Recovery Time and Concerns for Open Fractures of the Ankle - Orthopedics

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Questions related to the recovery time for open fractures of the tibia and fibula?


Hello Doctor: On August 15, I had a car accident resulting in an open fracture of the distal tibia and fibula in my left leg (near the ankle).
I underwent fixation with bone screws and plates, and I am currently attending regular follow-ups and rehabilitation.
I have a few questions:
1.
Since the injury is close to the ankle, my left foot's range of motion differs from my normal right foot.
Will there be any long-term consequences during recovery? (Will I regain the ability to move it up and down, side to side, and rotate? I will have my cast removed on September 18.)
2.
It has been two months since the injury, but my attending physician has advised that I still cannot bear weight.
Based on experience, when can a typical person start partial weight-bearing and when can they achieve full weight-bearing? (Considering an open fracture of the tibia and fibula, age 35-40 years, with no inflammation.)
3.
What does partial weight-bearing mean? Will I need any assistive medical devices? Are there time and force limitations?
4.
When I achieve full weight-bearing, will my walking appear abnormal?
5.
Will the bone screws and plates need to be removed in the future?
I appreciate your guidance on these matters! Thank you very much!

Houzi, 30~39 year old female. Ask Date: 2006/10/15

Dr. Li Wenlin reply Orthopedics


Hello,
In response to your question, the old saying goes, "It takes a hundred days to heal muscles and bones." If you were injured on August 15, a complete recovery will take at least until the end of November, or even longer.
Therefore, it is reasonable that the range of motion in your left foot is still limited at this stage.
If the condition improves day by day, you should regain more function in the future.
As for the possibility of residual effects, it depends on the type of fracture, the surgical method used, the patient's bone quality, and the rehabilitation process post-surgery.
For simple ankle fractures, recovery should exceed 95%.
However, if it is an open fracture or one that affects the joint surface, functional recovery may be poorer.
Generally, for distal tibia and fibula fractures, a cast should be applied for six weeks post-surgery.
After six weeks, the cast can be removed, and you should begin partial weight-bearing with crutches.
The standard method for partial weight-bearing is to first move both crutches under the armpits, then move the affected limb behind the crutches (with only a little weight on the toes of the affected limb).
Using the strength of your hands (while keeping the affected limb as weightless as possible), shift your healthy limb back behind the crutches, ensuring that the weight is placed on the healthy limb.
Repeat this process to move more freely.
For partial weight-bearing, you can use a scale.
Initially, only the toes should lightly touch the ground.
If there is no pain, you can gradually increase the weight on the affected limb, typically starting with one-quarter of your body weight and gradually increasing to one-half.
Only after you can bear more than half of your body weight should you switch from crutches to a single cane, which should be placed on the healthy side.
There are no specific limits on how far or how long you can walk; the standard practice is to walk more as long as there is no pain.
However, if you experience pain or if the pain persists the next day after walking, it indicates that you need to slow down.

Current guidelines suggest that if there are no adverse conditions related to anesthesia or surgery, plates and screws should be removed.
However, each case is different, and you should discuss this with your attending physician before making a decision.
Your attending physician understands your situation best, so please communicate with them frequently.
Wishing you a speedy recovery!

Reply Date: 2006/10/15

More Info


Recovering from an open fracture, especially one located near the ankle, can be a complex process that varies significantly from person to person. Here’s a comprehensive overview addressing your concerns based on the information provided.


1. Recovery and Potential Residual Effects
Given that you sustained an open fracture of the distal tibia and fibula, the recovery process will depend on several factors, including the severity of the fracture, the surgical intervention, and your adherence to rehabilitation protocols. Open fractures, particularly those near the ankle, can lead to complications such as stiffness, reduced range of motion, and potential post-traumatic arthritis.
In terms of movement, while it is common for the affected ankle to have a different range of motion compared to the uninjured side during the early stages of recovery, many patients experience significant improvement over time. With diligent rehabilitation, it is possible to regain most, if not all, of the functional movement, including up-and-down and side-to-side motions, as well as rotation. However, the extent of recovery can vary, and some individuals may experience lingering stiffness or discomfort.


2. Weight Bearing and Mobility
Typically, after an open fracture, the timeline for partial weight-bearing usually begins around 6 to 8 weeks post-surgery, depending on the healing progress observed through follow-up X-rays and clinical evaluations. Since you are currently at the 2-month mark, it is understandable to feel frustrated if your doctor has advised against weight-bearing activities.
In general, the timeline for transitioning to full weight-bearing can range from 3 to 6 months, contingent upon the healing of the fracture and the absence of complications. It is crucial to follow your physician's recommendations closely, as premature weight-bearing can lead to setbacks in recovery.


3. Understanding Partial Weight Bearing
Partial weight-bearing (PWB) means that you are allowed to place some weight on the injured leg, but not the full weight of your body. This is often facilitated using assistive devices like crutches or a walker. The goal is to gradually introduce weight to the healing bone while minimizing the risk of re-injury.
When practicing PWB, it is essential to listen to your body. If you experience pain, it may indicate that you are placing too much weight too soon. A common approach is to start with just the toes touching the ground and gradually increase the weight as tolerated, often starting with about 25% of your body weight.


4. Walking Mechanics Upon Full Weight Bearing
When you transition to full weight-bearing, it is not uncommon for your walking pattern to feel awkward or "off" initially. This is often due to muscle weakness, stiffness, or altered biomechanics resulting from the injury and immobilization. With continued rehabilitation and physical therapy, your gait should improve over time as strength and flexibility are restored.


5. Surgical Hardware Removal
Regarding the surgical hardware (plates and screws), the decision to remove them is typically based on individual circumstances, including the type of fracture, the healing process, and any symptoms you may experience (such as pain or discomfort). In many cases, if the hardware is not causing issues, it may be left in place permanently. However, if it becomes symptomatic or if there are concerns about future complications, your surgeon may recommend removal.


Conclusion
In summary, recovery from an open fracture near the ankle is a gradual process that requires patience and adherence to medical advice. Regular follow-ups with your healthcare provider, along with a structured rehabilitation program, will be key to optimizing your recovery. If you have any concerns or feel uncertain about your progress, do not hesitate to communicate openly with your medical team. They are there to support you through this challenging time and help you achieve the best possible outcome. Wishing you a smooth and speedy recovery!

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