Ankle Weber B with ORIF - 10 weeks post-op

[sofizmat]

Hello,

I sustained ankle fracture (right) Weber B which was repaired with ORIF (plate + 11 screws). I follow PT, however I have significant difficulties walking due to irritated skin over the ankle.
This also impacts the exercises prescribed by my PT, which normally are not difficult and I am motivated to do them, but about 15-20 minutes after the exercises or after simple walk to the office of 200 meters the skin around the metal implant gets irritated, red and hot. I also feel kind of soft tissue pain (tearing, stretching) in that area. This effect subsides after the rest of 1-2 hours, but it significantly limits my ability to follow PT sessions.
Otherwise no other pain or complaints. I feel I could easily walk about 5 km per day if not the effect afterwards which scares me a little bit.

Just to add that:
- I observe this effect only in the area around the ankle i.e. where the skin moves when walking. The scar above along the calf looks normal.
- I've always had issues with wounds healing and scars - it simply takes quite long time with me
- additionally the scar was significantly irritated by my previous PT, who was enthusiastic about physiotapes and was putting them on the scar despite the fact that I still had scabs there (obviously the scabs were torn off together with the tapes and I had to stop PT for two weeks to allow it to heal).

My questions are;
- is this normal at this stage?
- should I continue PT and ignore the fact that the area is red and irritated?
- is there any way my PT can treat it? She's trying US but I can't see the effect of it.
- is this the reason to opt for removing the plate quicker than one year?

thank you in advance for any advice

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[Judith Mollet]

hello,

i sustained ankle fracture (right) weber b which was repaired with orif (plate + 11 screws). I follow pt, however i have significant difficulties walking due to irritated skin over the ankle.
This also impacts the exercises prescribed by my pt, which normally are not difficult and i am motivated to do them, but about 15-20 minutes after the exercises or after simple walk to the office of 200 meters the skin around the metal implant gets irritated, red and hot. I also feel kind of soft tissue pain (tearing, stretching) in that area. This effect subsides after the rest of 1-2 hours, but it significantly limits my ability to follow pt sessions.
Otherwise no other pain or complaints. I feel i could easily walk about 5 km per day if not the effect afterwards which scares me a little bit.

Just to add that:
- i observe this effect only in the area around the ankle i.e. Where the skin moves when walking. The scar above along the calf looks normal.
- i've always had issues with wounds healing and scars - it simply takes quite long time with me then let it take time or consult your consultant if you still have an outpatient appointment
- additionally the scar was significantly irritated by my previous pt, who was enthusiastic about physiotapes and was putting them on the scar despite the fact that i still had scabs there (obviously the scabs were torn off together with the tapes and i had to stop pt for two weeks to allow it to heal). Why, if it's only 10 weeks now was she using tape?? What was her goal? Not neccessary!

My questions are;
- is this normal at this stage?
- should i continue pt and ignore the fact that the area is red and irritated? infection!Only for exercises perhaps somewhat reduced. If in doubt aske your surgeon or home doctor. You can't afford to have an INFECTION
- is there any way my pt can treat it? She's trying us but i can't see the effect of it. Us us will not help, leave the scar alone or consult a doctor or someone who knows about healing. Us could make everythin worse.
- is this the reason to opt for removing the plate quicker than one year? [B]Could well be if the surgeon is willing or the metal bits are really irritating the soft [/B]tissue

thank you in advance for any advice

what is your range of movement like? Has the physio been too agressive altogether? Sometimes less is more. There's hardly any "padding" around the ankle and the screws and plate relatively near to the surface. The potential for irritation is there. I would not mess around with your scar but concentrate on movement/mobilisation and gradual strenghtening.

[sofizmat]

Dear Judith,

Thank you for your reply.
I will try to comment/reply, but I need to underline at the beginning that some questions are difficult for me to reply as I am not professional, and when going to PT sessions I assume that my PT is and I can trust him, therefore I do not always ask why he is doing this or that.

From your reply and from the follow-up of the story I conclude that I should not have trusted him.

FIRST the follow-up.
Yes, you are right: what I had in my ankle turned out to be bacterial infection probably due to too aggressive PT. My OS got furious on the practices of my PT - especially on kinesiotapes being put on my scar only 6 weeks after operation. This is what in his view started infection as my skin was very delicate at that time and got irritated by the tapes (especially that the scabs were removed and massage performed without disinfecting the scar).
The objective of the tapes? As my PT explained: to get rid of oedema in the ankle.
Now I know the approach was wrong, but it is too late.
My OS would like to remove the hardware as soon as possible - most probably in two weeks time. He says the timing should be OK, as I will hit 3.5 month from operation and the bone should be healed by that time.

In terms of ROM:
difficult to say as nobody has ever measured it, but today at 12 weeks post-op I can easily walk up and down the stairs. Dorsiflexion with famous knee to wall test is only 2 inches smaller than the other ankle. Plantarflexion is almost the same.
For eversion and inversion - hard to say as I've had a sprain there so my PT advised to be cautious with these exercises.


Thank you for your reply
If there is any advice you could give me at this stage of the process, would be grate. But as you see the follow-up is not the best one