On top of this, I have a one year old nursing baby. These stabilise the two bones above the ligament whilst the ligament heals. Go to physical therapy for guidance on your ankle and lower body exercises. Ankle was shaking violently out of cast but now OK. I will be embarking on physiotherapy to help rebuild muscle that has disappeared over the last 3 months. I was not prepared. If a malleoli is fractured, you'll be diagnosed with a trimalleolar fracture. Im really glad I found this site as it gives me some insight into my mobility and flexibility while recovering. Furthermore, emergency indications for an operative treatment are: Despite the emergency operative treatment, there is a controversy about the optimal timing of surgery of closed trimalleolar ankle fractures. However, a simple trip or fall can also cause the injury. The ePub format uses eBook readers, which have several "ease of reading" features I had the Tri fracture with a dislocation. On January 16th I had surgery and 12 screws and a plate. After sustaining a trimalleolar fracture, yourdoctor will refer you to physical therapy. (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. 52 yr. 230 lb. You might need this procedure to treat your broken ankle. I have a knee scooter and can drive. I am from Oklahoma so i really had no idea about this mountain until i got to the hospital. A dye is being injected to the vein to give a cleared image of the bones. I still have pain, but I deal with it and I also walk all day but I can now run at top speed. My knee scooter saved my mental health, I used it to grocery shop, get safely thru my pool. Total bedrest for 2 wks. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. Im approaching the 12 week mark, but got the green light to start light ROM p/t at 7 weeks. Future studies need to provide further evidence to specify indications for open reduction and internal fixation or primary transfixation of the ankle joint in these elderly patients. So many people want to tell you their story too but most of the time its very disparagingI still hurt after 20 yearsIts never gotten better 4010 West 65th Street, Edina, MN 55435 Phone: 952-944-2519 Fax: 952-944-0460 www.mosmi.org Ankle Fracture Post-op Rehabilitation Protocol Exposed bones were irrigated and an internal fixator was put on on Aug 22. Anyone else had this done & did it improve your ability to walk & flex the ankle? I also take 10 to 20mg THC in between when pain comes back. In my mind I feel like Im going to be walking fine when I go back for my next appointment December 14th but the reality is I still have a long road of recovery ahead of me. I have had severe pain including really aweful burning (nerve damage) to my right foot and ankle every day since. Meanings for Trimalleolar fracture It is a medical term that defines a common ankle fracture. Cheerio love. You may notice problems with I tire of staying home with ankle elevated. Lamontagne J, Blachut PA, Broekhuyse HM, OBrien PJ, Meek RN. Ideally, a classification system should have a high inter-/intraobeserver reliability, be widely recognized, relevant for prognosis and applicatory in research and clinic. It is nothing you can rush and it will come with time lots of time to he and there will be a lot of bad days eventually good ones will come and you have push thru the pain to gain back mobility . I had surgery 2 weeks later & have 2 plates with 14 screws. I have a bimalleolar fracture from a freak accident. I am trim-fracture/dislocation since 27 Mar 2017. Anyone have icky ugly scars? Not only is my physical health turned upside down, but so is my mental health. Via an arthroscopy they also trimmed the scar tissue from the cartilage that joins the tibia & fibula resulting in a good improvement in range of movement. Swelling down after 2 and a half was. 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. Followed the same day by a late 20s woman going thru cancer treatment saw me in the wheelchair with the boot and genuinely asked if it hurt a lot. The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. lifesaver! Snowmobile accident on February 20, surgery on March 2 2017. I had a rotation of therapists and always dreaded when the ex gymnast was up. Hi I have a trimellior fracture from an obstacle race trying to be fitter lol. Minihane KP, Lee C, Ahn C, Zhang L-Q, Merk BR. Jodie, you poor buggar. Trimalleolar Ankle fracture surgery performed by Dr. Paul Steinke. This has been a rough, rough situation and am just ready to get back to some normalcy. In clinical practice, the evaluation of soft tissue status is still an important piece of information and can lead to a delayed surgery in case of excess soft tissue swelling.66 Latest studies showed no difference regarding different time categories and further studies are necessary to determine the best timing of surgery. For the most part I try and just ignore the pain and maintain a normal daily life. Occupational therapy designed a daily Out Of Bed routine to get me up and rolling. Each morning can barely raise my legs out of the bed because they feel so heavy. I am 65 and have a slight case of spastic cerebral palsy. A week walking the halls in my house with crutches (that took practice! I am inspired by all the posts I have read here and I will battle on to make my recovery. I have pain every day and I stave off painkillers as long as I can until I cant stand it. Hold one end of the towel in each hand, with your hands above your knees. its the best thing ever. The anxiety! I can now say i know what i am up against. 