trimalleolar fracture physiopedia
I am not needing a cane or anything. Im going to keep a positive mental attitude in place, look for the good not the bad, and be willing to laugh at myself because it appears that I will look like a clumsy dork for quite some time! This term trimalleolar fracture is broadly used to include the three structures, which get affected in the trauma or impact, which causes ankle fracture. The AO and Lauge-Hansen classification systems are widely used in the clinical diagnosis of ankle injuries. 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. Go back to the surgeon or ER & get it changed. Although fractured ankles are an injury seen in almost every age, it is becoming more prevalent in older, more active generations. Comminuted fracture of the distal fibula shaft. I dont want pain for the rest of my life, who does? Trimalleolar fracture with a dislocation here! Omg bi surgery June 9th casted June 26th this is now my second cast i dont go back to be rechecked until Aug 1st which at the time i am supposed to get a walking cast or boot.. i can cry now at the drop of a dime.. i cant do anything.. i have to wear a bit on my right leg because i severely sprained it at the time when i broke my ankle my foot is constantly numb and burns.. now the inside of my left ankle is feeling like my cast is rubbing against my incisions on that side.. i cant sleep because i cant get comfortable.. i cant take the pain medicine because i have an allergy.. Im miserable!!! A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. 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 . 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. (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. I had a trimalleolar fracture on March 1 with surgery on March 2. 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. 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!! In any case, the ankle is good, not as much flexibility as Id like, but Im walking. Not limping as much. Best purchase-portable wheelchair at Walgreens and a urinal! Know Your Terms: When the site of the fracture is exposed to do a surgical repair, that's referred to as an "open . My P Therapist suggested along with my regular exercises to try a hot/cold water treatment. Eat healthy and drink your water. This type of fracture occurs due to high-energy trauma and is seen mostly in females than males. Today I have a healed right ankle/foot and am a little more mobile with crutches. She was brought to the hospital for investigation and was diagnosed with a . I have discovered a help network amongst my friends and family that I never realised I had. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study, Lauge-Hansen classification of malleolar fractures: an assessment of the reproducibility in 118 cases. I went Monday to get my stitches out & for X-Rays.my Dr told me that now I need these same 2 screws, so Im going in the morning for this procedure. Lateral Malleolus Fracture the bone are reduced into their normal alignment. Inequality should raise suspicion of an unstable ankle injury. Keene DJ, Lamb SE, Mistry D, et al. I can now say i know what i am up against. I took the down time to review my life goals, relationships, strategies. and your ankle is healing!! That was the end of self pity for me! Things are so much better when the pain is lessened. I am a practicing neurologist and want to get back to work. 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. AE-Manual der Endoprothetik, In vitro kinematics of the axially loaded ankle complex in response to dorsiflexion and plantarflexion, The axis of rotation at the ankle joint in man; its influence upon the form of the talus and the mobility of the fibula, Biomechanics and functional anatomy of the upper ankle, Anatomy and kinematics of the human ankle joint [Anatomie und Kinematik der Sprunggelenke des Menschen], Anatomy of the ankle ligaments: a pictorial essay. For a while everytime you would push to new limits of exercise the ankle would rebel. Flew to Vegas for a well deserved R/R! 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. The posterior malleolus gained in importance in the last few years and current clinical evidence is endorsing direct open reduction and internal fixation to provide a stable and accurate reduction. My doctor told me that I needed to continue to wear the air-splint (stir-up) when on uneven ground. Thank you very much for the share. I know better than to go against what my surgeon has said I think hes a fantastic surgeon! I am 54 yrs old. Fracture is testing my patience greatly. Very painful. 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. 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. I have been to pt for a month now,doing the exercises,weight shifting,and movements. Hoping to walk by Christmas and hoping the nerve pain will go away soon. I am thinking of having the plate/screws removed. depressed, and now catch 22, if surgeon removes hardware, none of them exray afterward i.e. 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. 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. 1758, The treatment of unstable fractures of the ankle using the Acumed fibular nail. I am still not back at work ,had surgery and could not weight bear for 14 weeks. The ankle was a trimall fx with joint, ligament, and tendon damage, requiring surgery. Check for errors and try again. I dont know how this works but I hope I am alerted to everyones updates via email. This is an injury that you will never fully recover from. I had six oct 1 2017 after twisting my ankle at a wedding.Trimalleolar fracture, terrible. I had a trimalleolar fracture March 19th, surgery the next day. Keep your ankle propped up above your heart this really does help the swelling. