Open Fractures of the Tibia and Fibula: Recovery Insights

Tibial and fibular open fracture with internal fixation?

On April 7, I was involved in a car accident resulting in an open fracture of the tibia and fibula in my lower leg.
I underwent surgery the same day for wound closure and external fixation.
On May 7, one month later, the external fixation was removed, and an internal plate was successfully implanted.
The doctor advised me to return monthly for follow-up visits until the wound healed and the bones healed properly.

On August 7, after reviewing the X-rays, the doctor noted that the bone had grown a little, so my follow-up appointments were changed to every two months.
On October 12, after examining the X-rays, the doctor said that the fibula was healing well, but the tibia had not yet healed.
However, he mentioned that I no longer needed to come for follow-ups, as the bone healing was progressing satisfactorily.
He instructed me to return in a year to have the internal fixation removed.
As of October 12, I am currently using two crutches.
The doctor said I could gradually transition to using one crutch, then switch to a trekking pole for assistance, and eventually walk independently.
However, he did not specify the timeline for this process.
The progression is as follows: "two crutches → one crutch → trekking pole → independent walking." The doctor advised me to rely on my own feelings to make this transition gradually.
Now, on November 7, seven months have passed, and I have been using one crutch for a month.
I would like to ask the doctor, "Can I walk without any assistive devices now, or do I need to wait until the bones are fully healed? If I stop using any assistive devices now, will the internal plate bend?"

ian, 20~29 year old female. Ask Date: 2016/11/07

Dr. Shi Guozheng reply Orthopedics

After a fracture has completely healed, the crutches can be discontinued.
If the fracture has not fully healed, there is a possibility that the bone plate may deform.

Reply Date: 2016/11/07

More Info

Open fractures of the tibia and fibula, particularly those resulting from traumatic incidents such as car accidents, can present significant challenges during recovery. Your experience, which includes an open fracture followed by surgical intervention and ongoing rehabilitation, is not uncommon. Understanding the recovery process and the factors influencing healing can help you navigate this journey more effectively.

Recovery Timeline and Expectations
From your description, it appears that you have undergone a structured recovery process, which is crucial for optimal healing. After an open fracture, the initial focus is on stabilizing the fracture and preventing infection, which is why you had an external fixator followed by internal fixation with plates. The timeline for recovery can vary significantly based on several factors, including the severity of the fracture, the presence of any complications (like infection), and your overall health.

1. Healing Process: The healing of bone fractures typically follows a predictable pattern. Initially, a hematoma forms at the fracture site, followed by the formation of a soft callus, which eventually becomes a hard callus as the bone heals. In your case, the tibia appears to be healing slower than the fibula, which is not unusual given the differences in blood supply and mechanical stress on these bones.

2. Follow-Up Appointments: Regular follow-ups with your orthopedic surgeon are essential. These appointments allow for monitoring the healing process through X-rays and clinical assessments. Your doctor’s recommendation to extend the interval between visits suggests that they are confident in your healing progress, but it’s important to remain vigilant about any changes in your symptoms.

Use of Assistive Devices
The transition from using two crutches to one, and eventually to walking unaided, is a critical part of your rehabilitation. Here are some insights regarding the use of assistive devices:
1. Gradual Transition: It is generally advised to transition from two crutches to one crutch, and then to a walking stick (like a trekking pole) before attempting to walk unaided. This gradual approach helps ensure that you are not placing undue stress on the healing bone.

2. Listening to Your Body: Your doctor’s advice to rely on your own feelings during this transition is important. If you feel stable and confident, you may begin to reduce your reliance on assistive devices. However, if you experience pain, instability, or discomfort, it is advisable to revert to using your crutches or a walking stick until you feel more secure.

3. Risk of Bone Complications: Concerns about the internal fixation devices bending or failing if you walk without support are valid. While modern orthopedic hardware is designed to withstand significant loads, it is crucial to ensure that the bone is sufficiently healed before placing full weight on it. If you have any doubts, consult your orthopedic surgeon for personalized advice.

Long-Term Considerations
1. Full Weight Bearing: The timeline for achieving full weight-bearing status can vary. Generally, patients may begin partial weight-bearing around 6-8 weeks post-surgery, progressing to full weight-bearing as healing allows. Your surgeon will provide guidance based on your specific healing progress.

2. Physical Therapy: Engaging in physical therapy can enhance your recovery. A physical therapist can provide exercises to improve strength, flexibility, and balance, which are essential for regaining full function.

3. Monitoring for Complications: Keep an eye out for signs of complications, such as increased pain, swelling, or changes in the appearance of the surgical site. If you notice any concerning symptoms, reach out to your healthcare provider promptly.

Conclusion
In summary, your recovery from an open fracture of the tibia and fibula is a multifaceted process that requires careful monitoring and gradual progression. While it is encouraging that your healing is progressing well, it is essential to remain cautious and attentive to your body’s signals. Always consult your orthopedic surgeon before making significant changes to your rehabilitation plan, especially regarding the use of assistive devices and weight-bearing activities. With patience and adherence to your recovery plan, you can look forward to regaining your mobility and returning to your daily activities.

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