You may notice problems with In the classical AO technique, open anatomical reduction is secured, fixed with a lag screw and a lateral neutralization plate (e.g. A week walking the halls in my house with crutches (that took practice! open fracture with/without concomitant vascular or nerve injury. The PA-C says its ok as long as its not around the clock. Like bimalleolar fractures, these injuries are often unstable, and a dislocation can occur. Good luck to you all, and DO NOT get discouraged. Surgery was performed within 24 hours of accident. There are two very noticeable malleoli and a third that is not recognizable without the use of an x-ray. Desperate to get air on my scarsvhave a plate and 6 screws. I found hiring a knee scooter was my saviour. The treatment for a bi or trimalleolar fracture begins immediately. Dislocated trimalleolar ankle fractures should be reduced immediately, re-establishing joint congruity and reducing concomitant soft tissue injury.60 If closed reduction is unsatisfactory, an immediate open reduction should be achieved. Bad injury be patient. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. I started daily Physio after 2 months & followed their instructions religiously exercising several times a day. Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. I am about 6 weeks post surgery and still no weight bearing. Anyone have any experience with that? Usually the patient will have to wear a short-leg cast or a removable fracture boots to make sure that the legs fixation devices will be in place. Learn more about us on Yelp, Avvo or Google. Its been miserable. How to address the posterior malleolus in ankle fractures? Havent started PT, thinking i should start my own program for at least the rest of my body. Still taking meloxicam. I am using a walker and wheelchair. Ill take it a day at a time, little steps, and each forward progress is a goal attained even if its slow. The propeller flap wasnt allowed any pressure on it as it is soft tissue and was taken from my calf and literally twisted down to cover area of ankle where skin is gone. If anyone has any information about why it would be beneficial to have them removed verses leaving them in, I would appreciate hearing from you. So glad I found you lot, makes me part of a Tri(be)! Very depressing time. I get reevaluated 9 May. The arm was a dislocated elbow with an ulna fx, no surgery was needed. A fragment displacement of more than 2 mm or the involvement of one-quarter to one-third of the articular surface on the lateral radiograph were critical indications for operative treatment.115118 CT-based classifications of the posterior malleolus were developed, since the interpretation of plain radiographs poorly assess the posterior fragment size and configuration.47,119,120 The proposed classification by Bartonek and Rammelt may be used as a guide for decision making, but important factors have to be considered. Everyone heals at different rates and based on a lot of factors including age and how fit and active you are and your mental status. To get a trimalleolar fracture, the impact has to be very hard or from a particular angle to lead to this amount of damage. I am so relieved to have come across your post Jackie. Differential diagnosis Bennett C, Behn A, Daoud AI, Dikos G, Bishop J, Sangeorzan B. Buttress plating versus anterior-to-posterior lag screws for fixation of the posterior malleolus: a biomechanical study. More cases of osteoarthritis are found in trimalleolar . Hey, at least Ill be, H E Double Hockey Sticks, on wheels with my knee scooter and its bell! The ankle joint is a rather complex joint which is actually two joints in one. Does anyone else have this limitation in walking and this heaviness in legs one year after the tri-malleolar break, or have cerebral palsy? 1B). The type and severity of fracture will determine both treatment and length of recovery. I had six oct 1 2017 after twisting my ankle at a wedding.Trimalleolar fracture, terrible. The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. depressed, and now catch 22, if surgeon removes hardware, none of them exray afterward i.e. Anna, do not weight-bear before your doctor says it is ok. Thank God I was out with something that caused amnesia! Minimally displaced proximal fibula shaft fracture noted. I developed the blisters after the surgery and caused pain under the cast. So with each new hurdle, I an uplifted. It does not diminish the pain, inconvenience or lossit just puts this into some perspective. I dont want pain for the rest of my life, who does? I am 8 months on after a bi-malleolar fracture.Its a very long process.I was part weight bearing 6 weeks after surgery.I taught this isnt too bad.Was walking with limp after 12 weeks,and then i hit a wall.Progress has been extreamly slow.Im still walking with a limp in the morning until it warms up.Still have really bad ROM and pain when doing physio.Every day seems like starting all over again regarding the stiffness.I think