Trimalleolar Fracture

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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This past Monday (3/7) while skateboarding with my son, I fell and suffered a trimalleolar fracture (ankle). I'm scheduled for surgery tomorrow (Thursday, 3/10). The expected recovery is 8-12 weeks. Has anyone been through this? Can they tell me what to expect in the way of mobility and pain? Any info is appreciated.
 

Ifallalot

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Did you get any ligaments too? How about any tibia or fibula?

I did this plus 4 breaks in my tibia and fibula and ended up with 12 screws and a plate. I was on crutches in a cast for 3 months and was a gimp for months after, and this was when I was a 17 year old athlete. It still bothers me weekly and I have to limit how much I run. That was in 1998.

When I got the cast off I started swimming right away, swimming helped more than PT ever would have.

It doesn't bother me surfing and its my back foot.

Its going to hurt, but you have to get it moving again once the cast is off and you're healed

VonMeister recently had ankle surgery as well, hopefully he'll chime in
 

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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Thanks VaB! DD gave me some info. My surgery was 2.5 hours and 3 screws and a plate later, I'm looking at 8-12 non-weight bearing, then therapy after that. The pain is considerable, but it could always be worse...
 

Ifallalot

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Right on man.

I highly recommend swimming in addition to your therapy. You're going to have to build up your leg muscles again and that will help
 

VonMeister

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I shattered my calcaneus and had a avulsion fracture of the posterior tribal tendon, not sure with attachment. My 2 hour scheduled surgery took 6.5 hours.

The worst part was the non weight bearing.Crutches are brutal. I didn't use a scooter because I'm stubborn but I would highly recommend it. I started dealing with some pain between my shoulder blades from those stupid things and it still bothers me today. You can get collapsable crutches to travel with.

Physical therapy is dumb. Aside from some mobility stuff that you can seriously find on youtube, it's of little value. Swim and bike, squat when you are full weight bearing.

I was told by my physical therapist and the surgeons PA that I will never run a remarkable distance again, or even walk too far without discomfort and something about a 18 month to two year recovery period. Today I'm 6 months and a few days post op, I rode 43 miles, and followed it with a 5K run. At 12 weeks your bones will be healed, the rest is on you.
 

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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Thanks for the inspiration fellas. I'm in considerable pain, but hearing about your experiences really helps. One day at a time. For now, I'll just focus on learning whatever it is I'm supposed to learn from this experience.
 

SurfDoc

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That's a major joint fracture. Generally, you can't have that extensive disruption without damage to cartilage, ligaments, but tendons could be spared. Long non-wt. bearing time and rehab is key. Good luck man!
 

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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Thanks Doc! Yes, the ortho surgeon mentioned there was cartilage damage, nothing specific mentioned about ligaments or tendon damage, but I'll ask at my next visit. I started non-weight bearing active ROM this week. Like you said, I'm ~4 weeks out from surgery and it seems like I've been non-weight bearing forever. One day at a time.
 

VonMeister

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Congratulations. I was non weigh bearing for 11 weeks and it almost killed me. Partial weight bearing week 12, and FWB with boot week 13. The boot lasted all of 45 minutes and I ditched it. Probably took 10 days or so once FWB to walk without crutches.

From what I understand once you are cleared fro FWB the boot is mostly to make sure you don't roll your ankle and break something. After being NWB for a while you lose that necessary strength quickly and it takes months to fully come back. Keep that in mind as you progress. A set back at this point would be awful.
 

VonMeister

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One more thing, work on mobility. I sort of blew it off a lot and mainly worked on strength. My Achilles still is a bit stiff to this day, the whole ankle is really. Granted it hasn't been all that long but if I would have been vigilant about it early I think I would be further along with mobility today.
 

Ifallalot

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Spinktopus said:
Finally bearing weight today with a boot.

Today's X-rays...


Minor ligament damage. Hopefully rehabbing in the next 4 few weeks with weight bearing.
Looks just like mine
 

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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Thanks for the info & advice VonMeister. Ifall & Von, how long from when you started weight bearing till you were surfing again? I know everyone is different but I kind of wanted to get a ballpark. Some things I've read, it takes some an additional 3 to 4 months to return to the surf following surgery, which I hope is on the upper range of recovery..
 

VonMeister

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My injury was a fractured heel so it's a bit different. My Subtalar joint was rebuilt and I have very limited side to side movement in my foot. Also keep in mind I was non weight bearing for 11 weeks which takes a toll on your joints.

Surgery end of July, I was FWB in November. but I was told not to surf until March. I had a follow up in December and was given the green light to surf sandy bottom breaks around waist high. My surgeon surfed so he understood the importance of getting back in the water. I tried in January and the pain was a bit much. End of Feb I believe I started and the pain was bearable. Today there's good and bad days and I try not to surf places where you have to do the rock dance in and out.

Have you tried to walk on your foot without the boot but using crutches?
 

Spinktopus

Legend (inyourownmind)
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I was NWB for 6 weeks. I haven't tried to walk without the boot. I've walked a bit with the boot and crutches at about 25% weight and it felt weird with some pain. I'm still using the same range of motion PT exercises until Thursday when I go back to the therapist and give them the new orders for the ortho doc. I don't know how you psychologically managed 11 weeks of NWB. I was losing it at 6 weeks.
 

VonMeister

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For me the whole foot and ankle was painful when I was first FWB. In a couple weeks it will be a ton better. For me I just felt the boot was an unnecessary interim step. Once your FWB, your healed and it's not going to rebreak.
 

Spinktopus

Legend (inyourownmind)
Jul 31, 2011
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I'm walking without a cane/full weight bearing now. Not smooth, but walking nonetheless. I still occasionally wear the boot. The waves looked so fun yesterday, that I decided to paddle out on a surfmat an a fin on the good ankle. I was stoked to be in the water and catch a few waves on my belly. It was over all pretty damn fun. This whole thing has taken much longer than I originally thought.
 

VonMeister

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Good to hear. Can you balance on the bad foot yet?

Ditch the boot. It prevents you from recovering the lost leg strength you need to have a stable ankle/foot. You have an internal fixation, you don't need an external one anymore.

Work on balancing on the bad foot.