Post-Cast Recovery: Addressing Concerns After Fibula Fracture Surgery

Questions about rehabilitation after fibula fracture cast removal?

Dear Consultation Team,
I have a fracture and dislocation near the joint of my right fibula.
On July 20, I underwent a surgical procedure to fixate the bone with screws and was placed in a cast.
The cast was removed six weeks later on August 30, 2019.
According to my attending physician, I was allowed to bear weight on my right foot, and I could use either crutches, a single cane, or walk without any support based on my comfort level.

On the first day after the cast was removed, I was so excited that I walked for about 30 minutes, primarily using a single cane.
However, when I returned home to take a shower, I noticed that the inner side of my right ankle (the opposite side of the wound) had swollen and was quite painful.
Today marks the third day since the cast was removed (September 2), and the swelling on the inner side of my ankle is still very painful, including my calf.
Although the doctor mentioned that it is normal to experience soreness when starting to walk, I became very anxious when I noticed that an area that had been gradually reducing in swelling suddenly became swollen again due to walking and other activities.
I am scheduled to travel abroad at the end of September and hope to recover my ability to walk normally soon.

Additionally, I have encountered various opinions online, and I couldn't find any articles that match my situation.
Therefore, I kindly request the consultation team to address my concerns:
1.
Regarding the swelling and pain, should I return to my original clinic for a check-up, or should I seek another clinic for examination?
2.
Is there a risk of the screws becoming dislodged if I do not engage in vigorous activities such as running or jumping?
3.
Is this swelling a normal reaction to starting to walk? What could be the underlying causes, and what are the recommended management strategies?
Thank you for your assistance.

Niming, 20~29 year old female. Ask Date: 2019/09/02

Dr. Zhan Xian reply Orthopedics

After removing the cast, walking should be gradually increased and not done excessively at once.
If there is slight swelling, elevate the limb and rest.
If pain and swelling do not improve, consider returning to the original clinic for follow-up.

Reply Date: 2019/09/02

More Info

Post-cast recovery after a fibula fracture surgery can be a challenging and sometimes confusing process. It's essential to understand the healing process and address any concerns you may have. Let's break down your questions and provide some insights based on medical knowledge.

1. Regarding Swelling and Pain: It is not uncommon to experience swelling and pain after removing a cast, especially after being immobilized for an extended period. When you start to walk again, your body is adjusting to the new demands placed on it. The swelling you noticed, particularly on the inner side of your ankle, could be due to several factors, including increased blood flow to the area as it begins to heal, inflammation from the surgical site, or simply the effects of gravity when you are upright. If the swelling persists or worsens, it would be wise to return to your original orthopedic clinic or consult a healthcare provider to rule out any complications, such as a blood clot or infection.

2. Concern About Hardware Movement: The concern about the steel pins moving or "running away" is valid, but it is generally unlikely if the hardware was properly placed and the bone is healing as expected. The pins are designed to stabilize the fracture, and as long as you follow your doctor's advice regarding weight-bearing and activity levels, the risk of hardware displacement is minimal. However, if you experience significant pain or instability, it is essential to consult your physician.

3. Understanding Swelling as a Normal Reaction: The swelling you are experiencing can indeed be a normal reaction to resuming activity after a period of immobilization. When you start walking, the muscles and tissues that have been inactive may react with inflammation as they begin to work again. This is part of the healing process. To manage this swelling, consider the following strategies:
- Elevation: Keep your foot elevated when resting to help reduce swelling.

- Ice Therapy: Applying ice to the swollen area can help decrease inflammation and numb pain.

- Compression: Using a compression bandage can help control swelling, but ensure it is not too tight to avoid restricting blood flow.

- Gradual Increase in Activity: Gradually increase your activity level rather than jumping into long walks. This allows your body to adapt without overwhelming it.

In summary, while it is normal to experience some swelling and discomfort after removing a cast, persistent or worsening symptoms should be evaluated by a healthcare professional. Following your doctor's advice on activity levels is crucial for a successful recovery. If you have any further concerns or if your symptoms do not improve, do not hesitate to seek medical attention. Your health and recovery are the top priority, especially with your upcoming travel plans.

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