Fibula Fractures: My Experience and Key Questions

I have a fibula fracture and would like to ask some questions?

In early November, I was involved in a car accident where my left ankle was run over by a motorcycle.
Due to significant swelling, I immediately went to an orthopedic clinic that day to get an X-ray to confirm whether my bones were intact.
The doctor told me there was no issue.
I then limped along for about two weeks, but since the swelling did not subside and the color looked unusual, I decided to go to a larger hospital for a consultation.
To my surprise, I found out that my left fibula (near the ankle joint) was fractured.
The X-ray of the fracture can be found at this link: http://www.wretch.cc/album/album.php?id=nsepro&book=9.
I would like to ask a few questions, and I appreciate the doctor's responses.
1.
In this situation, is it possible that the initial X-ray did not reveal the fracture? (Because I walked on it for an additional two weeks, could the movement have caused displacement?)
2.
Is this considered a "fracture" or a "hairline crack"? I've seen three different doctors, and they have given me varying opinions, so I'm confused.
3.
One doctor immediately recommended surgery and hospitalization, but I later decided to use a cast for immobilization.
I'm wondering if not having surgery could lead to any long-term complications?
4.
It has been three weeks since I got the cast, and there is still significant swelling, and I occasionally experience sharp or aching pain at the fracture site.
Is this normal?
5.
The doctor mentioned that after getting the cast, I could put some weight on it while walking.
Will this cause any further displacement? Is it safe to put weight on it now, or should I wait until the cast is removed before putting weight on it?

Jiao Mu Jun, 20~29 year old female. Ask Date: 2008/12/08

Dr. Li Wenlin reply Orthopedics

Hello,
In response to your question, your X-ray images could not be accessed.
However, due to the limitations of online resolution, it is possible that some subtle fractures may be missed, so it's okay if they are not visible.
Considering your concerns, since I have not personally examined you or your X-rays, I cannot make a definitive judgment about your condition.
It is indeed possible for fractures to be undetectable on initial X-rays and only become apparent later.

The correct medical term for a fracture is "fracture." Common phrases like "the bone is cracked" or "the bone is broken" correspond to the medical terminology of a fracture, regardless of the severity or whether it is just a deformity.

Treatment for fractures varies based on the location, age, and specific needs of the patient.
Choosing not to undergo surgery is not necessarily the wrong choice.
It is wise to consider the advice of another specialist before making a decision.

Furthermore, there is a saying that "injuries to muscles and bones take a hundred days to heal." Since you have only been injured for three weeks and are still experiencing swelling, this is reasonable.
To reduce swelling quickly, it is essential to elevate the affected limb and perform some toe movements (if your ankle is immobilized in a cast).
Whether you can bear weight (put pressure on it) should be determined based on your X-ray findings, and you should follow the guidance of your current treating physician.

I hope this clarifies your doubts, and I wish you a speedy recovery!

Reply Date: 2008/12/08

More Info

I'm sorry to hear about your experience with the fibula fracture. It's understandable to have many questions and concerns after such an injury. Let's address your questions one by one, based on the information you've provided and general medical knowledge regarding fibula fractures.

1. Initial X-ray Findings: It's not uncommon for certain types of fractures, especially hairline or non-displaced fractures, to be missed on initial X-rays. The swelling and bruising can sometimes obscure the fracture line, leading to a false sense of security. Additionally, if the fracture is stable and not displacing, it might not be immediately apparent. This could explain why you were able to walk for two weeks before the fracture was confirmed at a larger hospital.

2. Classification of the Injury: A fibula fracture is classified as a complete fracture if the bone is broken into two or more pieces, or as a hairline fracture (or stress fracture) if there is a crack in the bone without complete separation. The terminology can vary among physicians, but if the X-ray shows a clear break in the continuity of the bone, it is considered a fracture. If there is just a crack without complete separation, it might be referred to as a "hairline fracture."
3. Surgical vs. Non-Surgical Treatment: The decision to operate on a fibula fracture often depends on the fracture's location, stability, and whether there are associated injuries (like to the ankle joint). Non-surgical treatment with casting is common for stable, non-displaced fractures. If your doctor recommended surgery, it may have been due to concerns about potential complications or instability. Non-surgical treatment can be effective, but it’s essential to follow up with your doctor to monitor healing and ensure there are no complications.

4. Ongoing Swelling and Pain: It's not unusual to experience swelling and discomfort even after three weeks in a cast, especially if the fracture was significant. However, persistent or increasing pain, especially if it is sharp or accompanied by other symptoms (like fever or increased swelling), should be evaluated by a physician. It's crucial to monitor these symptoms closely.

5. Weight Bearing on the Cast: Generally, the advice on weight-bearing can vary based on the type of fracture and the stability of the injury. If your doctor has advised you to put some weight on the cast, it likely means that they believe the fracture is stable enough to handle it. However, if you have any doubts or if you experience pain while doing so, it’s best to err on the side of caution and avoid putting weight on the injured leg until you have a follow-up appointment.

In summary, it’s essential to maintain open communication with your healthcare providers. If you have concerns about your recovery or the treatment plan, don’t hesitate to seek a second opinion or ask for clarification from your current doctors. Regular follow-ups are crucial to ensure proper healing and to address any complications early on. Remember to rest, elevate your leg, and follow your doctor's instructions regarding mobility and weight-bearing to facilitate a smooth recovery.

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