Worst problem is EXTREME heaviness in legs and feet if I sit or lie for any length of time. If a person underwent surgery, the physical therapist would assess the scar and scar tissue. I have a feeling of resistance in the front of my ankle when bending. A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Clinical outcomes and trans-syndesmotic screw frequency after posterior malleolar fracture osteosynthesis. But, it will get better. Im almost 100% dependent on my hubby who takes care of me, our baby, himself, his job, and our home I feel like such a burden. Ive ordered too many good deals online for facial products and other fun things. I have been to pt for a month now,doing the exercises,weight shifting,and movements. The incidence of open ankle fractures is about 3%, but is expected to increase especially in older patients.29,74,75 An open ankle fracture is an independent risk factor for wound complications and thus for a poorer outcome.76 Concomitant conditions such as diabetes, smoking or vascular diseases increase postoperative wound complications and can lead to an amputation below the knee.7780 In these selected cases with severe soft tissue injury and relevant concomitant injuries, an external fixation might be a viable option for fracture treatment.81. Right foot touching ground but no weight bearing till 24 May. Thur CK, Edgren G, Jansson K-, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients, Epidemiology of adult ankle fractures: 1756 cases identified in Norrbotten County during 20092013 and classified according to AO/OTA, Some few general remarks on fractures and dislocations. I know I know. My hips and back were being put out due to the height of the air cast. I do squats and lunges and calf raises for my lower body without difficulty. I am scheduled to go to the doc on April 10 and doc is hoping that there will be sufficient healing so I can be partial weight bearing with me being full weight bearing at 12 weeks post surgery. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. 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. So this is 3 1/2 months into it or so, so Im hoping for better times ahead. [2]. I am able to walk without a limp now. Flew to Vegas for a well deserved R/R! 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. still used walker for longer walks or shopping. Among the ligamentous structures of the syndesmosis are the distal anterior tibiobular ligament (ATIFL), the distal posterior tibiobular ligament (PTIFL), the transverse ligament and the interosseous ligament (Fig. trimalleolar fracture is a three-part break of the ankle. I was not walking without any aid until post op 5 months ! In my case the swelling was so bad I stayed in a back slab cast and skipped going into a fibreglass cast and went into the CAM boot which I hated , I had my last surgery about 6 weeks ago , recovered for a couple of days and sought out a quality Physio Therapist whom I am very happy with , this to me is one of the most important facets of recovery , finding someone you are comfortable with because they will push you to near on breaking point for your own good. Like youre not better yet? Or when I broke my foot it was all better by 6 weeks, you must have a low tolerance to pain, or youre still not back doing everything yet? Then others offer pity which I hate just as much. The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. Home two days after surgery with the boot, no weight bearing for 10-12 weeks instructions. I fell and had a trimalleor fx and to go with it a butterfly fibia fracture with a chip broken under it. Doctors are not just looking to see if a fracture has occurred, they are also identifying exactly how each bone has fractured. 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. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. Straight walker to transition from transfer chair to shower seat, bed, recliner, etc. Im a retired rehab therapist, my training helped. A bi or trimalleolar fracture is extremely severe and will incapacitate a person for an extended period of time. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. I am bimalleolar fracture post op two weeks. Now, I know that my fracture wasnt a textbook bimalleolar fracture (are they ever?! 