people need to be realistic about the time needed to recover from these bad injuries.My friend is 3 years on from the same fracture and at 90% ROM.I hope i get to 90% as i am at 50-60% at the moment.It will get better but it takes a lot longer than a year.I was told 6 months by my doc and physio,which was very misleading. I tire of staying home with ankle elevated. I have recently ended up with a trimalleolar fracture that I received from a nasty accident. You will trust your ankle again for the most part to do its job and hold you up while holding 100lbs and Ive done it and it held me. I think i feel more depressed now though knowing it might be even longer before things return to normalcy. We did get a good laugh though. The doc says he doesnt know why its numb, shouldnt be . Am now wearing a compression stocking which helps. i had surgery the next day. Its trueevery part. You dont HAVE to wait until August if you cast is hurting. Pt was restrained driver. You should be able to ride a stationary bike by 8-10 weeks and you should also be able to do seated upper body work. This has been a devastating & painful injury for me but I am thankful I can still walk, work and do nearly everything I did before. Patient is a 67 yo WF with h/o HTN that presents with left ankle pain after an MVC. He knows the details of your fracture, not the internet. The ER docs and nurses were dumbfounded. Sleeping in the boot ughbut its usually short term Im told, so just get thru it, right? Along with the exercises, elevation and ice packs, this treatment seems to lessen the stiffness & swelling. What is a Trimalleolar Fracture? When not swollen, my ankle looks Frankenstein, the screws stick out. Nervous I have damage in my foot as the top of foot is still very painful. Lamontagne J, Blachut PA, Broekhuyse HM, OBrien PJ, Meek RN. I have seen so many different posts with different recovery times n NWB times.my dr says 6-8 weeks but some ppl were walking in a boot 2-3 weeks after surgery! I get sharp stabbing pains. The surgeon put in one plate and 8 screws. I keep hearing people say that they are going to get the screws out. I was non-wgt bearing x 8 wks then gradually progressed to full wb by 12 wks. I spent 6 wks there. This is a great website and has been helpful! The doctor said removal is unwise because the bones now have holes from the screws and increases the risks for just another break. The areas that were not captured in the X-rays are being noted in the MRI. in just a few more weeks I will hit my 4 month mark of being off of work . Have been walking without cane/walker for 6 weeks but still have a limp & swelling by the end of day is significant. I will cont8nue this as I get walking more and re-awaken all those muscles in your calf that regulate the blood flow up and down and get them back to where they need to be..I anticipate those painful toe raises in the future.anyone have tips? I liked the splint because I was still able to use my toes but now the splint is off and the gave me a walking boot. Disadvantages of locking plates are that they provide minimal compression across the fracture (without lag screw), higher costs and thicker plate size, causing a possibly higher wound complication rate.89,94,95 But in a randomized control trial comparing locking and non-locking neutralization plates, there was no difference regarding the complication rates.96 Minimally invasive locking plate osteosynthesis of distal fibular fractures may be a viable option in critical soft tissue conditions.97 Therefore, a smaller incision is made at the distal end of the fibula and the locking plate is inserted from the distal side in a proximal direction using a locking drill sleeve.97 Furthermore, a locking plate system allows to safely fix distal fragments with small fragment locking screws in distal fibular fractures.89, Beside the standard lateral plating, posterolateral antiglide plate fixation is an alternative. In any case, the ankle is good, not as much flexibility as Id like, but Im walking. Only wear outside. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. Have kept moving toes and legs raises but hoping to have a boot instead of cast at week 5. The posterior malleolus can be classified according to Haraguchi, Bartonek or Mason. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Plus he has a minimum of 15 yrs medical experience. Ovaska MT, Mkinen TJ, Madanat R, et al.. Risk factors for deep surgical site infection following operative treatment of ankle fractures, The management of ankle fractures in patients with diabetes. Like the previous poster said its good to know what Im up against. My gait was off so my body and to adjust to a new walk, the way my feet hit the ground when I walked. While a trimalleolar fracture will drastically impact your life for months and may require physical therapy for up to a year, the injured ankle and leg will recover but only with compliance of the prescribed physical therapy program. Ideally, a classification system should have a high inter-/intraobeserver reliability, be widely recognized, relevant for prognosis and applicatory in research and clinic. ADVERTISEMENT: Supporters see fewer/no ads. Outcomes following posterior and posterolateral plating of distal fibula fractures. I had surgery on 8/19 and had a plate n several screws put in. It wasnt painful at first quite numb. The trauma is sometimes accompanied by ligament damage and dislocation. Make sure you eat healthier this helps the healing process. Thank you guys for sharing your stories of recovery. I cant put up with this so want it removed see surgeon 29th February but Ive not been told or given physio ?? II. Inversion injuries occur more often. If the numbness would just go away, then Id be a happy camper. Now swelling reduced can feel a sharpness I that i think is tge metalwork is this normal. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Ankle still swells up everyday to the point of discomfort. My ankle stayed splinted two wks after surgery and then I got switched to a cast with suture removal. I can only wear a shoe for about 4 to t hours and it has to come off. My arm was splinted for 3 wks and then removed. Thanks for the encouragement on this post. My knee scooter saved my mental health, I used it to grocery shop, get safely thru my pool. A retrospective study of 19 patients with non-operatively treated displaced bimalleolar and trimalleolar fractures reported an excellent functional outcome after 20 years.56 However, it is not feasible to draw reliable conclusions for the treatment of trimalleolar fractures, because only four patients with a trimalleolar fracture were available for final clinical and radiological evaluation. Im so glad I found this article. The physical therapist will help allay fears and will cheer you on in your recovery. The therapist may determine that you or a family member perform massage of the scar tissue at-home between treatment. It has been so hard to see the positives, when my wedding is the beginning of september. Clinical Presentation. I was bed ridden in hospital for 9 days for the swelling to go down enough for the surgeons to fix the plate and 8 screws to the break on the Fibula and a long screw through the Tib/Fib to inhibit movement , a couple of days after I was released with a back slab cast and crutches ,NWB for 8 weeks it wasnt my idea of fun thats for sure. A trimalleolar fracture refers to fractures of all three malleoli of the ankle: lateral malleolus, medial malleolus and the bottom posterior (backside) tibia. The ankle swells when my leg is vertical and it gets quite painful, but the swelling goes away after elevating my leg. No more pain medication needed anymore for me now. According to www.uptodate.com: Over five million ankle injuries occur each year in the United States alone. I spent 4 days in the hospital and then transferred to a rehab facility. Yea!!! Still swollen but less pain. The mechanism of injury is direct impact caused by inversion or eversion injuries. 1D). I feel your pain. Have tried to go without the Percocet as I do not want to get dependent on it but barely hanging on by a thread. Could not believe the impact it had on my life and the frustration at not being able to do what you want. I live alone, friends helped with meals & errands. My progression has been better than I thought. Due to that fact and the exclusion criteria of the study, the results should be interpreted with caution and cannot simply be transferred to the management of trimalleolar ankle fractures. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. This is usually left for about 5-6 weeks to make sure that the bones are fully recovered. . No weight bearing for 2 months. It depends. (Great, I should be pain free by 68!!!). This article is very thorough. 3 weeks to get walk further and shoe on longer so I can return to work. While no doubt I want to run through flowering meadows and walk my 5 miles a day, I have found other things to do. For a while everytime you would push to new limits of exercise the ankle would rebel. El-Shazly M, Dalby-Ball J, Burton M, Saleh M. The use of trans-articular and extra-articular external fixation for management of distal tibial intra-articular fractures. I am able to walk few hundred feet and almost 6 minutes intervals ..swelling is down looks good Pain level down to consistent 3 like dull tooth ache.. One year later, I still can only walk several yards without pain, with cane, can only walk without cane around my house. I am trim-fracture/dislocation since 27 Mar 2017. I have a plate with 6 screws on the outer part of the ankle and 2 screws on the inner ankle. I was resistant to begin seriously icky drugs. Im lucky enough to be able to be working from home starting this week, but not being able to clean my own house, do my own laundry, etc. ; Ankle Injury Management (AIM) Trial Collaborators. Lee JS, Curnutte B, Pan K, Liu J, Ebraheim NA. Wegner AM, Wolinsky PR, Robbins MA, Garcia TC, Maitra S, Amanatullah