1C). I fell February 17, 2017 and sustained a tri-malleolar fracture. Scar tissue massage Share Watch on Cant wait until this is all behind me. The concave-shaped incisura tibialis matches the convex shape of the fibula (Fig. Amazing to watch. There are only two malleoli, yet the term trimalleolar fracture is still used, and so it is misnomer. 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). ), and just got released to walk carefully outsidein the sun!! I suffered a bimalleolar fracture on May 21, 2017. Bi-malleolar fracture on 1Feb 2017. 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. Its four weeks since fixation surgery. It did takes several years to be completely pain free. 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. So with each new hurdle, I an uplifted. Hoelsbrekken SE, Kaul-Jensen K, Mrch T, et al.. Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. You are at a tough stage. This has been a long slow process but Im getting there. The video below explains how to massage a scar tissue. Is this pain normal? I have too much arthritis in my back, knees, hands to use crutches because that is 10 times as painful as the ankle. I will be getting 2 or more screws removed next month since they are too long and protruding into my joint. Everyones recovery is different but this gives me up. Surgery is needed to set the bones after a bi or trimalleolar fracture occurs. He said he expects me to walk in with a cane at my next visitI was in a wheel chair at the time. I have a feeling Im not quite half way to weight bearing walking by the way some of the comments Im reading here. This is an injury that you will never fully recover from. Walking with a limp because brain has been instructing body not to apply any weight to right leg for the last 3 months! Glad to find other stories and experiences. My best advice: follow MD/PT instructions, stay positive, accept help where you need it but dont baby yourself. A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Contd. Practically lived on my backside for weeks; tailbone still sore. I had physical therapy (which was very helpful) Went to the Grand Canyon on June 2nd for our 50th wedding anniversary (airports were great to provide a wheelchair & assist). They removed it 8 days postop and put me in a boot with no,wt bearing for at least 12 weeks. I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces. Looking at the coronal plane, the tibia shows a slight slope from medial to lateral and is concave-shaped in the sagittal plane (Fig. I still have a lot of pain and burning in the inner ankle and across the top of the ankle. I had my surgery April 13th and started weight bearing June 5th. 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. I know better than to go against what my surgeon has said I think hes a fantastic surgeon! 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 think this article does a great job in helping us realize what a slow process it is to recover from an injury like this. Home two days after surgery with the boot, no weight bearing for 10-12 weeks instructions. Im so worried my bones may have shifted if the resident had me start too soon. My gait was off so my body and to adjust to a new walk, the way my feet hit the ground when I walked. Better than 3 weeks ago in bed! Alicia, I remember feeling exactly the way you do, wondering if I would be walking by our beach trip planned for the last week in May, after my injury in January. He said it should prevent me from having more problems & pain in the future. Like bimalleolar fractures, these injuries are often unstable, and a dislocation can occur. It was far too damaged. To get a trimalleolar fracture, the impact has to be very hard or from a particular angle to lead to this amount of damage. Never did I think that this injury would have such a devastating impact on my life. already built in. This was mostly due to the gross instability of my ankle so, either the swelling caused the pain or if it was not swollen, the ankle flopping sidewards within the cast caused even more pain. II. New implants, such as headless or bioabsorbable screws were developed to reduce medial site pain and supersede implant removal, but prospective studies with a high scientific quality are missing to justify routine clinical use.44. Despite your allergies there are pain killers you can take. Yang T-C, Tzeng Y-H, Wang C-S, Lin C-C, Chang M-C, Chiang C-C. Untreated small posterior fragment of ankle fracture with early removal of syndesmotic screw is associated with recurrent syndesmotic instability. Dont let the stress win. No more pain medication needed anymore for me now. The issues I do find, (in addition to my wanting to be 100% right now), are friends and some family members that just dont understand and say things that dont help. Ankle still swells up everyday to the point of discomfort. I am a healthy and active walker/hiker, 66 yo who slid down two steps at the end of January 2018. Still slept with feet elevated but could sleep on my side so finally able to rest. But it is very hard to be when I have to depend on my fianc for everything. is driving me insane!! It was actually the ooze from the incisions into the combines that had dried as hard as a brick. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. Hey Susan, As an athlete & RN you get it; tissue heals given good conditions. This cast is so uncomfortable though. A trimalleolar fracture of the ankle often results from a high-impact injury, such as from a sport or car accident. to get you started web nov 26 2022 letter to the editor on aplastic posterior tibial artery in . You dont HAVE to wait until August if you cast is hurting. 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. I recently had a trimalleolar fracture in my right ankle. Jonas SC, Young AF, Curwen CH, McCann PA. Functional outcome following tibio-talar-calcaneal nailing for unstable osteoporotic ankle fractures. Triathlete and RN. Trimalleolar fracture is usually common in accidents where a huge force is applied on the ankle, like in skiing sports or an automobile accident. I have a great looking scar because my surgeon is a sports specialist, he didnt make big stitches or staples. Anyone have any experience with that? My problem is now (my good ankle) and calf is in a lot of pain and my ankle is starting to swell. OConnor TJ, Mueller B, Ly TV, Jacobson AR, Nelson ER, Cole PA. A to p screw versus posterolateral plate for posterior malleolus fixation in trimalleolar ankle fractures. I may need to find a new normal. Maybe that will help a little. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. Open reduction internal fixation of posterior malleolus fractures and iatrogenic injuries: a cadaveric study, Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures. I also get a twinge, yknow the twinge you get just before a muscle cramp comes on, did any of you feel this? 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 am 6 years in from a trimaleolar fracture and dislocation following a horse riding incident. Inmans joints of the ankle. I cant wait to keep going.but still have the fear of loss. How to address the posterior malleolus in ankle fractures? . I was put in the external fixator aug 19. Wei SY, Okereke E, Winiarsky R, Lotke PA. Nonoperatively treated displaced bimalleolar and trimalleolar fractures: a 20-year follow-up, Posterior malleolar fractures: a critical analysis review. 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. I go to gym 3 times a week and also do my physio at gym. Plate with 7 screws. 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. Arch strength taking forever to come back. Started PWB in cast a month ago and now to start WBAT (as tolerated) a little apprehensive and lots of excercises to do at home just to loosen all those tendons amd ligaments but feeling grateful. Could not believe the impact it had on my life and the frustration at not being able to do what you want. 3.5 mm lag screws, one-third tubular plates or locking plates. The addition of the proximal fibula shaft fracture to the radiological findings above would classify this pattern of injury as a Maisonneuve fracture (high Weber C). Hermans JJ, Beumer A, de Jong TA, Kleinrensink GJ. Some more productive than others. Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature, Surgical versus conservative treatment for ankle fractures in adults: a systematic review and meta-analysis of the benefits and harms. Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. Trimalleolar Fracture 1. The standard approach is a lateral incision above the distal fibula. My thanks to everyone for sharing their stories. I fell in the dark,in a 7 ft empty creekbed,on the way down i got my foot stuck in a trees root-ball . I am 4 1/2 weeks post surgery and agree with others being so dependent is awful had w weeks off work and have been very lucky with support from family friends and work colleagues but so bored of not being able to do simple things. I take 800mg of Ibuprofen but still require Percocet intermittently. This is after 2mo.s since accident. Knew immediately it was broken but no pain. Comparing the knotless tension band and the traditional stainless steel wire tension band fixation for medial malleolus fractures: a retrospective clinical study. I have seen some good progress since starting Physio and have recently started to walk with out crutches for short distances in a good quality shoe. I have a feeling of resistance in the front of my ankle when bending. I started walking FWB around 9-10 weeks. All the posts are very helpfulthank you. Another joint is called the syndesmotic joint and is the connection between the tibia . Just a head up with the air cast, try get shoes with some height for you good foot. Hartwich K, Lorente Gomez A, Pyrc J, Gut R, Rammelt S, Grass R. Biomechanical analysis of stability of posterior antiglide plating in osteoporotic pronation abduction ankle fracture model with posterior tibial fragment. Did the surgery and had an splint put on. Bimalleolar and trimalleolar fractures account for more than 30% of all ankle fractures. It does not diminish the pain, inconvenience or lossit just puts this into some perspective. Thursday i was able to check out of the hospital with 6 screws, one plate and a big ole boot. 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. what does ODG say for post-op PT after ORIF for a tri-M Fx ? I get reevaluated 9 May. I am able to do squats easily, lunges are still a struggle but I am making progress. The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. Im trying to not take pain medication because there really isnt pain, just discomfort. In this case report, we present a 52-year-old female patient who met with a road accident 15 months before presentation. That doesnt help you at all but at least you will know that is normal. I have recently ended up with a trimalleolar fracture that I received from a nasty accident. I am almost 12 weeks post surgery and anticipate that at the next visit I will become fully weight bearing. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. It has been the best thing I did to understand that an apparent hiccough in your life will change it forever. (B) Lateral radiograph of the ankle of the same patient of (A). 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. (My surgeon is apparently great, but not a great seamstress) Ive been using a silicone strip (no medication or other ingredients) called Cica Care. The boot is very painful cause it puts pressure right where my ankle hurts. TRIMALLEOLAR FRACTURES Trimalleolar fractures involve fracture of the medial malleolus and fibula, along with fracture of the posterior lip of the articular surface of the tibia. Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Patients complain of marked pain, swelling, and tenderness associated with an inability to bear weight or ambulate. Walking uneven terrain was still uncomfortable. The contact zone between tibia and fibula is covered by a thin layer of cartilage forming the syndesmotic recess.7, Furthermore, the fibula is connected with the corresponding articular surface of the talus.8 Due to the length of the fibula, the articular portion reaches further in distal direction in comparison to the medial malleolus.2 Via the syndesmotic complex, the fibula is dynamically fixed to the tibia (Fig. The trauma is sometimes accompanied by ligament damage and dislocation. Until you can walk without aid and without boot and feel comfortable slamming your foot on the break really hard, you cannot drive. Advertisement. Every day gets better. My doctor has not even offered that as an option. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. According to www.uptodate.com: Over five million ankle injuries occur each year in the United States alone. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry, Single-screw fixation compared with double screw fixation for treatment of medial malleolar fractures: a prospective randomized trial. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. A traffic collision involving a tanker truck and SUV resulted in minor injuries in Sacramento on November 28. 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. Diagnosis is made with plain radiographs of the ankle. Saithna A, Moody W, Jenkinson E, Almazedi B, Sargeant I. I just had my visit last Thursday with my doctor after being post surgery for two weeks. If I had to relay on the crutches I wouldve been treated for a fractured right ankle too( I have no balance). I spent 4 days in the hospital and then transferred to a rehab facility. But i know ill be fine because i wont allow a lazy attempt at recovery.. Prayers for makng it past surgeryheart to make it thru recovery. Thanks again. I have never appreciated my hubby so much in our 27 years! Will need surgery to remove but not till I have full weight bearing and swelling subsides. i have been reading all the posts. Keene DJ, Lamb SE, Mistry D, et al. A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients, Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial, Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases. Other posts are giving me hope. My timeframe- 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. Fracturing any bone can be painful and take time for recovery, but fracturing an ankle is particularly challenging. 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. Nguyentat A, Camisa W, Patel S, Lagaay P. A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries, Comparison of three plate system for lateral malleolar fixation. Regarding the length of the fibula, the articular portion reaches further in distal direction in comparison to the medial malleolus. Obviously Im off work. A formal physical therapy program over long period of time is vital to recovery. 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. 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 have a trimalleolar fracture from a freak fall accident that resulted in several (at least 6) screws and a couple (2 maybe 3) plates. A trimalleolar fracture refers to fractures of all three malleoli of the ankle: lateral malleolus, medial malleolus and the bottom posterior (backside) tibia. I seriously fell into the self-pity pit off and on every four or five days, based on the fear of losing full function. Wear tennis shoes most days and trying to find a comfy casual shoe. Weird to describe myself as lucky, but due to bad swelling never had screws placed and lived with external fixators for 8 weeks. Naumann MG, Sigurdsen U, Utvg SE, Stavem K. Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 36 years after operative fixation of closed ankle fractures. So this is 3 1/2 months into it or so, so Im hoping for better times ahead. When I went home, I was ordered home therapy. Let me explain. She slammed both feet down on the break, locking her legs, just before the collision. While this may seem minor, movement of the toes can keep blood clots and adhesion of the tendons from forming. Keep your toes and feet moving! Am now wearing a compression stocking which helps. Learn more about us on Yelp, Avvo or Google. This technique includes slow motion and the light use of force. Currently, I am week 6 and will go in for x-rays next week. You can use Radiopaedia cases in a variety of ways to help you learn and teach. I stopped the pain mess 4 days after sx take Tylenol now except sometimes to sleep need to take pain pill but do not take in the daytime. Cheers to all of the caretakers! You may switch to Article in classic view. Chin up to all stay strong and Im 60 years old and I know if I were younger the healing process would hve been shorter.. but pretty damn hapy with my body and its ability to heal xxx. thanks for the info i am 2 weeks post surgery and i understand about the splints they suck and hurt seems to rub all the time They told me NO IBUPROFEN, but the other pain meds did nothing, so Im taking ibuprofen anyway. A negligent driver in Sacramento near the Kenwood Street intersection killed a bicycle rider on November 9 and then fled from the scene. Providing further information about the stability of the injury, the Lauge-Hansen classification had become a widely used classification system for ankle injuries.32 According to the Lauge-Hansen classification, a trimalleolar fracture of the ankle can either be classified as SE IV or PE IV. In the following, the surgical options to anatomically restore the ankle joint function in trimalleolar ankle fractures will be outlined. Ive been extremely fortunate to have the help that I have had, but its still tough. 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. Physical therapy is part of the rehabilitation process for those who suffered a trimalleolar fracture. Due to the extended period of NWB status, patients typical lose a lot strength and experience decreased ROM. Vidovi D, Elabjer E, Mukardin IVA, Milosevic M, Bekic M, Bakota B. Posterior fragment in ankle fractures: anteroposterior vs posteroanterior fixation. Have been walking without cane/walker for 6 weeks but still have a limp & swelling by the end of day is significant. Im 3 months post surgery and I think Im doing pretty well with walking, but my entire foot is numb. 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. While patients are usually hesitant to put weight on the involved leg, a physical therapist can help with the transition. trimalleolar fracture: a fracture of the ankle through the lateral malleolus of the fibula and the medial malleolus and posterior process of the tibia. just from stepping off a curb in a parking lot that was steeper than I realized & over a storm drain! Does anyone else have this? Im so glad I found this article. I am getting some range of motion back into foot. 9/21-6 wks post op- full WB with boot The ankle joint is still tender and painful under certain movements. I have been instructed to only apply touch weight until 6 weeks after surgery. Surgery was performed within 24 hours of accident. I started reading this string a couple of weeks after my accident. I continue to do the PT exercises to gain strength back. I fell and broke my left arm and ankle. You can call us at 916.921.6400 or 800.404.5400. 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. 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. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. In the case of these fractures the pun three steps forward and two steps back really does apply. Stability of the syndesmosis after posterior malleolar fracture fixation. The Tibia has the medial and posterior malleoli and the fibula has the lateral malleoli. In this interview, Dr. Cristian Ortiz highlights the diagnosis, his treatment algorithm, and controversies of this indication. Im a retired rehab therapist, my training helped. Current management of trimalleolar ankle fractures Current management of trimalleolar ankle fractures EFORT Open Rev. Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. Went today and had my 3rd cast on but the pain of this one is awful compared to the other 2. My ankle stayed splinted two wks after surgery and then I got switched to a cast with suture removal. Miller MA, McDonald TC, Graves ML, et al.. This article does a great job explaining the general recovery from bi- and trimalleolar fractures. My doctor wrote a note for me not to work for another 3 weeks but Im conflicted because theres a lot going on. It is a fan-shaped complex reaching from the medial malleolus to the talus, calcaneus and navicular bone, bridging the TC and subtalar joint.23 The sheaths of the tibialis posterior and flexor hallucis tendons pass above the MCL complex.14, The ankle joint is not solely a hinge joint around a constant axis, but rather allows combined rotatory and hinge movements. My boss wants me to return to work in the soonest time but Im concerned as my job involves constant movement. Skin peeling like crazy. My foot was snapped back and literally was hanging. Dr Google (& ourselves) is/are our biggest enemy. This is an area that acts as an anchoring location for the ligaments that are the static stabilizing structures of the ankle/foot complex. 9/8-4 wks post op-use walker with 25% WB Fortunately, this injury will usually clear spontaneously. 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. professionals medtronic peroneus fibularis longus muscle physiopedia tibia fracture symptoms causes treatment rehabilitation cruciate ligament wikipedia anterior tibialis tendon rupture recovery and more verywell wellness library cigna tibial . I sat on the floor of my closet with my ankle up using the crutch to pull things off hangers and shelves to finally purge my closet. I have been in and out of hospital with pain and large blood blister on ankle where cast been rubbing. 