Slow Healing in Fibula Fractures: Key Questions Answered

Questions about slow healing of fibula fractures?

Hello Dr.
Wang,
I am currently working in Vietnam and unable to return to Taiwan due to the pandemic.
I have some questions I would like to ask you regarding my condition, which is summarized as follows:
On September 15, I sustained an injury to the outer side of my right leg near the ankle due to a collision, with no abnormalities found on the X-ray.
I experienced mild pain while walking.
On September 30, the pain worsened, and I sought medical attention locally.
The doctor suspected an infection at the injury site and prescribed a three-week course of antibiotics.

On October 28, I still felt pain while walking and sought medical care again.
An X-ray taken that day revealed a fibula fracture, and I was fitted with a long leg cast, which is expected to remain for 4-6 weeks.
The X-ray images can be found here: http://ppt.cc/fNH4hx.

On December 24, after eight weeks, another X-ray was taken, and the fracture had not healed, so the cast could not be removed.
The doctor prescribed a calcium supplement (Calcitriol 0.25 mcg, twice daily, one tablet each time) and a healing medication (Lignum dracaenae cambodianae 280 mg, three times daily, four tablets each time).
The X-ray images can be found here: http://ppt.cc/fZQ2Dx, and the medication packaging is shown here: http://ppt.cc/f4lhDx.

I have the following questions for you, Dr.
Wang:
1.
Based on the X-rays from October 28 and December 24, is there no improvement at all, or is the healing process just slow?
2.
Given that the fracture was already over a month old before the cast was applied, could this lead to nonunion?
3.
How long should the cast be kept on in this situation? After how long would it be considered abnormal?
4.
Should I continue to wait for healing, or should other interventions be considered? Is there a possibility that I may not be able to walk normally again?
5.
Should I take the calcium supplement and healing medication prescribed by the local doctor?
Thank you very much!

Angelina, 30~39 year old female. Ask Date: 2021/12/26

Dr. Wang Jiacheng reply Orthopedics

1.
Slow recovery.

2.
It will still heal.

3.
The cast will be in place for about three months.

4.
Just wait for it to heal.

5.
No medication is needed.

Reply Date: 2021/12/26

More Info

When dealing with a slow-healing fibula fracture, it is essential to understand the factors that can influence the healing process and the appropriate management strategies. Based on the information provided, it appears that the patient sustained a fibula fracture on October 28, and despite being in a cast for eight weeks, the fracture has not yet healed. Here are the answers to your questions, along with additional insights into the healing process of fibula fractures.

1. X-ray Evaluation: The X-ray images taken on October 28 and December 24 indicate that there has been little to no improvement in the healing of the fibula fracture. In general, a lack of visible callus formation or bridging across the fracture site on X-rays after eight weeks suggests a slow healing process. While some fractures may take longer to heal, significant delays can indicate underlying issues such as inadequate immobilization, poor blood supply, or nutritional deficiencies.

2. Timing of Cast Application: Delaying the application of a cast for over a month after the initial injury can indeed contribute to complications in healing. The fibula is a relatively small bone, and any delay in stabilization can lead to increased movement at the fracture site, which may hinder the healing process. However, it is still possible for the fracture to heal, albeit potentially at a slower rate.

3. Duration of Cast Immobilization: Typically, a cast is worn for 6 to 8 weeks for most fibula fractures, but in cases of delayed healing, it may be necessary to keep the cast on for an extended period, possibly up to 12 weeks or more. If there is no sign of healing after this time, further evaluation may be warranted, including the possibility of surgical intervention to promote healing.

4. Next Steps for Healing: It is advisable to continue waiting for the fracture to heal while adhering to the physician's recommendations. However, if there is no improvement after an extended period, additional interventions may be necessary. This could include physical therapy to improve mobility and strength or, in some cases, surgical options such as internal fixation to stabilize the fracture and promote healing. The concern about not being able to walk normally is valid; prolonged non-healing fractures can lead to complications such as malunion or nonunion, which may affect long-term function.

5. Calcium Supplementation and Healing Medications: The prescribed calcium supplement (Calcitriol) and the healing medication (Lignum dracaenae cambodianae) should be taken as directed by the physician. Calcium is crucial for bone healing, and vitamin D (which Calcitriol helps to regulate) is essential for calcium absorption. These supplements can support the healing process, especially in individuals who may have dietary deficiencies or other factors affecting bone health.

In summary, the healing of a fibula fracture can be influenced by various factors, including the timing of cast application, the patient's overall health, and adherence to treatment protocols. It is crucial to maintain open communication with healthcare providers and follow their recommendations closely. If there are concerns about the healing process or if symptoms worsen, seeking further medical evaluation is essential to ensure optimal recovery and prevent long-term complications.

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