DF. People think you should be up and running after six weeks. Im 2 years in August post op and still have pain in both my ankle and foot. Likewise, the anterior (Le Fort-Wagstaffe tubercle) and posterior tubercle of the fibula form a convex triangle. Dont let the stress win. The AO/OTA classification lacks a description of the fracture configuration of the medial and posterior malleolus. Cheerio love. Any signs or symptoms I should be aware of that may suggest my incisions may be infected even though I cannot visually see my incisions? Its been about one month since the surgery and Ive not worked since this is driving me batty sitting at home day after day. Wanted to see how you are doing on weight bearing without boot for your wedding? Trimalleolar Fracture also known as the "break in bone" is the state of the bones where the three parts of the ankle are dislocated or has a fracture. Sounds corny, but true. . Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Ribeiro HM, Silva J, Teixeira R, Fernandes P, Sobral L, Rosa I. 8/22-2 wks post op- Started PT. I started reading this string a couple of weeks after my accident. Did emergency surgery to clean out infection, and had propeller skin flap placed on inside part of ankle as the skin was damaged from infection. Andersen MR, Frihagen F, Hellund JC, Madsen JE, Figved W. Randomized trial comparing suture button with single syndesmotic screw for syndesmosis injury, Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device. This website is for informational purposes only and Is not a substitute for medical advice, diagnosis or treatment. I am 75 years old and on April 12 suffered a Trimalleolar fracture in dislocation of my left ankle. My right ankle was already in one, no surgery needed. Better than 3 weeks ago in bed! That was the end of self pity for me! Thanks again for the share! My ortho MD okd swimming with very soft kick as long as I was safe getting in/out. The problem is I have intense burning at the Medial Malleolar site (the bone on the inside of my foot) along with the bank across my ankle, which is exacerbated when I do my ROM exercises and burns and stings almost contantly. I slipped on day 2 of my holiday. I am in week 7 since the accident with 4 weeks after surgery. In clinical practice, the time of surgery also depends on staff and operating capacities so that definite operative treatment is neither feasible nor successful in many cases. Trimalleolar. However, Im a fighter. Dr. doesnt seem to be concerned, but I am. Had to hire some employees to rearrange my living area to first floor. Hi all.fixator-I have a trimalleolar open fracture with dislocated ankle. Minihane KP, Lee C, Ahn C, Zhang L-Q, Merk BR. My fract. If surgery were performed, scar tissue would form. Fractures of the weight-bearing portion of the tibia have a more guarded prognosis, since any change in the anatomic position of the fracture fragments is . Good luck to all of us I reckon. I am advised that the swelling may last several months. I also take 10 to 20mg THC in between when pain comes back. Vidovi D, Elabjer E, Mukardin IVA, Milosevic M, Bekic M, Bakota B. Posterior fragment in ankle fractures: anteroposterior vs posteroanterior fixation. The convex-shaped talus has a greater articular surface than the corresponding concave-shaped facies articularis inferior of the tibia (Fig. The thing that gets me is my Dr. said no physical therapy. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. If you are not fully ambulatory you CANNOT drive and DO NOT attempt to drive in a boot! by ACE Physical Therapy and Sports Medicine Institute. Introduction. My ankle still swells and I still ice it some but I have very little pain even after exercising. Just had the stitches removed today and a boot put on. Depending on the fracture configuration, the management and timing to definite surgery can differ significantly. Home two days after surgery with the boot, no weight bearing for 10-12 weeks instructions. Braunstein M, Baumbach SF, Bcker W, Mutschler W, Polzer H. [Arthroscopically assisted treatment of ankle fractures]. There will be pain, tingling, numbness in ankle/foot complex and a strong feeling of instability throughout the involved leg. The biggest cause of my pain pre-and post up was the casts. Initially I had no pain besides at the moment of break. The video below explains how to massage a scar tissue. sorry to hear what your going through. Antibiotics since the patient is at risk for sepsis or infection there is a need to take antibiotics to prevent it. The only thing that is concerning me at this point is if my incisions have healed properly. My doctor has not even offered that as an option. off pain meds 3 days after sugery nurses were impressed i was off of them so fast. Thursday i was able to check out of the hospital with 6 screws, one plate and a big ole boot. The incisura tibialis is formed by the anterior (Chaputs tubercle) (1) and posterior tubercle (2) of the tibia. I wanted to share my story to give hope to anyone going thru this experience. Gonzalez TA, Macaulay AA, Ehrlichman LK, Drummond R, Mittal V, DiGiovanni CW. I want to stress as little as possible to heal as quickly as possible. Im 2 weeks post-trimalleolar fracture surgical repair. