechanics of the ankle relative to this bone/ligament but mostly to convince me to stay off of it (because applying pressure to the foot could shift the bone).

I will definitely update with how my injury heals, next week and when I get out of the walking boot at least. Then if there is any problem or lack there of later. I found this post when searching for my specific fracture and I imagine others will find this in the same way.

So for 10 years you had this loose bone? And you were able to perform at your regular activities such as biking/football? It wasn't until some years later that it was aggravated again... was this due to cruciate reconstruction surgery or the stress from some other activity? Did the bone get further displaced or broke free of whatever connective tissue it healed to (or what else caused pain/discomfort to return)?

[mnob07]

Got my walking boot today (5 weeks since injury). Doc showed me the xrays and the bone definitely didn't mend back to the main bone but it IS still undisplaced which is good. He said that he did not expect it to mend back but that it doesn't really matter because the ligaments are holding it in place (surely not the ligament that tore it off in the first place though? I'm still confused about how it can be considered healed if still broken but oh well...)

Nonetheless, he said I would forget the injury happened in a couple months time. Hopefully I'm never reminded of it again, which would mean the ankle has redundant connections by design. Hate to be a pessimist, but I do expect to be reminded of this injury again in due time...

Pain has been virtually nonexistant. Some discomfort/soreness but only sometimes randomly. I mostly, even when moving around, feel no discomfort at all.

Will update again in three weeks. That's when I'm supposed to get out of the walking boot for good (and into some physical therapy)

[mnob07]

I should have grabbed photos of my x-ray, but mine looked similar to the preop x-ray the OP posted (although the OP's bone seems to have more calcium connecting to the main bone... I don't remember seeing any similar connection in mine but of course I am not licensed to interpret x-rays).

At first glance it seems an almost identical injury, however my doc is saying mine is not displaced. In contrast, the OP's was considered displaced? I am now also confused as to why, biologically, the OP began having having pain with it (would anyone be able to answer that?).

Again, very helpful to hear from someone with a similar injury, thanks OP for your posts. It's good to know the option of what could come next.