Post-Fracture Recovery: Addressing Common Concerns and Complications

Issues Related to Fractures

Hello Dr.
Shih,
On the evening of October 13th of this year, I was involved in a car accident that resulted in an open fracture of my right tibia and fibula.
Subsequently, the doctor performed surgery to install bone screws and plates, and applied a long cast from the sole of my foot to above my knee, secured with gauze.
I was discharged on November 16th and had my first follow-up appointment on November 22nd, where the doctor stated that the cast was no longer necessary and removed it.
After that, I noticed significant swelling in my knee and ankle.
During my second follow-up appointment on December 14th, the doctor mentioned that my bones had not yet healed, and I was still not allowed to put weight on my foot.
Additionally, the range of motion in my knee was quite limited (only about 30 degrees) due to adhesions caused by the cast, although my knee itself was not injured.
After returning home, I diligently performed the exercises recommended by the doctor, which involved swinging my right leg back and forth while sitting in a chair.
Within two to three days, I was able to achieve 90 degrees of flexion.
However, despite my efforts, I have been unable to bend my knee further, although the swelling in my knee and ankle has significantly decreased.
I would like to ask the following questions:
1.
When the doctor said that my bones have not yet healed, does this refer to the absence of callus formation or that the bones have not yet united?
2.
The doctor mentioned that achieving 90 degrees of knee flexion indicates that there are no adhesions, which I have accomplished.
However, while I can bend my knee to this extent without pain, it feels very tight, and I cannot bend it further.
I am hesitant to apply external pressure for fear of negatively impacting the healing of the fracture.
Is the limitation in movement due to the previous swelling? Will this situation improve naturally over time?
Thank you very much, Dr.
Shih, for taking the time to answer my questions amidst your busy schedule.
Thank you! ^_^

Ruohao, 30~39 year old female. Ask Date: 2016/12/28

Dr. Shi Guozheng reply Orthopedics

The healing of a bone fracture typically requires a period of time, and follow-up X-rays are necessary to assess the healing process.
It is unlikely for the fracture to heal in just two months; usually, it takes three to six months or even longer.
If there is poor flexion in the knee joint, rehabilitation is needed to improve the range of motion.
If there is no fracture, the joint's flexibility usually returns to normal.
Patients can seek rehabilitation services in a physical therapy department.

Reply Date: 2016/12/28

More Info

Dear Henry,
Thank you for your detailed description of your condition following your car accident. It sounds like you have been through a lot, and I appreciate your proactive approach in seeking clarity regarding your recovery. Based on your situation, I will address your concerns and provide some insights into post-fracture recovery, particularly focusing on the complications and common issues that arise.

1. Understanding Bone Healing: When your doctor mentioned that your bone has not yet healed, they are likely referring to the formation of a callus, which is the new bone tissue that forms during the healing process. This callus is essential for stabilizing the fracture site. If the doctor indicated that the bone has not "grown" yet, it could mean that the callus formation is insufficient or that the fracture has not yet achieved union, meaning the ends of the broken bone have not yet connected adequately. This is a critical phase in recovery, and it is essential to follow your doctor's advice regarding weight-bearing and activity levels to avoid complications.

2. Knee Mobility and Adhesions: You mentioned that your knee can bend to 90 degrees, which is a positive sign indicating that there is no significant adhesion. However, the tightness you feel when trying to bend further could be due to several factors, including swelling, muscle stiffness, or even the initial immobilization from the cast. It is common for patients to experience some degree of stiffness after prolonged immobilization. The tightness may improve over time with consistent, gentle stretching and rehabilitation exercises. It is crucial to avoid forcing the knee to bend, as this could lead to further injury or complications.

3. Swelling and Its Impact: The swelling you experienced in your knee and ankle can indeed restrict movement. As the swelling decreases, you may find that your range of motion improves. It is essential to continue with the exercises prescribed by your doctor or physical therapist, as they are designed to promote healing and restore mobility. If you notice that the swelling persists or worsens, it is advisable to consult your healthcare provider for further evaluation.

4. Importance of Rehabilitation: Engaging in physical therapy is vital for your recovery. A physical therapist can provide you with a tailored rehabilitation program that focuses on improving your range of motion, strength, and function. They can also employ techniques such as manual therapy, ultrasound, or electrical stimulation to help reduce pain and swelling.

5. Monitoring Progress: Keep track of your progress and communicate any concerns with your healthcare provider. If you feel that your knee is not improving or if you experience increased pain, it is essential to seek medical advice. Regular follow-ups will help ensure that your recovery is on track and that any complications are addressed promptly.

6. Patience and Persistence: Recovery from fractures, especially complex ones like yours, can take time. It is essential to be patient with yourself and to understand that progress may be gradual. Celebrate small victories, such as improved range of motion or reduced swelling, and stay committed to your rehabilitation exercises.

In conclusion, while it can be concerning to hear that your bone has not yet healed, it is essential to focus on your rehabilitation and follow your doctor's recommendations closely. With time, patience, and the right approach to rehabilitation, you can expect to see improvements in your mobility and overall recovery.

Wishing you a smooth and speedy recovery!
Best regards,
Doctor Q&A Teams

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