I broke my ankle The lateral malleolus in running injury

Patient

Q: I broke my ankle. The lateral malleolus in running injury. It was a clean break. The X-ray showed a nice straight line. I currently live in Germany as my husband works for the military. There was a bit of a language barrier and I misunderstood that I was actually suppose to bear weight on it while it was casted. 6 weeks later, I go in for an X-ray and the break looks worse! It's all crooked and the gap widened. The doctor prescribed 2 more weeks of full weight bearing. Then we will X-ray it again and see if has healed enough to remove the cast and of not I will need surgery. I did some research and some articles o read suggest NOT bearing weight on it at all. Does weight bearing on a broken ankle promote healing? And will weight bearing be enough to see progression in a couple of weeks? I want to avoid surgery as much as I can are there any ways to get this ankle to heal faster? Am I doomed for surgery?

Doctor

A:   Hello,
Thanks for the query to ATD for an opinion.
As mentioned that your injury to ankle has been 6 weeks old already and yet after the cast application there hasn't been any improvement or healing seen but the gap has been increased and the fracture line has become ragged indicating non-union.

Weight bearing with a cast is often not advised because the weight of the body for that limp is taken by the cast anyways so walking with case is easily acceptable. But weight bearing as such affecting the healing has not been proved unless it has been a comminuted fracture and weight bearing is being used to re-align the fracture segment back in line. In your case as after 6 weeks, the fracture site shows non-union and wide separation, next 2 weeks is unlikely to change the scenario. This shall require open reduction and internal fixation or ORIF surgery with possible nailing the bones with K-wires for stabilisation.

I am sorry, but surgery seems to be inevitable in your case, however the best assessment can be made if you can attach an X-ray picture of your ankle with cast for analysis and then I shall be able to guide you better.
I hope I have addressed your concerns,
Wishing you speedy recovery,
Regards

Comments / Follow Ups

Patient: The first one is from the initial injury the second is from my 5 week appointment
Doctor: Hello,
I have seen the X-rays . Yes, its a non healing fracture of the fibular bone and osteophyte deposition can be seen in between the fracture site but there is no callus formation at all which is important for healing. Hence it is felt that internal fixation shall be the next right option for you.
Regards

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