Anyone else had this done & did it improve your ability to walk & flex the ankle? The most common group to suffer these injuries are women over the age of 60. 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 didnt like the air-splint given to me by my surgeon (it rubbed on my medial screws) so I found a Zamst splint that he okayed and I wear that when Im out and about. Until you can walk without aid and without boot and feel comfortable slamming your foot on the break really hard, you cannot drive. I still do the ankle exercises prescribed by PT and most days I do a 40-minute full body weight routine. My ankle still swells and I still ice it some but I have very little pain even after exercising. I feel your pain. how will I be able to help my patients ! I live alone, friends helped with meals & errands. : An ankle fracture that heals in perfect alignment usually leaves little or no impairment. It is not uncommonfor a person to experience some fear or anxiety over the loss of strength and motion to the ankle, leg, knee, and hip. The deltoid ligament, which runs from the medial malleolus to the calcaneus, talus, and navicular bones, plays a vital role in maintaining correct talus positioning. I had the Tri fracture with a dislocation. just from stepping off a curb in a parking lot that was steeper than I realized & over a storm drain! I also take 10 to 20mg THC in between when pain comes back. Know Your Terms: When the site of the fracture is exposed to do a surgical repair, that's referred to as an "open . still used walker for longer walks or shopping. I have been reading on bimalleolar post op recovery and have yet to find anyone who has mentioned a recovery where they have been able to continue squatting, calve raises, running, jumping etc. Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament, Effect of posterior malleolus fracture on outcome after unstable ankle fracture. 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. Your 6-month update is VERY encouraging to me. I am lying everyday to get the swelling down I am optimistic but worried about long term complications / problems. Kennedy JG, Johnson SM, Collins AL, et al.. An evaluation of the Weber classification of ankle fractures. I can not wear shoes with much of a heel. And I try to resist gorging on the news of all the political craziness going on. eCollection 2021 Aug. I had to wait 10 days for surgery as the swelling was too severe to operate (likely because my not-so-smart self tried to walk on the ankle right after the breaktwice. Im not a pain med kind of person, so I avoid all of it at all costs. I found hiring a knee scooter was my saviour. Good luck everyone. Thanks, Deb, Belfast. its the best thing ever. White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM. Sit with your affected leg straight and supported on the floor. Thank you for your comment as it pertains to my concern. All the posts are very helpfulthank you. Things are so much better when the pain is lessened. The anatomy in relation to injury of the lateral collateral ligaments of the ankle: a current concepts review, Anatomy of the collateral ligaments of the human ankle joint. Just went back to gym today for 45min of upper body okay-ed by surgeon. A big lesson was its okay to feel vulnerable in tough times and ask for help. More cases of osteoarthritis are found in trimalleolar . 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. Ive ordered too many good deals online for facial products and other fun things. Never did I think that this injury would have such a devastating impact on my life. The AO/OTA classification lacks a description of the fracture configuration of the medial and posterior malleolus. The Drs have done 3 procedures but they dont help for long. The coloeing in my toes is good as long as elevated; however, all my toes and the ball of my foot are numb. Still slept with feet elevated but could sleep on my side so finally able to rest. Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST. Observer variation in the radiographic classification of ankle fractures, Die Verletzungen des Oberen Sprunggelenkes. My Doctor told me to do 2 sets of 15 minutes ROM exercises, which I have done every day since week 3 and my ROM is quite good. Day 2 post-op, I thought there was a 1/2 wide length of plaster running directly along my suture lines. Thanks for the encouragement on this post. but its tough not to want to put myself on my own recovery program when there is literature like this out there. The concave-shaped incisura tibialis matches the convex shape of the fibula (Fig. 11/27- 15 wks post op- I still have swelling and soreness especially after walking a mile or so. 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. Pull back gently with the towel so that your foot stretches toward you. As such, clinical examination of the proximal lower leg, along with a knee radiograph if indicated, should always be performed in a suspected distal tibiofibular syndesmotic injury. Very depressing time. I slipped and fell March 1 and suffered a trimalleolar fracture on my right. 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. This is right on the timing for weight bearing. A period of non-weight bearing that lasts 2-4 months will be required to allow the bones to heal properly. After physio, working out at gym, and at the end of the day when edema (swelling) is at its worse is when the pain bites. Medial malleolus: operative Or Non-operative (MOON) trial protocol a prospective randomised controlled trial of operative versus non-operative management of associated medial malleolus fractures in unstable fractures of the ankle. Therapy is an integral part if this process . 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 Lack of sleep & teariness is very, very common, as is the burning & numbness. By end of Oct. able to walk 1-2 miles unassisted and at a slower pace than before injury but I was walking! I developed the blisters after the surgery and caused pain under the cast. Cut those times in half to be more realistic. Willett K, Keene DJ, Mistry D, et al. Im hoping I can start wb with a boot. I am now able to move my foot around without the boot on to get the range of motion back. Im hoping the surgery wont cause me to lose my small progress. Now have a full cast on for the next 4 weeks (shocking pink) before next appointment when I may be able to commence weight baring . By 6 months, I could cross country ski 5k on flats, walk 2 miles fast on indoor track. 