Ankle Fibula Fracture Recovery and Shape Changes

Fibula fracture

Hello, I have a question: I sustained a fibula distal fracture 7 months ago and had an intramedullary nail implanted for fixation, which has now been removed.
Why do the shapes of the protruding areas of both ankles look different? The injured ankle appears less prominent, looks thicker and rounder, and seems slightly swollen, especially on the inner (anterior) side, although it does not hurt.
In contrast, the uninjured ankle looks sharper and more pronounced.
Is it possible that after the fracture healed, the bone did not return to its original shape and is now thicker than before? Is this normal (I have not had an X-ray since the nail was removed)?

mm, 20~29 year old female. Ask Date: 2005/05/29

Dr. Shi Guozheng reply Orthopedics

You can get an X-ray to see if the bone is thicker in that area; typically, the site of a fracture will appear thicker.
Additionally, the surrounding soft tissue may also be swollen.
If there is no pain, it should be fine.

Reply Date: 2005/05/29

More Info

When dealing with an ankle fibula fracture, especially one that has undergone surgical intervention with internal fixation, it is not uncommon to observe differences in the shape and appearance of the injured ankle compared to the uninjured one. This phenomenon can be attributed to several factors related to the healing process, the nature of the injury, and the body's response to trauma.

Firstly, after a fracture, the body initiates a healing process that involves inflammation, bone remodeling, and the formation of new bone tissue. This process can lead to changes in the shape of the bone and surrounding soft tissues. In your case, the ankle that sustained the fibula fracture may appear more rounded or swollen due to several reasons:
1. Soft Tissue Swelling: After an injury, it is common for the soft tissues around the fracture site to swell. This swelling can persist for some time, even after the bone has healed. The appearance of edema (swelling) can create a feeling of fullness or roundness in the ankle area, particularly on the inner side.

2. Bone Remodeling: The healing process involves the remodeling of bone, which can result in changes to the bone's shape. The body may not always restore the bone to its original contour, especially if there was significant trauma or if the fracture was complex. The new bone may be denser or have a different shape than the original bone, leading to a noticeable difference in appearance.

3. Muscle Atrophy and Weakness: Following an injury and prolonged immobilization, the muscles surrounding the ankle may weaken or atrophy. This can affect the overall contour of the ankle and foot, making the injured side appear different from the uninjured side. Strengthening exercises and physical therapy can help regain muscle mass and improve the overall appearance and function of the ankle.

4. Scar Tissue Formation: Surgical interventions often lead to the formation of scar tissue, which can also contribute to changes in the shape and feel of the ankle. Scar tissue can be less flexible than normal tissue, potentially leading to a feeling of tightness or altered shape.

5. Functional Recovery: While the bone may heal, functional recovery can take longer. If you are experiencing any stiffness or limited range of motion, it may contribute to the perception of swelling or abnormal shape. Engaging in a structured rehabilitation program can help improve mobility and strength, which may also influence the appearance of the ankle over time.

Regarding your concern about the asymmetry between the two ankles, it is essential to understand that some degree of difference can be normal after a fracture. However, if you notice significant swelling, pain, or functional limitations, it is advisable to consult with your orthopedic surgeon or a physical therapist. They may recommend imaging studies, such as X-rays, to assess the healing of the bone and rule out any complications, such as malunion or nonunion of the fracture.

In summary, while it is not unusual for the injured ankle to appear different from the uninjured one after a fibula fracture, ongoing monitoring and rehabilitation are crucial. If you have concerns about the appearance or function of your ankle, do not hesitate to seek professional advice to ensure a comprehensive recovery.

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