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. If surgery were performed, scar tissue would form. 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. My foot swells every day,elevation works for that. the display of certain parts of an article in other eReaders. Tibia fracture physiotherapy rehab protocol The goal of the surgical and rehabilitative team focuses on the return of a patient to their previous level of function often in the setting of competing for short-term goals 2. Good luck to all of us I reckon. Hermans JJ, Beumer A, de Jong TA, Kleinrensink GJ. My ankle was shattered & my life turned upside down but do what the doctors say, follow phyios instructions & do your exercises. Knew immediately it was broken but no pain. Still slept with feet elevated but could sleep on my side so finally able to rest. The first ankle fracture classification system developed by Percival Pott differentiated between uni-, bi- and trimalleolar ankle fractures.31 Despite the reproducibility, the classification system lacks the distinction between stable and unstable fractures.32,33 Lauge-Hansen developed a classification system for ankle fractures based on the mechanism of injury.34 It describes the position of the foot at the time of trauma and the direction of the deforming force.35 Depending on the severity of the ankle injury, different stages (I-IV) can be distinguished. Have a great PT but taking time to get my confidence back. It makes me feel so much better and accomplished. Hoefnagels EM, Waites MD, Wing ID, Belkoff SM, Swierstra BA. A trimalleolar fracture is a type of ankle fracture that occurs when you fracture three different areas in your ankle called the malleoli: the medial malleolus, lateral malleolus, and posterior malleolus. Go back in 2 weeks to get stitches out of 2 incisions, X-rays & cast back on for 4-6 weeks Ive been told, & then a walking boot. 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. The emotional struggle is rough. what does ODG say for post-op PT after ORIF for a tri-M Fx ? Hey Susan, As an athlete & RN you get it; tissue heals given good conditions. De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR. In this interview, Dr. Cristian Ortiz highlights the diagnosis, his treatment algorithm, and controversies of this indication. The Drs have done 3 procedures but they dont help for long. This Tri. Bariteau JT, Fantry A, Blankenhorn B, Lareau C, Paller D, Digiovanni CW. In the classical AO technique, open anatomical reduction is secured, fixed with a lag screw and a lateral neutralization plate (e.g. Loss of independence for many weeks or months, change I lifestyle, dependence, and on and on. Due to the nature of the fracture on the ankle joint, a trimalleolar fracture is considered an unstable fracture. I had surgery 2 weeks later & have 2 plates with 14 screws. 9 screws and metal.mountaing biking accident and just overwhelmed with the different time frames everyone has. Al-Nammari SS, Dawson-Bowling S, Amin A, Nielsen D. Fragility fractures of the ankle in the frail elderly patient: treatment with a long calcaneotalotibial nail. Non-displaced fracture of the lateral malleolus. 1Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany, 2Department of Traumatology and Reconstructive Surgery including Department of Orthopedic Surgery, Charite Universittsmedizin Berlin, Berlin, Germany. It will lessen your depression too. June 6th got into a fight ended up 2 on 1 got tackled broke 3 bones one in 6 pieces did phisical therepy off work 5 months now back for 3 weeks and its killing me got ankle braces tommy copper compression and have a compression sock coming in the mail tomm yes its a very serious break and swells up bad being on concrete all night at my job affected my living walk in pain with a bad limp and hope to god it gets better then this Dec 12th is my next xray hope I get goof news, My journey to recovery of trimalluear ankle fracture post op slip n fall has been very difficult and slow recovery process. Weird to describe myself as lucky, but due to bad swelling never had screws placed and lived with external fixators for 8 weeks. Im really glad I found this site as it gives me some insight into my mobility and flexibility while recovering. Required fields are marked *. Reading this, while informative, didnt help. The physical therapy referral may be provided post-surgery. My ankle still swells and I still ice it some but I have very little pain even after exercising. I fell on May 18, 2016 and it resulted in a trimaeleolar fracture. Had a previous post in June. because taken over a long time is bad for your kidneys. Ocassionally, I would feel as if my incisions were leaking and running down my ankle. I am stoutly independent and have refused help my entire life but have found people enjoy helping you out when you need it. The therapist will want to make sure the recovering person learn techniques to adapt to life while recovering that will prevent additional strain to the ankle. Place a towel around your affected foot just under the toes. 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. I have been in physical therapy since week 5. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. I am bimalleolar fracture post op two weeks. The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. Ill take it a day at a time, little steps, and each forward progress is a goal attained even if its slow. In their critical review, Rammelt and Bartonek analysed the importance of the posterior malleolus with conclusive data supporting the direct open reduction and fixation of posterior malleolar fragments.57 Vacas-Snchez et al proposed a CT-based algorithm for fixation of the posterior malleolus and Wang et al showed good functional outcomes following operative treatment of the posterior malleolus.58,59. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. Internal fixation performed through a hindfoot nail fusion (tibio-talar calcaneal arthrodesis) of the ankle joint. The concave-shaped incisura tibialis matches the convex shape of the fibula (Fig. 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. This is a great website and has been helpful! Amazing. Treatment of trimalleolar fracture comprises of often surgery to fix the broken bones together and hold them in place together as the healing takes place. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. But, it will get better. I also get a twinge, yknow the twinge you get just before a muscle cramp comes on, did any of you feel this? 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. I was non-wgt bearing x 8 wks then gradually progressed to full wb by 12 wks. This has been a rough, rough situation and am just ready to get back to some normalcy. Ive been extremely fortunate to have the help that I have had, but its still tough. Maybe this has helped. Some more productive than others. I work in a factory standing all day with heavy lifting. Overview timing to surgery of closed ankle fractures, Current management of trimalleolar ankle fractures. I stopped wearing the boot and just started limping around. Watch out! By the way, my kids loved their Netflix binging mom for the first few months when I was NWB. im not going to rush it i want to completly heal.long slow process. Surgery is usually the recommended treatment. I am able to walk without a limp now. is driving me insane!! the doctor told me i had a tri mal fracture and would need surgery the next day(Wed). 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. The mechanism of injury is direct impact caused by inversion or eversion injuries. Women ages 75 to 84 most commonly get trimalleolar ankle. The trauma is sometimes accompanied by ligament damage and dislocation. 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. I cant wait to keep going.but still have the fear of loss. I can only wear a shoe for about 4 to t hours and it has to come off. This has been a long slow process but Im getting there. Now, I know that my fracture wasnt a textbook bimalleolar fracture (are they ever?! Id shoot myself if I thought I would be disabled that long.After all, how many more years do I/we have? Bartonek J, Rammelt S, Tuek M, Naka O. Posterior malleolar fractures of the ankle. Until you can walk without aid and without boot and feel comfortable slamming your foot on the break really hard, you cannot drive. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. Prior to the injury I religiously participated in weight training daily, marathon running, hiking, softball, and kickball. If you are not fully ambulatory you CANNOT drive and DO NOT attempt to drive in a boot! I was resistant to begin seriously icky drugs. [Figure 4], Athletes who engages to high impact sports, Recurring conditions that does not encourage heavy lifting such as osteoporosis and neuropathy, Hemorrhage or excessive bleeding since the bone is one of the organs that produces red blosd cells (RBCs), Sepsis or infection because the body is being open making it prone to different foreign objects anf microorganisms such as osteomyletis, Delayed in the wound healing process resulting to a more unstable condition, Damage on the nerves, tendons and blood vessels. 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. My surgery was on 6/30/17. Effect of arthroscopic evaluation of acute ankle fractures on PROMIS intermediate-term functional outcomes. 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 fell in the dark,in a 7 ft empty creekbed,on the way down i got my foot stuck in a trees root-ball . Thanks for the encouragement! Best to you all. I attribute that to keeping my leg up on the bed as much as possible 24 hears a day. Two of my screws are too long and are sticking into joint. For choosing the optimal surgical treatment and implants, there are some important factors to be considered: Trimalleolar ankle fractures with severe soft tissue injury or open fractures pose a particular challenge. 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 .. Trimalleolar Fracture 1. I am a very active 28 year old petite female. Does anyone else have this? For the most part I try and just ignore the pain and maintain a normal daily life. A week walking the halls in my house with crutches (that took practice! eCollection 2021 Aug. A trimalleolar fracture can have long-term impact on your quality of life. The therapy will include strengthening exercises for the core and entire lower extremity. Hi all. 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). 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. . Ive ordered too many good deals online for facial products and other fun things. I have been non weight bearing since then. 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. The therapist will determine if massage of the scar tissue is necessary so that ankle remodeling occurs properly. 