Tibia and Fibula Fractures: Recovery and Rehabilitation Insights

Tibial and fibular fracture

Hello, Director Chen! I have a closed tibial and fibular fracture in my lower leg.
On December 1st, I had a plate inserted in my tibia, while the fibula had a hairline fracture near the knee and was not completely broken, so the doctor did not perform any treatment on it.
Three days after the surgery, the doctor said I could use a walker to get out of bed and move around.
However, during my follow-up appointment on December 18th, it was found that my foot was tilted about 30 degrees.
The doctor mentioned that due to the minimally invasive surgery, it might not have been corrected properly, so on December 20th, I underwent another surgery to adjust the angle.
I would like to ask you:
1.
Is it appropriate to get out of bed and walk with a walker just three days after surgery when no treatment was done on the fibula? Could this worsen my condition?
2.
Is the recovery time calculated from the first surgery or the second one? If it's from the first, I am almost at four months post-op, so why is my ankle still swollen and painful when using crutches, and why does my knee feel stiff and painful, even hot at times?
3.
After the second surgery, during my follow-up visits, the doctor has not taken any X-rays.
Each time, he says that the bones do not heal quickly and advises me to walk more and do pump exercises to reduce ankle swelling.
When can I expect to walk normally without crutches? Thank you for taking the time to respond!

Xiao Hui, 40~49 year old female. Ask Date: 2022/03/13

Dr. Chen Yongxue reply Orthopedics

1.
If the fibula has not been treated, can I get out of bed and walk three days after surgery? Will it worsen the condition? Fibular fractures, unless they occur at the ankle, typically do not require fixation.
The time to get out of bed after surgery can be quite early, but it is generally not recommended to bear weight.
You should use crutches or a walker for mobility.
2.
Is the recovery time calculated from the first surgery or the second? If it is from the first surgery, I am almost four months post-op, so why is my ankle still swollen and painful when I walk with crutches, and why does my knee feel stiff and even hot? This depends on the procedure performed during the second surgery.
Ankle swelling is quite common in patients with lower limb fractures due to the inability to bear weight, lack of muscle contraction, and poor blood circulation.
It will gradually improve once you start bearing weight.
In the short term, elevating the affected limb can help reduce swelling.
3.
After the second surgery, the doctor has not taken X-rays during my follow-up visits.
Each time, they say that the bone does not heal quickly and advise me to walk more and perform pump exercises to reduce ankle swelling.
When can I expect to walk normally without crutches? This question is best directed to your attending physician.
Thank you.

Reply Date: 2022/03/13

More Info

In addressing your concerns regarding tibia and fibula fractures, particularly in the context of your recent surgeries and recovery, it's essential to understand the nature of these injuries and the rehabilitation process involved.

1. Immediate Post-Operative Mobility: After your initial surgery on December 1st, your doctor allowed you to use a walker just three days post-operation. This is not uncommon in cases where the fibula is not fully fractured and is stable enough to bear some weight. However, the decision to allow weight-bearing activities so soon can vary based on the specific nature of the fracture, the surgical technique employed, and the overall stability of the limb. If the fibula is not fully fractured and the tibia is stabilized with a plate, limited weight-bearing may be permissible. However, it is crucial to follow your surgeon's advice closely, as premature weight-bearing can lead to complications, including malalignment or delayed healing.

2. Recovery Timeline: The recovery timeline is generally calculated from the date of the most recent surgery, which in your case is the second surgery on December 20th. Each surgical intervention can reset the healing clock, especially if adjustments were made to correct alignment issues. It is not unusual for patients to experience swelling and discomfort in the ankle and knee during the recovery phase, particularly if there has been a history of surgery and trauma. The presence of swelling and pain can be attributed to several factors, including inflammation, the body’s healing response, and potential overuse of the limb during rehabilitation exercises.

3. X-Ray Monitoring and Rehabilitation: It is concerning that your doctor has not performed follow-up X-rays after the second surgery. Regular imaging is critical to assess the healing process, especially after surgical interventions. If you feel that your concerns are not being adequately addressed, it may be beneficial to seek a second opinion or request further imaging to ensure that the bones are healing correctly. Your doctor’s advice to engage in walking and pump exercises is standard practice to promote circulation and reduce swelling; however, it should be balanced with adequate rest and protection of the injured area.

4. Timeline for Normal Mobility: The timeline for returning to normal walking without crutches can vary widely among individuals, depending on factors such as the severity of the fractures, the surgical technique, and your overall health. Generally, patients may expect to begin walking without assistance anywhere from 6 to 12 weeks post-surgery, but this can be longer if complications arise or if the healing process is slower than anticipated.
5. Pain Management and Rehabilitation: Persistent pain and swelling in the ankle and knee can indicate that you may be overexerting yourself or that there are underlying issues that need to be addressed. It is essential to communicate these symptoms to your healthcare provider. They may recommend physical therapy to strengthen the muscles around the knee and ankle, improve range of motion, and facilitate a safe return to normal activities.

In conclusion, your recovery from tibia and fibula fractures involves careful monitoring and adherence to your doctor's recommendations. If you continue to experience significant pain and swelling, or if you feel uncertain about your recovery progress, do not hesitate to seek further medical advice. Engaging in a structured rehabilitation program, possibly under the guidance of a physical therapist, can also be beneficial in regaining strength and mobility in your leg.

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