Concerns About Possible Displacement After Ankle Surgery: A Patient's Inquiry

Left calf fracture has undergone surgery and is suspected to be displaced?

Hello, on June 23, I underwent surgery for fractures in both legs, specifically the lower legs and the inner and outer malleoli in Thailand (the right inner malleolus was not operated on but is slightly displaced).
When I compare the left inner malleolus with the right ankle, I notice that the indentation where the calf bone meets the inner malleolus on the left side is deeper.
I would like to ask the doctor if there is a possibility of displacement or if this is part of the recovery process.
Additionally, since it has been a month since the surgery and I am starting to bear weight, could this have an impact? A doctor in Taiwan mentioned during my follow-up that the plates and screws are properly aligned, but I am currently concerned that walking might cause displacement.
I am also undergoing rehabilitation therapy; is it possible that massage could lead to displacement? Both feet are slightly swollen; should I pause rehabilitation? Thank you for your patience and assistance.
Below is the diagnosis certificate from the Thai doctor: Diagnosis: Open fracture of the left ankle, closed fracture of the right ankle.
Treatment: Surgery with ORIF (Open Reduction and Internal Fixation) with plate and screws for both ankles on June 23, 2023, and post-operative physical therapy using a wheelchair.

An An, 20~29 year old female. Ask Date: 2023/09/22

Dr. Chen Yongxue reply Orthopedics

Hello, the possibility of displacement after a fracture is not negligible.
It is essential to rely on pre-operative and post-operative X-rays.
Rehabilitation should generally wait for at least two months or until there are signs of healing at the fracture site visible on X-rays before starting.
Thank you.

Reply Date: 2023/09/22

More Info

After undergoing surgery for ankle fractures, it is understandable to have concerns about the healing process and the potential for displacement of the bones. Based on your description, it seems you had surgery on both ankles, with the left ankle showing some differences in contour compared to the right. Here are some insights and recommendations regarding your situation.

Understanding Bone Healing and Displacement
1. Bone Healing Process: After an orthopedic surgery involving fractures, the healing process can vary significantly from person to person. Generally, it takes several weeks to months for bones to heal adequately. During this time, it is common for patients to experience swelling, tenderness, and changes in the contour of the ankle. The depth of the indentation you feel may be due to swelling or the way the soft tissues are healing around the bone rather than an indication of displacement.

2. Signs of Displacement: Displacement refers to the misalignment of bone fragments after a fracture. If the surgical hardware (plates and screws) is properly positioned and the doctor has confirmed this during follow-up visits, the risk of significant displacement is lower. However, signs that may indicate displacement include increased pain, visible deformity, or inability to bear weight on the affected limb. If you are experiencing any of these symptoms, it is crucial to consult your orthopedic surgeon.

3. Impact of Early Weight Bearing: You mentioned that you began to bear weight on your legs one month post-surgery. While early mobilization can be beneficial for recovery, it is essential to follow your surgeon's specific recommendations regarding weight-bearing activities. If your doctor advised you to start walking, it is likely that they assessed your healing progress and deemed it safe. However, if you feel discomfort or notice changes in your ankle's appearance, it is wise to limit weight-bearing activities until you can discuss these concerns with your healthcare provider.

Rehabilitation and Physical Therapy
1. Role of Rehabilitation: Engaging in rehabilitation is crucial for regaining strength and mobility after ankle surgery. Physical therapy can help improve range of motion, strengthen the surrounding muscles, and enhance overall function. However, it is essential to communicate with your physical therapist about any discomfort or concerns you have during therapy sessions.

2. Massage and Movement: While gentle massage can aid in reducing swelling and improving circulation, it is vital to avoid aggressive manipulation of the ankle, especially if you are concerned about displacement. Always inform your therapist about your worries, and they can adjust the treatment plan accordingly.

3. Monitoring Swelling: Some swelling is expected after surgery, but if you notice significant or increasing swelling, it may be a sign to take a step back. Elevating your legs, applying ice, and resting can help manage swelling. If the swelling persists or worsens, seek medical advice.

When to Seek Medical Attention
If you have ongoing concerns about the alignment of your bones or the healing process, do not hesitate to reach out to your orthopedic surgeon. They may recommend imaging studies, such as X-rays, to evaluate the position of the bones and the integrity of the surgical hardware.
In summary, while some changes in the contour of your ankle may be normal during the healing process, it is essential to remain vigilant for any signs of complications. Continue with your rehabilitation, communicate openly with your healthcare providers, and prioritize your recovery. Your health and peace of mind are paramount, so do not hesitate to seek further evaluation if you feel it is necessary.

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