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. I asked for nursing which typically is not ordered because my dressing was something that I or my husband could do but I had never had a break like this before and wanted skilled eyes on my wound/dressing to ensure there was no infection and the healing was taking place as planned. I was in wheelchair so PT gave me ROM exercises that put me ahead of game and arm strengthening, which I sorely needed! ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work. I keep hearing people say that they are going to get the screws out. I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces. Depending on the fracture configuration, the management and timing to definite surgery can differ significantly. Day 2 post-op, I thought there was a 1/2 wide length of plaster running directly along my suture lines. I feel for you and it has been a very difficult road for me too. ( I already do some minimal wb for balance with no pain ). This has been really difficult to deal with, as I hate just sitting around and I dont like relying on others to do for me. I didnt realise how good it would be to stand up-right and walk around unaided, to be able to stand up in the shower and not have your leg poking out the shower door, However the best feeling came from the first day I could get back in the car and finally have some independence . A trimalleolar fracture refers to fractures of all three malleoli of the ankle: lateral malleolus, medial malleolus and the bottom posterior (backside) tibia. Is this normal? Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. ROM good but still limp if sore. Suffered a trimalleolar on feb 17 , going to see Md tomorrow for X-rays and see about upgrading weightbearing . Ankle still swells up everyday to the point of discomfort. Just went back to gym today for 45min of upper body okay-ed by surgeon. To what extent is up to you. After my post op appt I was put in a CAM boot. 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. Thank God I was out with something that caused amnesia! Never did I think that this injury would have such a devastating impact on my life. Find a comfortable shoe for pt was a tad bit of process left foot mans 10.5 and right foot regular size female 8. Seems to be helping after two weeks.flatten and lighten the creepy parts. White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM. Just a head up with the air cast, try get shoes with some height for you good foot. 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. My hardware is exactly as in the picture shown in this article. The surgical tibiotalar angle: a radiologic study, Biomechanics of the ankle and subtalar joint. Update: 19 June 2017: Went to Orthopedic surgeon-I am trim fracture dislocation 12 weeks in. Hurt like hell but he worked wonders. 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. This technique includes slow motion and the light use of force. Physical therapy taught me how to get around on all my devices and increased the type of exercises I did. I personally dont think it will get right. I did work using a wheelchair until I was released to walk with a cane. Exercises, etc. I have recently ended up with a trimalleolar fracture that I received from a nasty accident. A talar shift of 1 mm results in a 42 percent . I still have the eight pins and plate in place, no pain at all unless I hit the pins on something. A trimalleolar fracture is similar to a bimalleolar injury except the posterior malleolus is also broken. That was unbearable. The anxiety! I got knocked over and rolled my ankle ending up with a trimalleolar fracture on Feb 11th. This was causing me to limp more as well. I was not prepared. open fracture with/without concomitant vascular or nerve injury. I am 7 months out from surgery. 52 yr. 230 lb. This article is the best I have read to explain the fracture and the recovery. Surgery 2 weeks after and its now been 3 weeks post surgery. Badly sprained right ankle, and a left leg Trimaleollar fracture of tib/fib, with tibia dislocation over the talus bone. Yes, Im 2 years in August post op and still have pain in both my ankle and foot. I was sooooo happy to get moving. The surgeon put in one plate and 8 screws. Toxoids the patient had screws, plates and other fixation devices that is usually made of metal, to reduce the risk for tetanus this medicine is being taken by the patient. 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. Hi Stephen, I am curious, where did you have your surgery and what is the name of the doctor. If I had to relay on the crutches I wouldve been treated for a fractured right ankle too( I have no balance). tri-malleollar fracture tripping backward over a sewer cleanout. Pain is severe by 5 p.m. each day. Trying to stay positive, but continue to worry about my job and future fun. I am early on as my accident was March 8, 2017. Have lost some flex; still working on it. Thank you for your comment as it pertains to my concern. Proximal to that, the interosseus membrane forms also part of the tibiofibular complex.7 All of these structures stabilize the ankle mortise and at the same time allow movements of the fibula in relation to the tibia.14 The ATIFL is trapezoidal-shaped and extends from the Chaput tubercle to the Wagstaff tubercle.15 In the literature, an accessory ligament, called Bassetts ligament, running inferior and parallel to the ATIFL is described.16 Between the fascicles of the ATIFL lie perforating branches of the peroneal artery.14 In comparison to the interosseous ligament, the ATIFL is weaker, contributing to the fact that the ATIFL can be ruptured, but the interosseus ligament with the osseous membrane remains intact.17 The interosseus ligament is the distal continuation of the osseous membrane and is pyramid-shaped.18 The PTIFL is a strong ligament running from the posterior tibia in distal-lateral direction to the posterior tubercle of the fibula.7 It can be differentiated into a superficial and a deep part, also called the transverse ligament. My surgeon was pleased with my surgery on May 31, 2017 but did mention that the fibula was more crushed than he anticipated so he had to piece it back together and use a bigger plate than usual. My arm was splinted for 3 wks and then removed. No crutches while in cast. 