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. The posterolateral approach is indicated in posterior malleolus fractures with relatively small diameter (Bartonek and Rammelt Type 2 & 4) and the presence of intercalary fragments.121 According to the Mason classification, Mason Type 2 and 3 posterior malleolar fractures are treated with a posterolateral approach and only Type 1 fractures with trans-syndesmotic fixation.125 The posterolateral approaches allow open reduction and internal fixation of the posterior malleolus as well as the treatment of distal fibular fractures.99 Open reduction and internal fixation of the posterior malleolus can be performed with posterior screw or plate fixation depending on the fracture configuration and bone quality.121 There is no uniform recommendation for when to use screws, e.g. Like many people in this thread I got less than 4 hrs sleep a day for a month. I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces. My break was a trimalleolar. Recovery has been steady but I do struggle with nerve damage and continual pain. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach, Anatomie und Biomechanik von Sprunggelenk und Rckfu. occupational therapy helped me adjust to my new condition and helped me make adjustments to my daily routine so I could depend less on others. I lost my Job (but thank God I found a better one) and more than the physical pain emotionally this has been hard for me. Not being able to do for my self is horrible. 1 D).9, Over half of the surface of the talus is covered with cartilage without any tendon insertions.10 The shape of the talus is complex, resulting in a changing axis of rotation.11 Looking from above at the trochlea tali, it is wedge-shaped with a broader anterior portion.3 On the medial side, the articulation between talus and malleolus shows a larger contact surface.5,12 In the sagittal plane, there also exists an incongruity between the articular surface of the talus and the distal tibia. I slipped and had the tri break in my left foot while on holiday. The ankle joint proper is made by ligamentous connections which connect the distal tibia and distal fibula to the talus near the patient's heel. Ankle fractures, known more commonly as a "broken ankle", happens when there is a break in one or more of the bones that make up the ankle joint. In addition I have very thin ankles. Repeated 3 more times hot to cold. This has the been the longest 5 weeks of my life. All i can say it gets better it just take time and patience with your body. Fortunately, this injury will usually clear spontaneously. Karbassi JA, Braziel A, Garas PK, Patel AR. its the best thing ever. Computed tomography is essential for classification and operative planning. This term trimalleolar fracture is broadly used to include the three structures, which get affected in the trauma or impact, which causes ankle fracture. I had my surgery April 13th and started weight bearing June 5th. I have a tri fracture that happened 5.6.17. Before reaching the point of walking we have to ensure that all the component of walking is intact. Had my accident July 5 out of state and due to some really extenuating circumstances didnt get surgery until 5 days later (dislocated the whole time) It was diagnosed as a Trimaleoler but ended up being 4 breaks. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. Today I have a healed right ankle/foot and am a little more mobile with crutches. They will also help set realistic goals to keep a person moving forward in their recovery. I was not prepared. I guess that I seemed much more relaxed (like I had a choice). Leardini A, OConnor JJ, Catani F, Giannini S. A geometric model of the human ankle joint, Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion. I had the Tri fracture with a dislocation. Fracture - Physiopedia Fracture Definition A fracture is a discontinuity in a bone (or cartilage) resulting from mechanical forces that exceed the bone's ability to withstand them. A year and a half ago I had surgery for a trimalleolar fracture. have split and spend most days resting leg splint is terrible seems like it rubbing stitches and dont sleep very well. I had a lot of very localized nerve pain on the inside of the foot at the arch (no break there) after a few weeks. Amazing. Long-term results of ankle fractures with a posterior malleolar fragment. Trimalleolar fractures are unstable fractures often associated with significant ligamentous injury and almost always require internal fixation. (Or standing in a shower washing your hair, or getting in and out of vehicles and so on and I have learned a new empathy for individuals who are permanently handicapped!). Slip and fall on tile floors. 