1758, The treatment of unstable fractures of the ankle using the Acumed fibular nail. A meta-analysis of 11 cadaveric studies showed that a dynamic fixation system (suture button) provides less rigidity in comparison to metal screws.140 Looking at the clinical and radiological outcome, the dynamic fixation for acute syndesmotic injuries is superior compared to static screw fixation.141144 But these studies included mainly syndesmotic injuries with or without a unilateral malleolar fracture.141144 Thus, these results cannot simply be transferred to the treatment of trimalleolar ankle fractures and future studies need to prove superiority of dynamic stabilization devices. He said everything looks great and told me to start exercises, just flexing my foot back and forth. The prescribed physical therapy after a trimalleolar fracture may initially help the patient properly use any prescribed assistive walking devices. 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? Some individuals may be left with post-traumatic arthritis of the ankle joint, continued pain, or a tendency for recurrent ankle sprains. 8/22-2 wks post op, cast gone, given Boot and aircast on sprained foot. I used a knee scooter, it makes getting around so much easier, and even fun! I have two plates and thirteen screwsvery painful. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model. Its been 14 days I have a trimalleolar fracture. I go for a 6 wk post op follow up on 8/14/17. Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. 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. Non-displaced fracture of the lateral malleolus. Best purchase-portable wheelchair at Walgreens and a urinal! If you are not fully ambulatory you CANNOT drive and DO NOT attempt to drive in a boot! My ankle was shattered & my life turned upside down but do what the doctors say, follow phyios instructions & do your exercises. Fracture and dislocation classification compendium2018. Fracture reduction is the term used to describe how a bone is fixed or set after it's broken. Add a meaning Add Trimalleolar fracture details Phonetic spelling of Trimalleolar fracture Add phonetic spelling Synonyms for Trimalleolar fracture Add synonyms Antonyms for Trimalleolar fracture Add antonyms Examples of Trimalleolar fracture in a sentence I cant imagine still using crutches 5 months in. Pull back gently with the towel so that your foot stretches toward you. Nonsurgical treatment would be recommended only if surgery would pose too high of a. I spent 6 wks there. ), but it sure is daunting to think about how much more there is to go. I was amazed that the hot water in my shower registered 115 degrees, the cold water 57 degrees. Baumbach SF, Herterich V, Damblemont A, Hieber F, Bcker W, Polzer H. Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. It makes me feel so much better and accomplished. (Although at the moment of the break and a few seconds after on the ground, I found I can actually bellow like a cow!) At first moving around on crutches made toes turn purple and I almost passed out a couple of times. Cast was removed before I went home on Aug 24. 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. Plus, Ive only been able to visit my horse 3 times since the accident and I am missing her, and riding her, like CRAZY!! (2-4 months.quicker than I will be walking!). It can also increase the risk of infection and delay healing after surgery. It is probably those screws to which people refer. The former developed a computerized tomography (CT)-based classification system for posterior malleolus fractures depending on transverse CT sections.45 Mason et al modified the Haraguchi classification indicating the severity and pathomechanism of the fracture.46 Bartonek et al postulated a more specific CT-based classification system that also takes the stability of the tibiotalar joint and the integrity of the fibular notch into consideration.47 These classification systems of the posterior malleolus can guide further operative or non-operative treatment, but fail to fully characterize the kind of trimalleolar fracture. Worst problem is EXTREME heaviness in legs and feet if I sit or lie for any length of time. Post-reduction radiographs obtained through plaster also demonstrate a minimally displaced fracture of the posterior malleolus. I have a trimalleolar fracture and am 12 weeks non-weight bearing. The swelling had nowhere to go so it pressed into the plaster splint. I am the worst patient! Sept 4 was put on IV antibiotics because of the blood infection I had developed. ), 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. by ACE Physical Therapy and Sports Medicine Institute. Ribeiro HM, Silva J, Teixeira R, Fernandes P, Sobral L, Rosa I. It was a big scene. Bimalleolar and trimalleolar ankle fractures are specific types of injuries that commonly occur because of trauma, such as slips on the ice, a fall down stairs, sports injuries, and car crashes. I am advised that the swelling may last several months. 1B). ; Ankle Injury Management (AIM) Trial Collaborators. i broke my ankle on March 7, 2017 hiking down Camelback Mountain in Arizona, the firefighters had to come rescue me. 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