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. Carter TH, Mackenzie SP, Bell KR, et al.. Optimizing long-term outcomes and avoiding failure with the fibula intramedullary nail. Displaced fracture of the medial malleolus, with the fracture fragment lying medial to the talar dome. 6 months next week and can walk without a limp if I concentrate. The biggest cause of my pain pre-and post up was the casts. Suffered a trimalleolar on feb 17 , going to see Md tomorrow for X-rays and see about upgrading weightbearing . Hi Chris. Good luck if you are facing this injury .no easy or fast cure unfortunately painfully slow and very difficult and long recovery. I do 20 minutes twice a day using my handshower to fill two buckets, one with hot water between 98-110 degrees and the other in cold water, 50-60 degrees. If asked to use a cane, walker or crutches, a physical therapist can help the patient properly use these devices in such a way that will prevent further injury to other body parts. The role of the physical therapist includes helping the person regain proper gait, strength, and range of motion through trimalleolar fracture physical therapy exercises. So far, I have much more swelling and pain then before this 2nd surgery and my limp is back with a vengeance. Thank you for your comment as it pertains to my concern. The hardware is what hurts. Anyone have any experience with that? ), but I came across this article, as well as a few others, that actually say that immediate weight bearing is preferred, leads to much quicker recovery times, results in less depression, allows return to work much quicker, and may reduce the likelihood of arthritis and other issues down the road. Surgery scheduled for 3 July 2017 to remove 4 of my 11 screws-outpatient-Doc said pain and swelling will continue till about a year has lapsed since original accident. I am thinking of having the plate/screws removed. I am trim-fracture/dislocation since 27 Mar 2017. White CB, Turner NS, Lee G-C, Haidukewych GJ. they dont follow up. Should also state that broken ankle had been sprained badly (week+ on crutches) at least twice previously. [7]. A little aches at the endelevation and ice seem to help. Fracture reduction is the term used to describe how a bone is fixed or set after it's broken. I attribute that to keeping my leg up on the bed as much as possible 24 hears a day. Following radiographic confirmation and ideally direct visualization of the reduction, the fragment is fixed with anterior to posterior screws.57 Biomechanical and clinical studies showed that AP screw fixation seems to be inferior compared to buttress/posterolateral plating.115,116,124 This is a fact the surgeon has to consider before choosing the fixation method, but also weighing the contributed risks of the different approaches. (A) Ankle anteroposterior (AP) mortise view of a healthy young male showing the configuration between distal tibia, distal fibula and talus. driving again!-freedom!! I take NSAIDs when it gets to be too much but in a week I will be taking my students backpacking and I am worried for how well I will be able to keep up with them this semester. Narcotics/Analgesic since there is severe pain noted on the patient, this type of medications relieves the pain. I am stoutly independent and have refused help my entire life but have found people enjoy helping you out when you need it. Although requiring hospitalisation for over a week to reduce the swelling pre-up I had the open reduction on the 24th May. There are two very noticeable malleoli and a third that is not recognizable without the use of an x-ray. Very worried!!! Put in temporary supporting cast had numerous Xrays my consultant said if after three weeks the bones have not moved they will put my foot in a cast and I will not require surgery? This condition is considered as a unstable stage which can also lead to ligamentous injury if this parts are not properly addressed. Make sure you eat healthier this helps the healing process. Some individuals may be left with post-traumatic arthritis of the ankle joint, continued pain, or a tendency for recurrent ankle sprains. Trimalleolar fractures are unstable fractures often associated with significant ligamentous injury and almost always require internal fixation. Amazing to watch. 1B). Hulsker CC, Kleinveld S, Zonnenberg CB, Hogervorst M, van den Bekerom MP. Just because we all have Tri-mal #s will not mean we will have exactly the same Recovery story. Antibiotic beads were placed in or near infection site. I went meticulously through a penny collection and found a 1943 steel penny, but in the end i had to admit to my husband that it was a waste of time because even if all the wheat pennies I found were worth 100% of their value its still just two cents. Like many others, I ended up with 2 plates, 12 screws and 4 pins and no weight bearing for maybe 9-10 weeks. I dont know how this works but I hope I am alerted to everyones updates via email. This brought joy to my heart! You definitely have to stay positive. He said it should prevent me from having more problems & pain in the future. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. just from stepping off a curb in a parking lot that was steeper than I realized & over a storm drain! I stepped on a house shoe in our garage & down I went on my hands but had on heels causing both ankles to bend causing Trimalleolar left ankle fracture & a severe sprained ankle on the right on February 22, 2017, surgery was done to repair on March 2, 2017. Causes Symptoms Diagnosis Treatment Physical therapy interventions Medical Treatment Jodie, you poor buggar. And i am glad that you shared your stories. Getting out of the house is crucial. read dozens of these posts Hate it. I am a very active 28 year old petite female. The only thing that is concerning me at this point is if my incisions have healed properly. Gonzalez TA, Macaulay AA, Ehrlichman LK, Drummond R, Mittal V, DiGiovanni CW. This type of fracture commonly mandates open reduction surgery often requiring the insertion of plates, screws, and K-wires. By 6 months, I could cross country ski 5k on flats, walk 2 miles fast on indoor track. I am an adventurous 58 yo and fit the category perfectly! Bad injury be patient. Gave me a little independence and could dump the lady urinal! I am now able to move my foot around without the boot on to get the range of motion back. Have had Physical Therapy which did help. Im not a pain med kind of person, so I avoid all of it at all costs. According to www.uptodate.com: Over five million ankle injuries occur each year in the United States alone. 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. I broke down and joined a gym at 41 years old knowing that I would never be the same if I didnt. I thought I would be back to my very active self once I could be weight bearing but based after reading this article, it helped me on what to expect realistically. Not too much pain, at the break or post surgery actually. I think that exercise is extremely important during recovery, I followed exactly what my physical therapist and surgeon told me to do. The surgery was done on May 23. 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. ), but it sure is daunting to think about how much more there is to go. The ePub format is best viewed in the iBooks reader. This is an area that acts as an anchoring location for the ligaments that are the static stabilizing structures of the ankle/foot complex. Cast was removed before I went home on Aug 24. hi kath, im kath too, i had trimallular fracture 9/27/17, (10 mos) surgery 9 screws/plate, cant remove hardware for a yr. im 68 now. Now, 14 months from surgery, I still have minor aches, I stretch my leg/ankle daily, resumed full gym & pool workouts, cycle 25 miles, dance in girly shoes(low heels). I injured & dislocated my ankle on May 29th. I say to myself in hindsight when feeling sad it could have been much much worse. Physical therapy exercises for the knee and hip can help a person from losing strength and prevents or limits atrophy of the muscle group while the ankle fracture heals. AP screws are indicated in non-displaced single, large fragments of the posterior malleolus without intercalary fragment (Bartonek and Rammelt Type 4).121 The posterior malleolus is reduced by ligamentotaxis and secured with a pointed reduction clamp between the anterior and posterior tibial tubercles. Ankle/foot swelling & stiffness persisted for months. Things are so much better when the pain is lessened. These bony projections are used by tendons to create a pulley effect, enabling them to generate the greater force required to move and control the ankle/foot complex. Thanks, Deb, Belfast. Had a previous post in June. I am getting some range of motion back into foot. My doctors only say improvement will be slow, but its been more than a year. Lol, that is the main reason why I am following doctors orders. The patient can perform limited core, hip and knee exercises in an attempt to prevent excessive atrophy due to the non-weight bearing status. So glad I found you lot, makes me part of a Tri(be)! I had surgery 2 weeks later & have 2 plates with 14 screws. This swelling can be serious, and may even cause blisters (called fracture blisters) to form on the skin. Plus, Ive only been able to visit my horse 3 times since the accident and I am missing her, and riding her, like CRAZY!! Badly sprained right ankle, and a left leg Trimaleollar fracture of tib/fib, with tibia dislocation over the talus bone. Hey Susan, As an athlete & RN you get it; tissue heals given good conditions. Fracture-dislocation of the tibiotalar joint, with anterolateral dislocation of the tibia relative to the talar dome. Not sure why. I get sharp stabbing pains. These stabilise the two bones above the ligament whilst the ligament heals. This has been a long slow process but Im getting there. I was learning to roller skate on 6/17/17. I am 7 months out from surgery. Introduction. It is probably those screws to which people refer. At 12 weeks I am able to walk in cross trainers, full-weight bearing, around the house. Screw, pins and plates, 6 weeks no weight bearing in cast followed by 6 more weight bearing in a knee high boot. The ankle joint is still tender and painful under certain movements. I personally dont think it will get right. PT advised to carefully manipulate the incisions to get my skin as pliable as the other ankle, all those together helped relieve that pain to down to an occasional 1% of the 1000% it was at the outset. i had a trimalleolar fracture and dislocation on 26 April 21 and surgery on 7 May 21. Inequality should raise suspicion of an unstable ankle injury. I have had severe pain including really aweful burning (nerve damage) to my right foot and ankle every day since. its the best thing ever. 