11/27- 15 wks post op- I still have swelling and soreness especially after walking a mile or so. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular ligaments and the deltoid ligament. My resident told me to start weight bearimg on June 6th (7.5 weeks post op) and when I went back to ortho for my next check up at 10.5 weeks the consultant told me to start to weight bear. Im not in pain just a lot of discomfort. just from stepping off a curb in a parking lot that was steeper than I realized & over a storm drain! 9/27-7 wks post op-boot off and walking with walker. I am able to do stairs one foot at a time. The video below explains how to massage a scar tissue. Operative treatment aims to re-establish posterior stability while restoring the size and articular surface of the tibial pilon, the stabilizing function of the posterior tibiofibular ligament and the integrity of the fibular notch.121 The quality of reduction and joint congruity are significant factors influencing prognosis.122 To achieve these goals, there are different operative strategies depending on the fragment configuration and concomitant injuries. The swelling had nowhere to go so it pressed into the plaster splint. Since it is a fracture in the bones and it concerns ligaments and joints surgeries are the most effective way to correct such condition: [2], There are also different approaches of this surgical procedure depending on which bone area is affected during the dislocation or fracture: [3], Operations and surgeries may have associated complications and risks since it involves an open procedure: [2], Surgeries and operations are not easily healed and needs time to make sure that the patient can gain their body homoeostasis and to assure that the bones are properly back o its normal state. i had a trimalleolar fracture and dislocation on 26 April 21 and surgery on 7 May 21. OA licence text: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed. A posterolateral approach is used in case of a concomitant fracture of the posterior malleolus requiring open reduction and internal fixation.100,104 The distal fibula is openly reduced and fixed from the posterior side with a neutralizing one-third tubular plate with or without lag screw.100, In contrast to open surgical fixation of distal fibular fractures, a percutaneous method was developed to minimize soft tissue stress while providing a reliable fixation method. Normally, the patient is approved to transition to full weight bearing the end of the 3rd or 4th month. I was apprehensive of this additional surgery but Fab has put my mind at ease. I am devesrated to say the least but everyone keeps getting on me for being so depressed, saying that I have to be positive. The standard approach is a lateral incision above the distal fibula. I am getting some range of motion back into foot. Due to the weight and mobility restrictions a person faces after an ankle fracture, a physical therapist may teach the injured person knee and hip exercises to perform while the ankle recovers. 2021 Aug 10;6 (8):692-703. doi: 10.1302/2058-5241.6.200138. By end of Oct. able to walk 1-2 miles unassisted and at a slower pace than before injury but I was walking! WEEKS 5-12 It took about five weeks post surgery for the surgical area to heal (stitches were on the inside and outside of ankle) which meant I was approved to start swimming. I had surgery next day after injury & had an exterior fixator after the manual reduction didnt work in ER after 2 attempts! The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. they dont follow up. Im hoping the swelling will go away altogether. I have pain every day and I stave off painkillers as long as I can until I cant stand it. The ePub format uses eBook readers, which have several "ease of reading" features You will likely also be advised to move your toes while the foot is in a cast. I fell and sustained a trimalleolar fracture and had surgery on April 12th. That doesnt help you at all but at least you will know that is normal. After reading the comments I am concerned that he may want me to be partial weight bearing too soon. Knupp M, Ledermann H, Magerkurth O, Hinterman B. This test uses radio waves and a strong magnetic field to give a more precise imaged of the fracture. In patients with osteoporotic trimalleolar ankle fractures and relevant concomitant conditions, further evidence is awaited to specify indications for open reduction and internal fixation or primary transfixation of the ankle joint. Nonsurgical treatment would be recommended only if surgery would pose too high of a. Fracture reduction is essential to ensure that the bone heals properly and that permanent functional loss or deformity is avoided. The prescribed physical therapy after a trimalleolar fracture may initially help the patient properly use any prescribed assistive walking devices. I teach college and work EMS so I am on my feet a lot during the day. I followed the plan religiously and still do RX exercises. The influence of timing of surgery on soft