Fracture Complications: When to Seek Urgent Medical Attention?

The fracture hasn't healed yet and has been aggravated again?

Hello Doctor: In late December, I injured my foot while rollerblading at school.
I went to see a doctor and had an X-ray, which revealed a comminuted fracture of the smaller bone in my lower leg.
After two weeks of swelling reduction, I underwent surgery on December 31 to have a plate and screws inserted.
Two weeks after being discharged, I returned for a follow-up and found that my wound had become infected.
The doctor mentioned that this type of situation usually occurs in elderly patients, indicating that my healing capacity is poor.
I was hospitalized for a week for debridement, and two weeks later, an X-ray showed that the bone, which had initially been healing well, had shifted slightly.
However, the doctor said it was not a major concern.
Later, while in the school restroom, my crutches slipped, and my foot forcefully hit the ground twice.
After that, I felt significant pain in my heel, my ankle felt warm, and my toes seemed slightly swollen, although my ankle was not swollen and the wound appeared fine.
I was wearing a removable plastic cast when I stepped on the floor.
I would like to ask the doctor if it is urgent for me to seek medical attention, as my next follow-up appointment is in a month.
I would appreciate your advice.
Thank you.

Shanghuan, 10~19 year old female. Ask Date: 2017/02/23

Dr. Hong Ximing reply Orthopedics

If re-injury occurs, it is necessary to return for a follow-up appointment to confirm whether there has been another injury.

Reply Date: 2017/02/23

More Info

In your situation, it is crucial to understand the potential complications that can arise from a fracture, especially after undergoing surgery. Given your history of a comminuted fracture in your leg, followed by surgery to insert plates and screws, it is essential to monitor your recovery closely.
From your description, it seems that you have experienced a setback after your recent incident in the school restroom, where you inadvertently put significant pressure on your healing leg. The symptoms you are experiencing—pain in the heel, warmth in the ankle, and slight swelling in the toes—are concerning and warrant careful consideration.

When to Seek Urgent Medical Attention
1. Increased Pain: If you notice a significant increase in pain that is not relieved by your usual pain management methods, this could indicate a complication such as a fracture nonunion or malunion, where the bone does not heal properly.

2. Swelling and Warmth: The warmth in your ankle and swelling in your toes could suggest inflammation or even infection. While the wound itself appears fine, internal complications can still arise, especially after surgery.

3. Changes in Sensation: If you experience numbness, tingling, or a loss of sensation in your foot or toes, this could indicate nerve involvement, which requires immediate evaluation.

4. Mobility Issues: If you find it increasingly difficult to move your foot or if you experience instability, this could suggest that the hardware (plates and screws) may have shifted or that there is a new fracture.

5. Signs of Infection: Although you mentioned that the wound is not problematic, keep an eye out for systemic signs of infection such as fever, chills, or increased redness around the surgical site.

Recommendations
Given your situation, here are some recommendations:
- Contact Your Surgeon: It is advisable to reach out to your orthopedic surgeon or the medical team that performed your surgery. Explain your recent incident and the symptoms you are experiencing. They may recommend an earlier follow-up appointment or imaging studies (like an X-ray) to assess the integrity of the surgical site and the healing process.

- Monitor Symptoms: Keep a close watch on your symptoms. If they worsen or new symptoms develop, do not hesitate to seek medical attention sooner than your scheduled appointment.

- Rest and Elevation: Ensure that you are resting your leg and keeping it elevated as much as possible to reduce swelling and promote healing.

- Pain Management: Continue to manage your pain with prescribed medications, but do not exceed the recommended dosages. If the pain becomes unmanageable, seek medical advice.

- Physical Therapy: If you have not already been referred to physical therapy, consider discussing this with your doctor. A physical therapist can provide exercises to strengthen the area and improve mobility, which is crucial for recovery.

Conclusion
In summary, while it may be tempting to wait until your next scheduled appointment, your recent symptoms and the nature of your injury suggest that you should seek medical attention sooner rather than later. Complications from fractures can lead to long-term issues if not addressed promptly. Your health and recovery are paramount, so do not hesitate to advocate for yourself and seek the care you need.

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