Open Reduction Internal Fixation - Ankle

[Ottime]

So, I broke my ankle a few months back. A week after break, I has surgery - open reduction internal fixation. Broken fibula (lateral malleolus) and a torn syndesmosis (tendon holding tibia to the fibula across the ankle. I received a lateral plate for the break and a tightrope for the tendon.

I am 6 weeks post-op, with almost 3 more weeks before the cast is removed. My ortho says I should be weight bearing when the cast is removed. My ortho is also an android. Technically, he is excellent. Fixes ankles snd is the ortho for the Santa Cruz Warriors (d leauge). But he has poor communication skills and completely lacks any empathy, so he has a hard time understanding normal, non technical questions. His answers never exceed five words. So, I come to the commune to get answers.

Looking through other broken fib threads, it sounds like a number of you have had the same injury. I'm trying to get an idea on recovery time. What to expect once out of the cast. When will I be able to ski with my six year old. We will be at Kirkwood Dec 29th, just a few days past 3 months post op. Hoping to ski a few runs each day with my son.

When I ask my surgeon about recovery, as in when can I expect to walk, run, jump, ski, surf, etc. he said, "Normal in 4-6 months, depending," which is really no info at all. I can't even talk with the PT until the cast is off, due to insurance rules.

Been stretching on the floor, doing some light core work, cleaning, cooking, gardening. Trying to stay active, and rest to keep swelling down.

Any insight on what things will look like the first few weeks after cast removal would be appreciated, and give me something to shoot for. And if skiing is out of the question, knowing that would help me make alternative plans. Maybe I just build a kick ass snow fort.

[mtngirl79]

I didn't have to have surgery, so I think yours is worse than mine, but I was 7 weeks non weight bearing in a cast and 3 weeks weight bearing in a boot.

About halfway through the boot time I realized I could walk fine without the boot and did a little at home, taking a shower, or to go across the room.

I also walked a ton in the boot... I wore it out.

Last Wednesday I got the ok to lose the boot and get back into things. I've been on my mountain bike 3 times and it feels pretty solid for weight bearing, but I wouldn't want to twist it. I also have no calf strength... I can't stand on my toes..

I feel like I could definitely ski, but probably not all day. For sure groomers or mellow pow.

Hope that helps. I had a hard time getting timeline answers from them, too. I think it varies a lot per person.

[MrB]

typically 6 weeks for healing, 6 weeks rehab, 6 weeks reconditioning

in short...I’d say 6 weeks after you get your boot off you might be able. Don’t rush it. Listen to your body. Worst thing you can do is rebreak it and miss the entire season

[old goat]

Ask your surgeon what you're allowed to do, not what you'll be able to do. He can answer the first question, but the answer to the second is . . . wait for it . . . it depends. People are hugely different in terms of pain tolerance, motivation, the variables of the injury and the surgery, some of which may not be apparent. I'm not one an ortho, but I was always amazed by the difference in recovery time between someone who was self employed, someone with no sick leave, and someone with good sick leave. As a patient I was also amazed by the difference between the right side and the left (hernias), both done the same way by the same surgeon.

That said--do not be afraid to insist on an adequate answer. The impatient, uncommunicative, unempathic surgeon will generally respond to confrontation with a patient, informative discussion. I know this because I was one of those. Usually we don't realize we aren't giving an adequate answer until someone gets up in our face.

Better yet listen to Mr B.

[Ottime]

Thanks. Mtngrl, I read through your thread and got some good info. I did not want to hijack it, cause it had a life of its own. And mine is a little different.

Will listen to B. And OG, that is great advice. I have not gotten in his face, as I was concerned the answers would stop coming all together. But I will push, as he wont allow me to talk with a PT, I guess he needs to be the guy.

I'll give you an example of how his mind works. As we were talking about options, I asked him how long I would be in a cast after surgery. He said 6 weeks. Which was an honest answer, as I am in a cast for exactly six weeks. What he failed to tell me was I would be in a splint for 19 days as well, making the total much closer to 9 weeks. When I asked about why he had not told me it would be 9 weeks before I got out of my cast, he simply stated that my question was "how long will I be in a cast." Which was true - but who would think that was the essence of my question? So, what I have learned from my ortho is that I need to be very specific about my questions.

I will ask "what am I allowed to do" and push to get good answers, but to be honest, I'm looking forward to talking with the PT when I get to that. Everyone else in my care group has been awesome. And while I feel like I did get very good technical care from my ortho, I am not sure he is actually a living being.

And OG, I'm self employed and eager to get back to work and projects that need finishing before the real rain season begins. I'm motivated to heal and can not wait to start doing movement and exercise. So tired of being at home.

[old goat]

I'll give you an example of how his mind works. As we were talking about options, I asked him how long I would be in a cast after surgery. He said 6 weeks. Which was an honest answer, as I am in a cast for exactly six weeks. What he failed to tell me was I would be in a splint for 19 days as well, making the total much closer to 9 weeks. When I asked about why he had not told me it would be 9 weeks before I got out of my cast, he simply stated that my question was "how long will I be in a cast." Which was true - but who would think that was the essence of my question? So, what I have learned from my ortho is that I need to be very specific about my questions.

