Conflicting Medical Advice on Tibia Fracture Recovery: What to Do?

Questions about tibial fractures?

Hello Doctor: I was in a car accident on the evening of October 13, 2016, which resulted in an open fracture of my right tibia and fibula.
I was taken to the hospital for treatment and had bone screws and plates installed.
Since then, I have been returning to the hospital for monthly follow-ups, during which my orthopedic surgeon has consistently advised me not to put weight on my right foot and to use crutches to walk on one leg.
Now, nearly a year later, my orthopedic surgeon still says my bones have not healed properly and has suggested a bone graft.
In August, I could no longer tolerate this and sought a second opinion from another orthopedic surgeon.
After reviewing my X-rays, he advised me to start walking with 80% weight and asked why I had not started walking after almost a year.
I was shocked.
What is going on? One doctor has prohibited me from bearing weight for nearly a year, while another says my foot has not healed properly due to lack of weight-bearing pressure and recommends that I start walking as soon as possible, ideally without crutches, to avoid the risk of developing a nonunion, which would require surgery later.
This has left me feeling very conflicted.
The previous doctor warned me that the screws and plates might break if I put weight on them, while the other encourages me to start walking.
I have begun practicing walking, but after nine months of not using my foot, my muscles have atrophied to the point where I have no strength to walk with crutches.
My second concern is the fear that the screws and plates might break, so I am still supporting myself with my hands on the crutches.
Doctor, can the screws and plates support a weight of 40-50 kg on one leg? Additionally, when I walk, my right ankle feels as if it is twisting with each step, causing pain.
Is this normal? Thank you for clarifying my concerns.

Garcia, 30~39 year old female. Ask Date: 2017/09/03

Dr. Shi Guozheng reply Orthopedics

A tibial fracture that has not healed after a year is considered to be healing slowly.
However, in the case of an open fracture, it may take a year and a half to two years to heal.
If there is significant bone loss, bone grafting may be necessary.
The physician recommends weight-bearing activities, as this may stimulate bone growth.
Experiencing ankle pain while bearing weight could be normal.

Reply Date: 2017/09/03

More Info

It sounds like you are experiencing a very challenging situation with your tibia and fibula fracture recovery, especially given the conflicting advice from different orthopedic surgeons. Let’s break down your concerns and provide some clarity based on medical principles.

First, it’s important to understand that the healing process for fractures can vary significantly from person to person. Factors such as age, overall health, the type of fracture, and the specific treatment received all play critical roles in recovery. In your case, you have been advised by one doctor to avoid weight-bearing activities for nearly a year, while another has suggested that you start putting weight on your leg. This discrepancy can understandably cause confusion and anxiety.

1. Weight-Bearing and Fracture Healing: Generally, after a fracture, the bone goes through several stages of healing. Initially, the bone forms a soft callus, which later hardens into a more stable structure. Weight-bearing can stimulate bone healing by promoting blood flow and encouraging the formation of new bone tissue. However, if the fracture is not stable or if there are concerns about the integrity of the fixation (like plates and screws), doctors may recommend avoiding weight-bearing activities to prevent complications such as nonunion or malunion.

2. Conflicting Medical Advice: The advice from the second orthopedic surgeon to start weight-bearing activities may be based on the assessment of your X-rays and the overall clinical picture. If the bone appears to be healing well, they may feel that it is safe to begin weight-bearing. However, if you have been non-weight-bearing for an extended period, your muscles will have weakened, leading to atrophy. This is likely why you are experiencing difficulty and pain when attempting to walk.

3. Concerns About Hardware Failure: Regarding your concern about the plates and screws, they are designed to withstand significant loads. In most cases, they can support the weight of the body during normal activities. However, if there is any doubt about the stability of your fracture or the integrity of the hardware, it is crucial to communicate this with your orthopedic surgeon. They may recommend imaging studies to assess the situation.

4. Pain in the Ankle: The pain you are experiencing in your ankle when you attempt to put weight on it could be due to several factors, including muscle weakness, joint stiffness, or even compensatory movements due to the prolonged non-weight-bearing status. It is not uncommon for patients to experience discomfort as they begin to use a previously injured limb again.

5. Next Steps: It would be beneficial to have a thorough discussion with your orthopedic surgeon about your concerns. You might consider asking for a second opinion from a third orthopedic specialist who can review your case comprehensively. In the meantime, if you are starting to practice walking, consider working with a physical therapist who can guide you through the process safely and effectively. They can help you strengthen your muscles, improve your balance, and ensure that you are using proper techniques to minimize the risk of injury.

6. Monitoring Progress: Keep a close eye on your symptoms. If you experience increased pain, swelling, or any other concerning symptoms, it’s essential to seek medical attention promptly.
In summary, while it is essential to follow your doctor's advice, it is equally important to feel confident in the treatment plan you are following. Open communication with your healthcare providers and possibly seeking a third opinion can help clarify the best course of action for your recovery. Remember, recovery from a fracture can be a lengthy process, and patience, along with appropriate rehabilitation, is key to regaining strength and function.

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