Pregnant female with Pain and swelling in a previous fractured Ankle

Patient

Q: I had my ankle reconstructed 2 years ago (bone taken from my hip, plate and pins to hold it together) Last time I was pregnant it started to hurt at 8months and the doctor said it was my ligaments loosening before birth. But now I'm only 3 months pregnant and it hurts so much I can hardly walk on it. I know there are 2 pins broken, but any doctor I have talked to have said it is fine. I'm just wondering if there is anything I can do. I've tried rest and painkillers but it hasn't helped. Thank you, Victoria

Doctor

A:    It is a very well known fact that the overweight, in your case for pregnancy and lack of exercise can cause problems in the weight bearing joints like ankles, knees, and also Lumbar Spine, this seems to be your case and more with your previous history of an open reduction and internal fixation (ORIF) of a ankle fracture with osteosynthesis material and bone graft. Some patients, as your case, keep experiencing episodic pain and swelling in the place where the hardware was placed, sometimes they get relief when the material is removed,once, of course, there is clinical and x-ray evidence that the fracture has  healed; but roughly almost the half of them do not experience any difference and the pain and swelling still happen. Depending on the severity of the fracture at the beginning and the damage produced, a post traumatic arthritis may develop. Another factor to consider in your case is that with the pregnancy there is a tendency to get swelling in the feet because the compression of the pelvis veins. With the pregnancy you can’t take anti inflammatory medication as “motrin”, “advil” or similar, the only medication for pain that you are allowed to take is Acetaminophen (Tylenol). You can try too a combination of elevation, ice, compression, relative rest and protected ambulation.

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