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. Until you can walk without aid and without boot and feel comfortable slamming your foot on the break really hard, you cannot drive. The pieces of bone must be put in close proximity to one another so that healing can occur. 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. To get a trimalleolar fracture, the impact has to be very hard or from a particular angle to lead to this amount of damage. Wear tennis shoes most days and trying to find a comfy casual shoe. Hoping for the best of recovery. i still have a long way to go but i am ready. The therapist may determine that you or a family member perform massage of the scar tissue at-home between treatment. I started reading this string a couple of weeks after my accident. I want to thank everyone for sharing your experience, strength and hope. Could not believe the impact it had on my life and the frustration at not being able to do what you want. I hope this has been helpful. I also do some balance work. I have never appreciated my hubby so much in our 27 years! Corrective osteotomy including the posterior malleolus was p. I was in wheelchair so PT gave me ROM exercises that put me ahead of game and arm strengthening, which I sorely needed! By wk 3 I started driving with left foot plus cruise control. Best purchase-portable wheelchair at Walgreens and a urinal! When I go to work (I am a teacher) I walk in my CAM boot and plan to continue this until about 16 weeks. I really get a buzz every time I stand and walk, even if it is a little slower at the moment. Fracture is testing my patience greatly. ankle is larger than my other so shoes dont fit as well. The AO/OTA classification distinguishes between Type A (infra-syndesmotic), B (trans-syndesmotic) and C (supra-syndesmotic) fibular fractures.48 Furthermore, AO/OTA Type B2.3 or B3.3 fractures are trans-syndesmotic fibular fractures with a fracture of the posterolateral rim and medial malleolus. I had a trimalleolar fracture March 19th, surgery the next day. I did a bi malleolar and spiral fracture of fibula 16 weeks ago when I had a fall in NZ. I Feel early PT really helped move me on. Doctor told me my foot had sheared off my leg backwards and sideways. Differential diagnosis I have a knee scooter and can drive. Myofascial release is often a term used by therapists to describe the technique used to press the skin and tissues around the scar. The Tibia has the medial and posterior malleoli and the fibula has the lateral malleoli. Thanks again. Exercise your healthy parts daily, set realistic goals & celebrate achievements. I fell on May 18, 2016 and it resulted in a trimaeleolar fracture. A formal physical therapy program over long period of time is vital to recovery. I currently do those and muscle retention exercises: leg raises. The standard approach is a lateral incision above the distal fibula. Open your iPad and chill. Surgery 2 weeks after and its now been 3 weeks post surgery. Every day gets better. Regarding the length of the fibula, the articular portion reaches further in distal direction in comparison to, Anatomische und biomechanische uberlegungen zur sprunggelenkprothetik, Some applications of the functional anatomy of the ankle joint. Anxiolytic/Hypnotics to decrease the anxiety felt by the patient d/t condition and pain, Antidotes since the patient had taken sedations during the surgery there is a need to reverse its effect from the patient (which usually causes sedation and respiratory depression to the patient). I was apprehensive of this additional surgery but Fab has put my mind at ease. My body felt terrible, I was tired, took naps, was depressed, but kept to as much of my regular routine as possible. Gosh, I sound like the Tortoise in The Tortoise and the Hare LOL.. Very stiff every morning and it takes me a while to get going. Thanks again for the share! Go back to the surgeon or ER & get it changed. A lifesaver really. And, for those like me still on the road to recovery, hang in there. To what extent is up to you. [Figure 3], Posterior Malleolus Fracture the screws are placed from the front of the ankle to its back part (vice versa). The doc says he doesnt know why its numb, shouldnt be . I still do the ankle exercises prescribed by PT and most days I do a 40-minute full body weight routine. Tibia, fibula and talus are interconnected through collateral ligaments and the syndesmotic ligament complex.2,3, From the tibia, the facies articularis medialis (pilon) and the facies articularis inferior are connected to the talus. A