Navigating Rehabilitation After a Fracture: Key Questions and Concerns

Rehabilitation issues

On December 19, 2016, I was involved in a car accident resulting in a comminuted fracture of the right navicular bone.
On December 21, I underwent surgery for internal fixation with a self-funded plate.
On February 25, during a follow-up visit, the orthopedic doctor reviewed the X-rays and confirmed that the bone had healed and I could begin rehabilitation.
The physician arranged for physical therapy, but I had to wait for the hospital's notification.
I inquired whether I could start rehabilitation at a small clinic while waiting for the hospital's notification, and the doctor confirmed that I could.
On March 16, during another orthopedic follow-up, I asked the doctor about the expected progress of my rehabilitation.
The doctor indicated that I should be able to walk normally and navigate stairs, but I still could not walk properly, and I experienced a prickling sensation in my injured foot when bearing weight, requiring the use of a walker.
Therefore, the doctor scheduled an MRI for March 27 due to suspected soft tissue issues.
Starting from March 6, I began visiting a clinic for rehabilitation assessment, providing X-rays and CT scans of the injury and post-surgery healing.
I attended rehabilitation six times a week (including heat therapy, ultrasound, traction, and electrical stimulation for a total of one hour).
On March 13, the rehabilitation doctor noted that I was still only able to bear 50-33% weight on the injured foot.
In addition to pain during rehabilitation, I frequently experienced prickling sensations in the injured foot and required pain medication to sleep.
Consequently, the doctor recommended that I see a neurologist at a collaborating hospital.
On March 22, after undergoing nerve conduction studies, the neurologist diagnosed me with distal right peroneal neuropathy and prescribed Euclidan 50 mg for peripheral vascular circulation issues.
I asked the doctor about the possibility of nerve repair surgery, even if self-funded, but the doctor indicated that it was not an option and recommended continuing rehabilitation.
Questions:
1.
Regarding my rehabilitation progress, should I follow the advice of the rehabilitation department or the orthopedic department? As of March 24, I was able to bear 50% weight while walking and attempted to walk for about 5 minutes using only my injured ankle for support, but my legs felt weak.
2.
The neurologist stated that nerve damage is indeed affecting my rehabilitation.
If the normal nerve response is 10 and I only have 2, should I make a new appointment to discuss this with the orthopedic doctor?
3.
Is there a nerve repair surgery specifically for distal right peroneal neuropathy? I went to a small hospital that does not have an operating room.
I found information online about nerve repair surgery and ultrasound-guided injections.
Which department should I consult for an evaluation? I am open to self-funded surgery, as I have heard there is a critical window for nerve repair, and I am concerned about being permanently disabled.
4.
I will have an MRI on March 27, and the report will be available a week later.
What other factors might be affecting my slow rehabilitation, and are there any other specialties I should consult for further evaluation? I apologize for the urgency, but I have heard that there is a critical period for rehabilitation, and I want to start as soon as possible to avoid long-term complications.
Thank you very much for your assistance!

Panghuangzhe, 30~39 year old female. Ask Date: 2017/03/24

Dr. Yin Xinbei reply Rehabilitation

It is unclear whether the distal right peroneal nerve lesion is located at the foot or near the knee in the calf.
The nerve conduction study report should indicate: 1.
The orthopedic department is not yet aware of your nerve damage, so rehabilitation progress will naturally depend on the actual rehabilitation situation.
2.
You can discuss this further during your next scheduled orthopedic follow-up.
3.
There is no indication of a complete nerve transection; it is likely due to a compression injury.
If the area of compression is not subjected to further pressure (from external forces or tissue swelling), the nerve may gradually repair itself.
If you need to inquire further, you should consult a neurosurgeon.
4.
For now, continue with rehabilitation.
In addition to Euclidan, you may take methylcobalamin (active Vitamin B12) and other supplements to promote nerve repair.

Reply Date: 2017/03/24

More Info

Navigating rehabilitation after a fracture, especially following a significant injury like a navicular bone fracture, can be a complex process filled with questions and concerns. Based on your situation, here are some insights and recommendations to help you through your recovery journey.

1. Rehabilitation Guidance: Orthopedic vs. Rehabilitation Specialist
In your case, both the orthopedic surgeon and the rehabilitation specialist play crucial roles in your recovery. The orthopedic surgeon focuses on the structural integrity of your bones and the healing process, while the rehabilitation specialist concentrates on restoring function, strength, and mobility. Since you are experiencing pain and difficulty with weight-bearing activities, it is essential to communicate openly with both specialists. If the rehabilitation progress is slower than expected, it may be beneficial to discuss your concerns with your orthopedic doctor, especially regarding the nerve damage that has been diagnosed.

2. Addressing Nerve Damage
The diagnosis of distal right peroneal nerve injury is significant and can indeed impact your rehabilitation. Nerve injuries can lead to symptoms such as pain, tingling, and weakness, which may hinder your ability to perform rehabilitation exercises effectively. It is crucial to inform your orthopedic surgeon about the nerve condition, as this may influence your overall treatment plan. If your nerve function is significantly impaired, it may require a tailored approach to rehabilitation that considers both the orthopedic and neurological aspects of your recovery.

3. Surgical Options for Nerve Repair
Regarding your inquiry about nerve repair surgery, it is essential to consult a neurologist or a neurosurgeon who specializes in peripheral nerve injuries. They can evaluate the extent of your nerve damage and determine if surgical intervention is appropriate. Nerve repair surgeries can be time-sensitive, often referred to as having a "golden period" for optimal recovery. If surgery is deemed necessary, it is best to act promptly to maximize your chances of regaining function.

4. Additional Evaluations and Imaging
As you prepare for your MRI on March 27, it is vital to consider what other evaluations may be necessary. The MRI will provide detailed images of your soft tissues, which can help identify any additional injuries or complications that may be affecting your recovery. Depending on the MRI results, further evaluations by specialists in physical medicine and rehabilitation, or even pain management, may be warranted.

5. Importance of Early Rehabilitation
You are correct in your understanding that rehabilitation has a "golden period." Early and consistent rehabilitation can significantly influence your long-term outcomes. Engaging in physical therapy as soon as you are cleared to do so is crucial. This may include exercises to improve range of motion, strength training, and functional activities that mimic daily tasks.

6. Pain Management and Sleep
The pain you are experiencing, particularly the "pins and needles" sensation, can be distressing and may affect your sleep. It is essential to manage this pain effectively, as adequate rest is vital for recovery. Discuss with your healthcare provider about adjusting your pain management plan, which may include medications, physical therapy modalities, or alternative therapies.

Conclusion
In summary, navigating your rehabilitation after a fracture involves a multidisciplinary approach. Maintain open communication with your orthopedic surgeon and rehabilitation specialist, address any nerve-related concerns with a neurologist, and ensure you are proactive in your rehabilitation efforts. By doing so, you can optimize your recovery and work towards regaining full function in your foot. Remember, your health and recovery are the top priorities, and seeking the right guidance and support is key to achieving the best possible outcome.

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