Open Fractures: Recovery Challenges After a Tibia and Fibula Injury

Open comminuted fracture of the distal third of the right tibia and fibula due to a car accident?

Hello Doctor: I have an open comminuted fracture of the tibia and fibula in my right lower leg due to a car accident, which was surgically repaired on November 8 of this year with internal fixation using plates and screws.
However, due to the presence of a traumatic wound, I have not yet been able to apply a cast.
Currently, I am using an L-shaped splint and bandages for temporary stabilization.
I have a few questions:
(1) Given that there is an external wound and I cannot apply a cast, is the stabilization provided by the L-shaped splint and bandages less secure, making the fracture site more susceptible to movement? (Currently, I am using a walker and wheelchair to avoid putting weight on my right foot.)
(2) I am experiencing stiffness in my ankle.
Is it advisable for me to move my ankle, and will this affect the fracture site?
(3) The doctor mentioned that since I have an open fracture, the bone was exposed during the accident, and it needed to be cleaned during surgery to prevent infection.
Therefore, there is a possibility that the bone may not regenerate properly.
If the fracture site does not heal with callus formation, I may need another surgery for bone grafting to aid recovery.
After complete recovery, I would need another surgery to remove the internal plates and screws.
Hearing this from the doctor has made me very anxious.
Is it really possible that I will face this situation?

Wallence, 30~39 year old female. Ask Date: 2012/12/25

Dr. Li Wenlin reply Orthopedics

1.
If the wound is not healing well, a splint can be used to support the area for easier wound management, although it is not as effective as a cylindrical cast for stabilization.

2.
The treatment should be based on X-ray findings, as the distal tibia near the ankle joint may be affected.

3.
Open fractures are classified into five grades, with increasing severity related to the risk of infection and nonunion.
In common situations, sometimes it is sufficient to observe and address issues as they arise.

Reply Date: 2012/12/25

More Info

Open fractures, particularly in the tibia and fibula, present significant recovery challenges due to the nature of the injury and the potential for complications. Your situation, involving an open fracture with internal fixation using plates and screws, requires careful management to ensure optimal healing and minimize the risk of complications.

1. Stability of the Fixation: The use of an L-shaped splint and bandaging instead of a traditional cast can indeed lead to concerns about stability. Open fractures are particularly vulnerable because the surrounding soft tissue is compromised, and the fracture site may be more susceptible to movement. The L-shaped splint provides some support, but it may not offer the same level of immobilization as a cast. This could potentially lead to increased movement at the fracture site, which may hinder the healing process. It is crucial to follow your physician's advice regarding weight-bearing and movement to avoid any undue stress on the fracture.

2. Ankle Mobility: Regarding the stiffness in your ankle, gentle range-of-motion exercises may be beneficial, but they should be approached with caution. Engaging in ankle movements can help prevent stiffness and improve circulation, but it is essential to avoid any movements that cause pain or discomfort at the fracture site. Consult with your physical therapist or physician before starting any exercises to ensure they are safe and appropriate for your specific situation.

3. Bone Healing Concerns: Open fractures carry a higher risk of complications, including infection and delayed union or nonunion of the bone. The fact that your fracture was exposed to the environment at the time of injury necessitates thorough cleaning during surgery to prevent infection. If the bone does not heal properly, it may indeed require additional surgical intervention, such as bone grafting, to facilitate healing. However, it is important to note that many patients with open fractures do heal successfully with appropriate care and rehabilitation. Your physician's monitoring and follow-up will be critical in assessing the healing progress and determining if any further interventions are necessary.

4. Future Surgery for Hardware Removal: The need for hardware removal after complete healing is common in cases of open fractures. The internal fixation devices (plates and screws) are typically removed once the bone has healed sufficiently to restore function and strength. This is usually done to alleviate any discomfort or complications that may arise from the hardware being in place long-term.

In summary, while the recovery from an open fracture of the tibia and fibula can be complex and fraught with challenges, many patients do achieve successful outcomes with diligent care. It is essential to maintain open communication with your healthcare team, adhere to their recommendations, and report any concerning symptoms promptly. Engaging in a structured rehabilitation program, as guided by your physical therapist, will also be crucial in regaining function and mobility in your leg. Remember, recovery is a gradual process, and patience is key.

Similar Q&A

Post-Surgery Recovery Challenges After Tibia and Fibula Fracture: Seeking Solutions

Hello, last July I suffered a fracture of the tibia and fibula in my lower leg, and underwent fracture reduction and fixation with a locking plate. The doctor recommended purchasing a pneumatic brace, but I have not actually worn it for walking. Four months post-surgery, the doct...

Dr. You Dianqi reply Orthopedics
If you experience any discomfort, it is recommended to consult your primary care physician for evaluation. Subsequent physical therapy can be pursued at the rehabilitation department outpatient clinic. Thank you.

Understanding Recovery Time and Concerns for Open Fractures of the Ankle

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 questi...

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 rang...

Challenges in Healing Open and Comminuted Tibial Fractures: Surgical Options Explained

Hello Dr. Wang, I was involved in a car accident on November 26, 2019, which resulted in an open and comminuted fracture of my right tibia. On December 2, 2019, Dr. A performed intramedullary nailing surgery. It has now been over two years, and the fracture site has still not hea...

Dr. Wang Shouji reply Orthopedics
Hello, 1. Generally, it is not necessary to remove the intramedullary nail; using a steel plate for fixation carries a higher risk of plate fracture if healing does not occur. 2. It is important to assess the overall volume of the defect; if the volume is significant, there is...

Understanding Open Fractures: Challenges and Recovery Insights

Hello, doctor: This year, I suffered an open fracture of my foot due to a work accident. The wound was very deep and large. Initially, I was taken to a military hospital where they said amputation was necessary. However, I later received external fixation from a well-known orthop...

Dr. Shi Guozheng reply Orthopedics
An open fracture is defined as a fracture where the broken bone is exposed to the external environment through the skin. Depending on the condition of the soft tissue and the degree of bone fragmentation, open fractures can be classified into several grades, with higher grades in...