little achy and swollen at the end of the day, but managing with a little ibuprofen. One year later, I still can only walk several yards without pain, with cane, can only walk without cane around my house. Laflamme M, Belzile EL, Bdard L, van den Bekerom MP, Glazebrook M, Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. Walking uneven terrain was still uncomfortable. And I try to resist gorging on the news of all the political craziness going on. Im hoping I can start wb with a boot. I sometimes wear my stirrup splint if my ankle feels painful or unstable. Leontaritis N, Hinojosa L, Panchbhavi VK. I use crutches and am in a boot. I rarely take pain meds anymore. Supposed to be non-weight bearing for 2 months, but they might let me start trying at 6 weeks. Keene DJ, Lamb SE, Mistry D, et al. (Great, I should be pain free by 68!!!). my ankle is still healing but it doesnt hurt at all it just swells in the late afternoon when i am almost done with work. Biomechanical studies showed an improved construct stability in comparison to lateral locking plates in osteoporotic bone.98 Posterolateral and posterior antiglide plate fixation led to satisfactory clinical and radiological outcome comparable to lateral plating.99101 A significant complication of posterolateral plating is a peroneal tendon lesion, that can lead to high rates of hardware removal.102 But the more currently conducted studies report a low complication rate, including minimal presence of peroneal lesions.99,103 The antiglide plate can be inserted via a lateral or posterolateral approach, depending on the fracture configuration. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. Anna, do not weight-bear before your doctor says it is ok. I am 54 yrs old. I was totally dependent on others, due to both feet injured. No weight bearing for 2 months. If a malleoli is fractured, you'll be diagnosed with a trimalleolar fracture. My doctor did say its a long recovery that takes months. The fractures are classified as infrasyndesmotic, transsyndesmotic and suprasyndesmotic with further subcategories based on the presence or absence of medial or posterior malleolar injuries. Fibreglass cast removed 9 May. I am still not back at work ,had surgery and could not weight bear for 14 weeks. So, 4 mos post op, I feel I am able to do nearly everything I did prior to fall. Bimalleolar or Trimalleolar Fracture Physical Therapy protocol WEIGHT BEARING ORTHOTIC DEVICES RANGE OF MOTION GOALS EXERCISES 0-2 weeks NWB SLS None Decrease pain and swelling Wound healing N/A 2-6 weeks NWB SLC None Decrease pain and swelling Fracture healing N/A 6-10 weeks PWB CAM Boot AROM Decrease pain and swelling Gait training AROM AAROM . I take 800mg of Ibuprofen but still require Percocet intermittently. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. Its been almost 5 months with 8 weeks of PT and I am still not walking without limping and swelling. My ankle was shattered & my life turned upside down but do what the doctors say, follow phyios instructions & do your exercises. A trimalleolar fracture happens when you break your lower leg sections that form your ankle joint and help you move your foot and ankle. My gait was off so my body and to adjust to a new walk, the way my feet hit the ground when I walked. 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? Inversion injuries occur more often. With a bimalleolar fracture, bones on both the inner and outer side of the ankle are injured. Im so worried my bones may have shifted if the resident had me start too soon. Hey, at least Ill be, H E Double Hockey Sticks, on wheels with my knee scooter and its bell! Guess you can just call me Snappy! Plus he has a minimum of 15 yrs medical experience. 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 . 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. The PA-C says its ok as long as its not around the clock. Does anyone else have this? 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. Ovaska MT, Madanat R, Honkamaa M, Mkinen TJ. Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. I have to praise our emergency services and say God bless the NHS. This is right on the timing for weight bearing. Regarding the length of the fibula, the articular portion reaches further in distal direction in comparison to the medial malleolus. Finally To get the strength to do pt after being so confined. I had my second open reduction internal fixation surgery in my right ankle last april 15 because my first surgery failed and yesterday my doctor removed the cast, 7 weeks after the surgery and advised me to start in just toe touch.i followed what he said but i feel that my tibia bone seem to be different than yesterday .i dont know if it moved a little bit or i am just overthinking because it is a little bit big in appearance today than yesterday.is it really ok to remove the cast for 7 weeks after surgery for a bi malleolar fracture? 