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I am 5 weeks s/p medial malleolar fracture of my left ankle…

I am 5 weeks...

I am 5 weeks s/p medial malleolar fracture of my left ankle from a skiing accident. No surgery. Was in a short leg cast for 4 weeks. Last week I was placed in a boot, but I'm still non-weight bearing. Earlier tonight, I bumped my boot against the side of a desk, kind of knocking it to the side.

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

There is no swelling. There was a sharp pain in the moment that i bumped the boot, but as of now, the pain seems to have returned to "normal" (that is, every now and then I feel bits of pain at the site of the injury). But no swelling. I am, of course, concerned about the risk of having reinjured the bone at this point, and am wondering about the risk of having done damage at 5 weeks, with this "bumping/knocking" of the boot.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Nothing.

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Answered in 2 minutes by:
3/27/2018
Dr.Sawhney
Dr.Sawhney, Orthopedic Surgeon
Category: Orthopedics
Satisfied Customers: 7,567
Experience: More than a decade of post qualification experience
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Thanks for your question.
I am Dr. Sawhney an Orthopaedic surgeon and I would be happy to help you today.
I am reviewing your question and would respond shortly.
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Customer reply replied 24 days ago
Thank you Dr. Sawhney. If it helps, I will add that the specific force involved was relatively light. I was pivoting on a desk chair and knocked the "foot" part of the boot on the desk leg, such that my lower leg twisted a bit. It was not much force, but it was enough to cause a quick jolt of pain and to raise concern that I've somehow knocked the fracture out of alignment. I have attached the most recent x-ray, taken a few days ago to the extent that it is helpful in evaluating whether the fracture is healing.
Customer reply replied 24 days ago
The files attached hereto are for comparison. The files titled March 22 are, of course, the most recent x-rays, and the files titled Feb17 are on the date of injury at the ER.
Thanks for the detailed reply and the X-ray image.
The risk of fracture getting displaced is practically zero with this knock at 5 weeks post original injury.
At 5 weeks the fracture is nearing Union and is quite gummy and would not get displaced unless lot of force is applied.
The mechanism you described would not exert the force necessary to displace the fracture at this stage.
You should try to keep the foot elevated and give it rest.
Nothing more would be needed.
Feel free to ask any follow up questions.
Do take a moment to honour my work and time by rating my answer hopefully 5 stars.
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Customer reply replied 24 days ago
Thank you Dr. Sawhney. This is the answer I was hoping for. As follow-up, is it "generally" to be expected that an injury that would cause re-fracture would cause more significant pain and perhaps swelling? In other words, I've read language to the effect of, "If you re-fractured it, you would know it!" And yes, certainly, I will be happy to give you a top rating for your patient, timely, and complete answers. A final question (more of a curiosity): when I see "classical" illustrations of bone healing, the callus is quite evident as a large bulge around the fracture site. I don't see that in my x-rays. Is callus formation different in this area of the bone as opposed to the tubular tibia? Thanks again in advance for your thoughtful reply.
You are correct regarding the manner of bone healing in tubular bone versus cancellous bone.
Cancellous bone present in the medial malleolus area does not heel with abundant fusiform callus formation.
It heals with image of sclerosis at the fracture site when bone formation occurs between the two fragments.
An injury with much greater force would be required to cause a re fracture at this stage.
It would also cause much more pain and swelling.
Dr.Sawhney
Dr.Sawhney, Orthopedic Surgeon
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