tissue complications in closed ankle fractures. Did this 23 October 2015 its February 5th and I can walk a little before really bad pain but at the top of My plate. And 325 mg Hydrocodone at night. Miller AN, Carroll EA, Parker RJ, Helfet DL, Lorich DG. This condition is considered as a unstable stage which can also lead to ligamentous injury if this parts are not properly addressed. This cast is so uncomfortable though. Doing physio is really important but not easy, especially if you are having pain or your ankle feels like its in a vice or against a sharp blade. ), and just got released to walk carefully outsidein the sun!! When this first happened I couldnt even think where I would be 4 mos later. Although this time is killing me I dont want to set myself back at all. Cut those times in half to be more realistic. [Figure 3], Posterior Malleolus Fracture the screws are placed from the front of the ankle to its back part (vice versa). Once in a while, the patient has to undergone series of x-rays to check if the bones are properly aligned. If the injury involves the ligament that joins the tibia & fibula near the ankle joint, the surgeon may need to insert a couple of syndesmotic screws I.e the long screws you see on some X-rays that go through the fibula AND tibia. [Figure 2], Medial Malleolus Fracture since this a fracture that involves an impact or indent on the ankle joint, bone grafting is necessary. but i am hoping for a quick recovery as my wedding is the beginning of seotember, and I am not limping nor wearing a boot down that aisle. Best for ROM was sitting in a hot bath several times a day and forming the letters of the alphabet using your big toe as the pen tip. To everyone else out there with a similar injury, just keep fighting, it will get better and finally heal. i empathise with the sleepness nights and feeling helpless. Kneeling scooter was a life saver after the first week and I could tolerate moving the booted leg. Kilian M, Csrg P, Vajczikova S, Luha J, Zamborsky R. Antiglide versus lateral plate fixation for Danis-Weber type B malleolar fractures caused by supination-external rotation injury. Best purchase-portable wheelchair at Walgreens and a urinal! Hi all. had a Trimalleloar fracture R leg, bad sprain on L. In general, it is accepted that trimalleolar fractures are treated operatively.50,51 But in selected groups, where satisfactory initial closed reduction is possible, a conservative treatment can lead to a comparable outcome.52 A randomized controlled trial comparing close contact casting with surgery of unstable ankle fractures among 620 older adults found satisfactory results following conservative treatment.53 Even after three years of non-operative treatment, the equivalence in function between both groups remained.54 The conservative therapy consisted of a close contact cast below the knee applied under anaesthesia, non-weight-bearing for four weeks and full weight-bearing by week six to eight. If all looks good, then Ill be put in a boot and, a couple of weeks after that, will begin weight bearing. I have a great looking scar because my surgeon is a sports specialist, he didnt make big stitches or staples. Straight walker to transition from transfer chair to shower seat, bed, recliner, etc. The patient may experience the following signs and symptoms upon bone fracture: Some of the fracture in the bones may not be necessary for imaging tests but severe complications may need for further assessment and diagnosis. It is almost a month since that visit and I am using a walker and am nowhere near putting my full weight on that leg. Cant wait until this is all behind me. A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. Today it was removed yay, and all looks technically pretty good.. lots of therapy presctibed and a walking boot for another month but so happy to be able to sit and sleep without it. I didnt like the air-splint given to me by my surgeon (it rubbed on my medial screws) so I found a Zamst splint that he okayed and I wear that when Im out and about. Gave me a little independence and could dump the lady urinal! ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. I have tried other sites but not as informed as this site. A negligent driver in Sacramento near the Kenwood Street intersection killed a bicycle rider on November 9 and then fled from the scene. I was hoping I could be back at it soon as I am an avid lifter and now I can literally do nothing to work out for my upcoming wedding. Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C. Fractures of the ankle joint: investigation and treatment options. The ATFL typically shows a double-banded morphology and is separated by vascular branches.14,21 It is almost horizontally located to the ankle in neutral position and depending on the position of the foot, one band tightens while the other relaxes.14 Due to its characteristics, it limits anterior displacement of the talus and plantar flexion of the ankle.22 The CFL originates below the ATFL at the fibula and inserts at the posterior region of the lateral surface of the calcaneus.14 Its fibres run obliquely backwards/downwards and the CFL is located directly underneath the peroneal tendons. If it is only nausea you get when taking some pain killers, take them with food &/or anti-nausea medication. Anyone else experience this intense burning pain? Trimalleolar Ankle fracture surgery performed by Dr. Paul Steinke. Biomechanical comparison of intramedullary fibular nail versus plate and screw fixation. To be honest you shoud never stop your physical therapy, always find time to do it at home for the next few years if not for the rest of your life. I would appreciate any feedback on how long narcotic pain meds are generally used. I am glad I found this information as my doctor did not prepare me for what to expect. The bones that broke, made up my ankle,those are missing and replaced with plates and screws. Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. Ive ordered too many good deals online for facial products and other fun things. Now have a full cast on for the next 4 weeks (shocking pink) before next appointment when I may be able to commence weight baring . Malek IA, Machani B, Mevcha AM, Hyder NH. Corrective osteotomy including the posterior malleolus was p. (13 screws in all). Physical therapy and Occupational therapy. Sit with your affected leg straight and supported on the floor. I must say that the recovery timeline given at the top of this article is way to pessimistic and extreme. I did work using a wheelchair until I was released to walk with a cane. This is an injury that you will never fully recover from. Another joint is called the syndesmotic joint and is the connection between the tibia . I had physio for over a year and Im still doing exercises. . Traci: I take Tramadol 55mg during the day once, 1000 mg acetaminophen to help when Tramadol wears off. You might need this procedure to treat your broken ankle. Amazing to watch. i have been reading all the posts. Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Find a comfortable shoe for pt was a tad bit of process left foot mans 10.5 and right foot regular size female 8. I have never appreciated my hubby so much in our 27 years! I have a trimalleolar fracture and am 12 weeks non-weight bearing. Overview timing to surgery of closed ankle fractures, Current management of trimalleolar ankle fractures. A head-on crash close to Rio Vista on November 27 cost the life of a young motorist, and the other driver was arrested for suspected DUI. I stopped wearing the boot and just started limping around. Hermans JJ, Beumer A, de Jong TA, Kleinrensink GJ. The Trimalleor Tribe or TTT for short. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. I have been to pt for a month now,doing the exercises,weight shifting,and movements. Just couldnt move. Without the aides to living life over the past few weeks would have been difficult. Incidence of trimalleolar fractures peaks in higher age groups and is becoming more relevant in fracture care in the future due to the demographic development. This brought joy to my heart! I think that exercise is extremely important during recovery, I followed exactly what my physical therapist and surgeon told me to do. [2]. I go back 7.7.16 for another check up and x-rays and will see if there is any problem. Treatment includes surgery and extensive physical therapy. After reading up on the condition I am happy to report that I appear to be recovering well. Then no more pain until after surgery. Usually this diagnostic exam assures no overlapping of results and images of the bones. Myofascial release is often a term used by therapists to describe the technique used to press the skin and tissues around the scar. On the one side, there is a growing number of elderly patients with osteoporotic fractures and relevant concomitant conditions in which internal fixation to restore anatomical ankle joint congruity poses a particular challenge. This Injury so sucks! three weeks since initial break and 2 weeks post op they inserted screws and plates. how will I be able to help my patients ! After the surgery I was immediately put in a splint and told that I was to be Non weight bearing until my post op follow up two weeks after. I am still not back at work ,had surgery and could not weight bear for 14 weeks. I have to praise our emergency services and say God bless the NHS. It was actually the ooze from the incisions into the combines that had dried as hard as a brick. Immediate or delayed operative treatment of fractures of the ankle, Early versus late surgery for closed ankle fractures, Risk factors for wound complications after ankle fracture surgery. I slipped and fell March 1 and suffered a trimalleolar fracture on my right. 8/22-2 wks post op, cast gone, given Boot and aircast on sprained foot. The concave-shaped incisura tibialis (filled arrowhead) matches the convex shape of the fibula. 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