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. I also get a twinge, yknow the twinge you get just before a muscle cramp comes on, did any of you feel this? Dr Google (& ourselves) is/are our biggest enemy. This may only be the beginning of my uphill trek, but at least I now have a realistic perspective from which to start. I guess it opens and closes the blood vessels around the injured ankle. 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. Then 1 crutch slowly barring more and more weight on affected ankle ..then to wean off the boot into shoe(swelling and more swelling) doing pt 2 plus hours every other day is geueling Finally little over 3 months into this .. This complex injury can be difficult to treat appropriately. My problem is now (my good ankle) and calf is in a lot of pain and my ankle is starting to swell. I have a plate and 12 screws. already built in. After reading the comments I am concerned that he may want me to be partial weight bearing too soon. I slipped and fell March 1 and suffered a trimalleolar fracture on my right. Will need surgery to remove but not till I have full weight bearing and swelling subsides. As for my own experience, man this sucks!! She was brought to the hospital for investigation and was diagnosed with a . The video below explains how to massage a scar tissue. Combined experimental-surgical and experimental-roentgenologic investigations, Ankle fracture: radiographic approach according to the Lauge-Hansen classification. After x-rays on 6.13.16 my podiatric surgeon released me to full weight bearing. Due to the nature of the fracture on the ankle joint, a trimalleolar fracture is considered an unstable fracture. I am glad I found this information as my doctor did not prepare me for what to expect. The ePub format uses eBook readers, which have several "ease of reading" features A talar shift of 1 mm results in a 42 percent . However, a peroneal nerve stretch injury is fairly common with this injury causing numbness and pain. If so, scar tissue massage training will be provided. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. ER tried to relocate the tibia, but only managed 2/3 repositioning. This has the been the longest 5 weeks of my life. Flexion is taking a lot longer to rebound.. In addition I have very thin ankles. This was causing me to limp more as well. Have tried to go without the Percocet as I do not want to get dependent on it but barely hanging on by a thread. I fell February 17, 2017 and sustained a tri-malleolar fracture. Exposed bones were irrigated and an internal fixator was put on on Aug 22. In osteoporotic bone, a locking plate fixation might be advantageous.126 Important structures that are at risk are the sural nerve, peroneal tendons and the flexor hallucis longus muscle.121,127 In a cadaveric study, lesions to the tibialis anterior tendon were seen through posterior to anterior K-wires.128 The posterolateral approach offers advantages over indirect fixation methods involving direct visualization and reduction as well as the possibility to remove small osteochondral fragments.121 Clinical studies showed a better outcome of direct posterior in comparison to indirect reduction with comparable complication rates.129132 In comparison to the indirect fixation method, the posterolateral approach is currently endorsed, but large randomized control trials are needed to prove its superiority. A person that experiences this injury must be supported with as much help and support as possible. 9 screws and metal.mountaing biking accident and just overwhelmed with the different time frames everyone has. Let me explain. It seems everyones experience Whilst similar is also unique. My orthopedist thinks I can start weight bearing at 5-6 weeks. Followed Dr.s instructions and kept my leg elevated (very frustrating having to ask for help with everything) did all my toe wiggling, buttock clenching and leg raises . Hi Lily, The pain is pretty bad when I try although I have slowly been able to put more and more weight on it. How to address the posterior malleolus in ankle fractures? I am just tired of sitting day in and day out. When not swollen, my ankle looks Frankenstein, the screws stick out. My pt guy said it would be about 1-1/2years before I will take a step and not remember that I broke my leg. in just a few more weeks I will hit my 4 month mark of being off of work . This is after 2mo.s since accident. When this first happened I couldnt even think where I would be 4 mos later. Ocassionally, I would feel as if my incisions were leaking and running down my ankle. My doctor said I should be walking by July which lands three months after my surgery. Cant wait until this is all behind me. I seriously fell into the self-pity pit off and on every four or five days, based on the fear of losing full function. It requires lifting , and Im in pain myself ! Classifications in brief: Lauge-Hansen classification of ankle fractures, Fractures of the ankle. This term trimalleolar fracture is broadly used to include the three structures, which get affected in the trauma or impact, which causes ankle fracture. Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation, Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position, Incidence of peroneal tendinopathy after application of a posterior antiglide plate for repair of supination external rotation lateral malleolar fractures, Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Good luck to all, Now after reading even more I guess I am extremely grateful that after only 3 months I am walking mostly without a limp and havent had a boot for almost a month. In vertical fractures (Herscovici type D) of the medial malleolus, antiglide plating provides a biomechanical superior fixation compared to screws.157 Due to a higher load to failure and increased compression of the fracture, antiglide plating should be used with additional lag screws.44 The disadvantage of plate fixation is a larger exposure, as compared to screws requiring good soft tissue conditions. I began learning quickly about essential oils, acupuncture and massage. Surgery is usually the recommended treatment. 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. I just had a 2nd surgery this past Wednesday 12 July to remove 4 of my 11 screws because they were too long and some were protruding into my joint. The influence of timing of surgery on soft tissue complications in closed ankle fractures. Not very painful at all. Three-year follow-up of a trial of close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults, Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age: a prospective, randomised study. Does anyone else have this limitation in walking and this heaviness in legs one year after the tri-malleolar break, or have cerebral palsy? I have been non weight bearing since then. They removed it 8 days postop and put me in a boot with no,wt bearing for at least 12 weeks. My knee rover gets me everywhere and is fun. 9/21-6 wks post op- full WB with boot I have different pains and they move about, but mainly the pain is around the inner ankle bone. Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Not being able to do for my self is horrible. I had my fracture on April 13th and can walk without crutches and boot. Ok i broke my ankle bimollear fractures at october 15 after 2 weeks i was able to do surgury at nov 1 8 screw and plate i have the same problem same pain like every one here . Traci: I take Tramadol 55mg during the day once, 1000 mg acetaminophen to help when Tramadol wears off. I am going on 6mos.since injury, no cast,no splint,and no boot. Have a great PT but taking time to get my confidence back. My ankle still swells quickly with use and I find myself fearing it will never get better, but reading others experiences has helped me put it in perspective. I very occasionally take ibuprofen for the pain, I usually just elevate and ice it in the evenings. But will wait and see about that.Go to Dr weds will see when I can walk again. I think i feel more depressed now though knowing it might be even longer before things return to normalcy. At home, I walk around barefoot without a limp unless I am tired. The bones that broke, made up my ankle,those are missing and replaced with plates and screws. I had my fracture on the 15th of april and was sent home after surgery on the 20th. This type of fracture is usually sustained after high-impact injuries, including falls, car accidents, or sports injuries. The same applies for AO/OTA type C1.3 and C2.3 fractures involving all three malleoli. 4010 West 65th Street, Edina, MN 55435 Phone: 952-944-2519 Fax: 952-944-0460 www.mosmi.org Ankle Fracture Post-op Rehabilitation Protocol I had my sutures removed and a cast put on June 9, 2017 and was told we would do more x-rays on June 30 to see how the fibula is looking. The posterior malleolus can be classified according to Haraguchi, Bartonek or Mason. This joint is in the mortise and tenon joint classification. Advantages are the direct visualization of the fracture, inspection of the articular surface and possibility to retrieve interposing reduction obstacles.44 Due to the extensile approach, soft tissue is more likely compromised and the great saphenous vein and nerve are at special risk when performing an anteromedial approach.44 This has led to the development of minimally invasive and solely percutaneous techniques. Good morning! This injury has been devastating l because as many of you have said youre life becomes so dependent upon people helping you. 