Tibia and Fibula Fracture Healing Challenges

Issues with healing of tibial and fibular fractures?

Hello Doctor, I sustained a closed fracture of the tibia and fibula in the lower third of my right leg on December 18, 2016.
I underwent surgery and had an intramedullary nail inserted.
During my follow-up appointment on February 3, 2017, the X-ray showed that there was still no callus formation.
How long does it typically take for callus formation to be visible on an X-ray? It has been one and a half months, and I am concerned that the healing process may be slow.
Is it true that fractures lower down the leg take longer to heal? Additionally, while the swelling in my leg has significantly decreased, my ankle appears darker red compared to my normal foot when I do not elevate my leg.
Could this indicate poor blood circulation?

Livy, 20~29 year old female. Ask Date: 2017/02/09

Dr. Hong Ximing reply Orthopedics

A fracture of the distal one-third of the tibia and fibula may have a slower blood supply and circulation; however, since surgical reduction and fixation have been performed, it should heal properly.
As for the ankle being darker red, this is a normal phenomenon associated with weaker muscle strength.
Elevating the leg and performing strength exercises during rehabilitation can help improve this condition.

Reply Date: 2017/02/09

More Info

When dealing with tibia and fibula fractures, particularly in the context of your injury from December 2016, it's essential to understand the healing process and the factors that can influence recovery.
First, let's address the timeline for bone healing. Generally, bone healing can be divided into several stages: inflammation, soft callus formation, hard callus formation, and bone remodeling. The formation of a visible callus on X-rays typically begins around 2-3 weeks post-injury, but it can take longer depending on various factors, including the severity of the fracture, the patient's age, nutritional status, and overall health. In your case, at 1.5 months post-surgery, it is not uncommon for the callus to still be forming, especially if the fracture was complex or if there are other underlying health issues affecting bone healing.

Regarding the location of the fracture, it is true that fractures in different locations can heal at different rates. Generally, fractures closer to the knee (proximal) may heal faster than those closer to the ankle (distal). This is due to the differences in blood supply and mechanical stress on the bones. However, the tibia and fibula are both long bones, and healing can vary significantly among individuals.

Your concern about the discoloration of your ankle is also valid. The black-red coloration you are observing when your leg is not elevated could indicate a few things. It might be a result of venous stasis, where blood pools in the lower extremities due to gravity, especially if you are not moving around much. This can happen after a fracture and immobilization, as the muscles that help pump blood back to the heart are not being used as much. It's crucial to keep your leg elevated when possible to help improve circulation and reduce swelling.
If you are experiencing persistent swelling, discoloration, or pain, it is essential to communicate these symptoms to your healthcare provider. They may want to assess for any complications, such as deep vein thrombosis (DVT), which can occur after prolonged immobility, or other circulatory issues.

In terms of your overall recovery, patience is key. Bone healing can be a slow process, and while it is natural to feel anxious about the progress, it is essential to follow your doctor's advice regarding weight-bearing activities and rehabilitation exercises. Engaging in physical therapy can help improve circulation, strengthen the muscles around the fracture site, and promote healing.

In summary, while it may feel concerning that you have not yet seen bone callus formation on your X-ray, it is not uncommon at this stage post-injury. The location of your fracture and your overall health can influence healing times. Pay attention to your symptoms, maintain communication with your healthcare provider, and follow their recommendations for rehabilitation to support your recovery.

Similar Q&A

Post-Surgery Recovery Challenges After Tibia and Fibula Fracture: Seeking Solutions

Hello, last July I suffered a fracture of the tibia and fibula in my lower leg, and underwent fracture reduction and fixation with a locking plate. The doctor recommended purchasing a pneumatic brace, but I have not actually worn it for walking. Four months post-surgery, the doct...

Dr. You Dianqi reply Orthopedics
If you experience any discomfort, it is recommended to consult your primary care physician for evaluation. Subsequent physical therapy can be pursued at the rehabilitation department outpatient clinic. Thank you.

Challenging Recovery from Distal Tibia-Fibula Fracture: Healing Strategies

On July 20, 2016, I was involved in a car accident that resulted in a comminuted fracture of the distal tibia and fibula. Traction was performed on the same day, and on July 29, I underwent external fixation surgery (due to trauma, I had to wait for the wound to heal). On August ...

Dr. Li Yongheng reply Orthopedics
Hello, you have sustained a distal tibiofibular comminuted fracture with poor healing, and you have undergone an autologous bone grafting procedure. If the fracture continues to heal poorly, you may require another autologous bone grafting surgery in the future. In addition to au...

Understanding Open Fractures: Recovery Challenges After a Tibia and Fibula Injury

Hello Doctor: I have an open comminuted fracture of the tibia and fibula in my right lower leg due to a car accident, which was surgically repaired on November 8 of this year with internal fixation using plates and screws. However, due to the presence of a traumatic wound, I have...

Dr. Li Wenlin reply Orthopedics
1. If the wound is not healing well, a splint can be used to support the area for easier wound management, although it is not as effective as a cylindrical cast for stabilization. 2. The treatment should be based on X-ray findings, as the distal tibia near the ankle joint may b...

Understanding Tibial Nonunion: The Role of Fibula Grafting Surgery

Hello Dr. You, I was in a car accident on November 26, 2019, which resulted in an open and comminuted fracture of my right tibia. On December 2, 2019, Dr. A performed an intramedullary nailing surgery. To this day, the fracture site has not healed. I have consulted with two other...

Dr. You Dianqi reply Orthopedics
Hello: Online Q&A is not face-to-face medical care, and it can easily lead to misunderstandings; the following is for reference only. The larger the bone defect, the more difficult the healing process, which may require more complex surgeries, such as vascularized fibula graf...