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. Comparing the knotless tension band and the traditional stainless steel wire tension band fixation for medial malleolus fractures: a retrospective clinical study. 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. Let me explain. 8/22-2 wks post op, cast gone, given Boot and aircast on sprained foot. Since a person will be limited in walking or standing during the recovery of their ankle, the knee and hip muscles will weaken. We did get a good laugh though. (A) Ankle anteroposterior (AP) mortise view of a healthy young male showing the configuration between distal tibia, distal fibula and talus. I was rushed to hospital & had ankle relocated and surgery in theatre next day. Chen X-Z, Chen Y, Liu C-G, Yang H, Xu X-D, Lin P. Arthroscopy-assisted surgery for acute ankle fractures: a systematic review. Have kept moving toes and legs raises but hoping to have a boot instead of cast at week 5. I suffered a bimalleolar fracture on May 21, 2017. Anyone else have numbness? The fractures are classified as infrasyndesmotic, transsyndesmotic and suprasyndesmotic with further subcategories based on the presence or absence of medial or posterior malleolar injuries. Across the top of the ankle is very tight. The Lauge-Hansen classification revisited. I try not to take those pain meds like Advil, Tylenol, etc. The doc says he doesnt know why its numb, shouldnt be . 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. Heckman JD, McKee M, McQueen MM, Ricci W, Tornetta P, III. I rarely take pain meds anymore. And by the way, this injury really does suck and it is unfair that any of us have to go through this. Ribeiro HM, Silva J, Teixeira R, Fernandes P, Sobral L, Rosa I. I broke down and joined a gym at 41 years old knowing that I would never be the same if I didnt. I slipped on day 2 of my holiday. With a growing number of elderly patients, trimalleolar ankle injuries will become more relevant in the form of fragility fractures, posing a particular challenge for trauma surgeons. Per my Surgeon, no Physio for a fortnight but I still cheat at home to keep my range of motion hoping my stitches wont break. Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Total bedrest for 2 wks. already built in. 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. in just a few more weeks I will hit my 4 month mark of being off of work . Lilyquist M, Shaw A, Latz K, Bogener J, Wentz B. Cadaveric analysis of the distal tibiofibular syndesmosis. I now have regained 80 to 90% range of movement, only mild swelling & occasional niggles if I walk too far. Freak accident. My hips and back were being put out due to the height of the air cast. I want to thank everyone for sharing your experience, strength and hope. 1D). By 3 months I could walk a half mile with no limp, ride my bike 5 miles, swim a mile. So this is 3 1/2 months into it or so, so Im hoping for better times ahead. The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. Post-reduction radiographs obtained through plaster also demonstrate a minimally displaced fracture of the posterior malleolus. Im following my doctors orders, but Im also one of those that wants to speed things up and looks for reasons to do so. Regular radiographs were conducted to monitor joint congruency.53 Nineteen percent of patients needed conversion to internal fixation due to a loss of fracture reduction, and the non-operative group had a six times higher probability of a radiologic malunion.53 Unfortunately, the type of malleolar fracture was only described as relevant to the syndesmosis and not classified according to one of the common classification systems. Thanks, Deb, Belfast. The PA-C says its ok as long as its not around the clock. I am about 6 weeks post surgery and still no weight bearing. Hi all.fixator-I have a trimalleolar open fracture with dislocated ankle. A little achy and swollen at the end of the day, but managing with a little ibuprofen. Amazing to watch. For those of you who have the Knee Scooter. Dont let the stress win. The Tibia has the medial and posterior malleoli and the fibula has the lateral malleoli. This article does a great job explaining the general recovery from bi- and trimalleolar fractures. I am doing physical therapy and I have been off work 2 months they want me to work I cant even walk. Dr. doesnt seem to be concerned, but I am. Guess you can just call me Snappy! Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. Outcomes following posterior and posterolateral plating of distal fibula fractures. Trimalleolar Equivalent Fracture. I Feel early PT really helped move me on. 2010-2018 ACE Physical Therapy and Sports Medicine Institute, Physical Therapy Falls Church VA | Physical Therapy Arlington Virginia | Physical Therapy Alexandria VA | Physical Therapy Fairfax VA | Physical Therapy Leesburg VA | Physical Therapy Tysons VA, Designed by Elegant Themes | Powered by WordPress. 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. 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