As you should be with anyone with autism spectrum disorder. Sheesh.

[LightRanger]

PM RoverDoc and have him respond. This is his wheelhouse.

Sent from my SM-G930V using Tapatalk

[LightRanger]

And I've had a similar experience with an ortho. He was the head of orthopedics at UCI at the time (maybe still is). Just terrible bedside manner. I'm sure he would've been an excellent surgeon (had wrok elsewhere), but he came across as an insensitive prick. E.g. "you can walk, why would you want to run again?" (Speaking to a 27 YO former XC racer.)

Sent from my SM-G930V using Tapatalk

[old goat]

For the record--my wife's current ortho --chief of her dept--is a total sweetheart, as well as a hell of a surgeon. Her previous ortho (retired, male) likewise. (Our family keeps orthopedists on retainer). Ottime's experience is all too common though. One is tempted to say that it doesn't matter, at least with a surgeon as long as they can operate, but it's well documented that patient compliance is much better if they can communicate well with their doctor, regardless of the specialty.

[LightRanger]

^^^ OG, doesn't happen to be Jim Voigtlander does it?

(And, yes, agree 100%.)

[old goat]

^^^ OG, doesn't happen to be Jim Voigtlander does it?

(And, yes, agree 100%.)

Dahlia Lee did the surgery--south sac kaiser.

[Ottime]

PM RoverDoc and have him respond. This is his wheelhouse.

Sent from my SM-G930V using Tapatalk

Perfect. Will do.


Two more weeks. Cast got loose again. Only took a week to pack it out.

Just based on feel, it seems pretty solid in there. Can move around quickly, bang it a little, etc and feel no more than the discomfort of a cast.

We were going to be at KW for thanksgiving but I did not want to travel to elevation and across the snow to a small cabin with a cast. I was afraid that normal swelling would be too much. And hard to get around. And boring just reading in the cabin. But man do I want to get up and see the snow.

Another month.

[old goat]

Two more weeks. Cast got loose again. Only took a week to pack it out.

Damn cheap cast liners. Go with the Intuition the next time.

[XXX-er]

Got a question for ya^^ OG, back when I was a kid it seemed like people would get a cast when they broke a bone

It seems like nowdays the pro's are very likely to put in a rod SO has medicine changed?

In General why do you rod as opposed to a cast?

[mtngirl79]

Perfect. Will do.


Two more weeks. Cast got loose again. Only took a week to pack it out.

Just based on feel, it seems pretty solid in there. Can move around quickly, bang it a little, etc and feel no more than the discomfort of a cast.

We were going to be at KW for thanksgiving but I did not want to travel to elevation and across the snow to a small cabin with a cast. I was afraid that normal swelling would be too much. And hard to get around. And boring just reading in the cabin. But man do I want to get up and see the snow.

Another month.

I got a new cast every two weeks. They always got loose.

It was nice to keep them fresh tho.

[roverdoc]

Well i usually stay out of these threads but here it goes. This topic can be confusing. The information gets confused when people share their experiences from a simple fibula fx vs bimalleolar ankle fracture vs a trimalleolar pattern. A ankle fracture with a syndesmosis injury is a different injury all together. In general terms fractures heal faster, ligament injuries such as syndesmosis disruption take longer and not uncommon to restrict weight bearing for 10-12 weeks post op out of concern of stressing the repair. Good news is tight rope is more reliable to get an anatomic repair vs screw fixation. You should focus your energy on getting flexibility of ankle first, dorsiflexion specifically as this will be naturally restricted with the tight rope or any device constraining your syndesmosis. I would say walk at 3 months, bike at 4 months, ski/surf etc 5-6 months. All guesses not knowing your fitness, prior shape and severity of injury. Key is healing up well the first time around. A failed syndesmotic repair is no joke and you will develop post traumatic arthritis and require additional surgery. Heal up! Its frustrating to have to wait it out.

[Ottime]

Thanks. That was super helpful. Many of my assumptions agree with what you wrote. I was able to find good resources to describe my procedure, but this gives me an idea on healing.

My cast comes off 61 days post op. I'll see what my ortho says then, but he thought I'd be full weight bearing. He has not said as much, but I think my tear was small. The broken piece of the fib was displaced a few mm.

Anyway, I don't mind staying off it, as long as I can get out of this cast. Looking forward to flexing my foot. Been trying to keep the hamstrings, and other body parts loose. I was doing yoga 2-3 days/wk when this happened, so I've been keeping up with some sitting poses as I healed. Went about 4 weeks doing nothing, tho.

And thanks for the reminder to not re injure. I want this to be a one time thing.

On the nice side of things, I had a slip and had to put my cast down pretty hard on the floor briefly. Not pain at all doing that. Not that I plan to do it again, but it was nice feedback.