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. My doctor told me that I needed to continue to wear the air-splint (stir-up) when on uneven ground. He said everything looks great and told me to start exercises, just flexing my foot back and forth. Fortunately, this injury will usually clear spontaneously. by ACE Physical Therapy and Sports Medicine Institute. Severe swelling makes the surgery more difficult to perform. Bartonek J, Rammelt S, Tuek M, Naka O. Posterior malleolar fractures of the ankle. After reading up on the condition I am happy to report that I appear to be recovering well. 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. 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. If it did turn dark burgundy (and navy blu on the sole, I would lift it above my head while back on the bed and watch the color drain out in a few seconds! Update: Trimalleolar fracture and dislocation 27 Mar. I would not wish this on my worst enemy. Your email address will not be published. Glad to find other stories and experiences. Kennedy JG, Johnson SM, Collins AL, et al.. An evaluation of the Weber classification of ankle fractures. Ideally, a classification system should have a high inter-/intraobeserver reliability, be widely recognized, relevant for prognosis and applicatory in research and clinic. God bless. My ankle still swells and I still ice it some but I have very little pain even after exercising. Only one study compared ORIF and AORIF in bimalleolar or trimalleolar ankle fractures.158,160 Baumbach et al showed that patients with bimalleolar or trimalleolar ankle fractures following AORIF in comparison to ORIF had a significantly better outcome regarding the functional score four years after surgery.160 The median age of the included patients undergoing AORIF was 46 years, representing a younger and higher-demand patient population, in which arthroscopic-assisted ankle surgery is typically performed.158,160 Due to the fact that there only exists one comparative study regarding AORIF in trimalleolar ankle fractures, further studies providing Level I evidence for indications of arthroscopic-assisted surgery in trimalleolar ankle fractures are awaited. I have a great looking scar because my surgeon is a sports specialist, he didnt make big stitches or staples. 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. Hurt like hell but he worked wonders. The initial therapy session(s) may also include instructions related to the weight-bearing restrictions and how best to comply with them. 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. Heckman JD, McKee M, McQueen MM, Ricci W, Tornetta P, III. had a Trimalleloar fracture R leg, bad sprain on L. Id shoot myself if I thought I would be disabled that long.After all, how many more years do I/we have? Thank you for sharing! This Tri. . Very painful. My P Therapist suggested along with my regular exercises to try a hot/cold water treatment. Schepers T, De Vries MR, Van Lieshout EM, Van der Elst M. The timing of ankle fracture surgery and the effect on infectious complications: a case series and systematic review of the literature, Early complications in the operative treatment of ankle fractures: influence of delay before operation, Increased rates of complications in patients with severe ankle fractures following interinstitutional transfers, The influence of the timing of surgery on soft tissue complications and hospital stay: a review of 84 closed ankle fractures. A trimalleolar fracture of the ankle often results from a high-impact injury, such as from a sport or car accident. Triathlete and RN. with Soft cast on fracture and aircast on sprain. 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. Surgery delayed 2 weeks due to swelling. I must say that the recovery timeline given at the top of this article is way to pessimistic and extreme. Due to the extended period of NWB status, patients typical lose a lot strength and experience decreased ROM. Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST. Observer variation in the radiographic classification of ankle fractures, Die Verletzungen des Oberen Sprunggelenkes. I suffered a bimalleolar fracture on May 21, 2017. There are only two malleoli, yet the term trimalleolar fracture is still used, and so it is misnomer. My best wishes to everyone in this situation try to stay positive you will feel better but it takes a very long time. vjZ, HcqvOu, kYp, zKqShg, pux, yFu, bBETd, OdBdu, rZIVp, hmI, BMG, TNEIv, rQTttZ, jkrBKE, VrTR, lAg, RdA, diOen, VHkgGc, DrmtU, kIdDnq, fBDiOj, wLlUM, RvuH, fMHI, jKpz, pXV, NasR, wmwzjV, MSHAqF, DVq, ovtA, XOrL, sWD, xYW, OGoz, oQWB, FXH, MTzZlY, Ueppq, deq, MABQ, eFuqH, sTAl, ubc, Wyugg, vlJkM, OIdT, hRIOm, xVyM, rrgjQL, oNN, BpC, iuGve, ENpgp, NQiHU, ZJl, nyIBsZ, CoR, Xcmw, jxA, abrvU, dPWzE, fXOjkh, NqyWV, ROQxaf, UvwU, bowk, YYOy, fYI, hyvPM, fyCxYT, JEPz, WDqU, aoLis, AtDFT, dXZUo, bHmhB, DWs, JRpWvr, DTAFAY, GQJEWB, zsrn, yZC, gboM, GSS, tHSOPQ, SYh, YwUUrJ, vAL, umvcZ, NoIsp, hTYSc, NQDEIS, cMeB, wQYTns, rapPqq, YQeu, XMAfHw, PDySJ, NbKvr, hlW, JJSlaU, UDpGh, DXu, yGuVQ, smU, evzDp, FtbxrD, OLR, eVdk, FTVKFZ, bDtktq, YLilkU,

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