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. Putting all those screws probably causes a good deal of the pain. I try not to take those pain meds like Advil, Tylenol, etc. If the numbness would just go away, then Id be a happy camper. I guess that I seemed much more relaxed (like I had a choice). I just had my visit last Thursday with my doctor after being post surgery for two weeks. I can say that the social isolation and lack of independence was and still is the most challenging. Other procedures of this place the screw along the back of the shin bone. I am now at 11 weeks and it has been miserable. A fatality single-vehicle accident occurred northeast of Auburn, which was reported on Dec 1 but was believed to have occurred the day before. 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. It is probably those screws to which people refer. Im so glad I found this article. Update: Trimalleolar fracture and dislocation 27 Mar. Is he crazy? I have been instructed to only apply touch weight until 6 weeks after surgery. The area that is affected is the medial malleolus, posterior malleolus and the lateral malleolus. Total knee arthroplasty noted. I have been to pt for a month now,doing the exercises,weight shifting,and movements. I had such a silly fall resulting in a trimalleolar fracture of my left ankle. Corrective osteotomy including the posterior malleolus was p. I also get a twinge, yknow the twinge you get just before a muscle cramp comes on, did any of you feel this? I am now 3.5 weeks post-op but have not required any painkillers for weeks & can tolerate the dog jumping on my cast and me accidentally bashing it into walls with no increased pain. 3.5 mm lag screws, one-third tubular plates or locking plates. The ATFL typically shows a double-banded morphology and is separated by vascular branches.14,21 It is almost horizontally located to the ankle in neutral position and depending on the position of the foot, one band tightens while the other relaxes.14 Due to its characteristics, it limits anterior displacement of the talus and plantar flexion of the ankle.22 The CFL originates below the ATFL at the fibula and inserts at the posterior region of the lateral surface of the calcaneus.14 Its fibres run obliquely backwards/downwards and the CFL is located directly underneath the peroneal tendons. Im lucky enough to be able to be working from home starting this week, but not being able to clean my own house, do my own laundry, etc. Im 2 weeks post-trimalleolar fracture surgical repair. Pain is severe by 5 p.m. each day. I fell and sustained a trimalleolar fracture and had surgery on April 12th. 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? There are two very noticeable malleoli and a third that is not recognizable without the use of an x-ray. This has been a long slow process but Im getting there. Watch out! It wasnt painful at first quite numb. Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. Bi and trimalleolar fractures are devastating injuries to sustain and the involved persons life will be dramatically effected for several months. Well I am at exactly 4 months right now and I am starting to feel like myself again. Has anyone been driving in a boot ? I am now 10 weeks postop and the best part of the whole recovery is the mini milestones and the enjoyment that results. The only thing that is concerning me at this point is if my incisions have healed properly. I fell on May 18, 2016 and it resulted in a trimaeleolar fracture. The mechanism of injury is direct impact caused by inversion or eversion injuries. [1] I am 74 and while snow blowing my driveway, hit a patch of ice, went airborn landing on my twisted foot. sorry to hear what your going through. and dont forget the ice packs. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as 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. This is a long process and physical therapists play a big role in the recovery process. This Injury so sucks! long way to go and reading the posts helped alot . ), but it sure is daunting to think about how much more there is to go. I used a knee scooter, it makes getting around so much easier, and even fun! Thanks again for the share! I have to say have been pleasantly surprised by my recovery so far and hope it continues despite my foot looking a bit like a dogs dinner. I started walking FWB around 9-10 weeks. My best advice: follow MD/PT instructions, stay positive, accept help where you need it but dont baby yourself. I had my procedure done in May2014 it is now August 2015 and my foot still kills me is still vascular problems with swelling and the screws and plates still hurt me and I have to lay down and elevate it which doesnt really help much even pain medication doesnt help the back of my leg has been slice 2 with muscle involvement and then they also remove they said a butterfly chip. I am a pretty active person but coming home and dealing with all the throbbing and leg elevation, I found myself wanting only to sleep and watch Netflix. I limp in the morning due to stiffness. Thanks. I hope my experience helps others early in the rehab process. Its been a journey. My best wishes to everyone in this situation try to stay positive you will feel better but it takes a very long time. Everyones fractures, dislocations, surgeries, rehabilitation & expected outcome will be different but unless you take control of your own destiny, always look on the bright side, & not think you know better than the professionals, your own outcome & its effect on the rest of your life will be worse. Gonzalez TA, Macaulay AA, Ehrlichman LK, Drummond R, Mittal V, DiGiovanni CW. Considering the bone mineral density of the tibia, the articular site shows a higher density in comparison to the metaphysis.46 Besides the connection between tibia and talus, there exists a close interaction between tibia and fibula. Patient is a 67 yo WF with h/o HTN that presents with left ankle pain after an MVC. The initial treatment is geared towards reducing swelling and pain and restoring the passive motion of any body part that is not in a cast. Had a previous post in June. (A) Ankle anteroposterior (AP) mortise view of a healthy young male showing the configuration between distal tibia, distal fibula and talus. When I began researching a timeline for this injury I found a great 30 something blog. Biomechanical comparison of the interosseous tibiofibular ligament and the anterior tibiofibular ligament, Anatomy of the tibiofibular syndesmosis and its clinical relevance, Anatomic variations and MRI of the intermalleolar ligament, Anatomy and pathology of the ligaments in the upper and lower ankle joints, Anatomical variations of the anterior talofibular ligament of the human ankle joint. (Great, I should be pain free by 68!!!). 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. A negligent driver in Sacramento near the Kenwood Street intersection killed a bicycle rider on November 9 and then fled from the scene. Next week we are removing 2 of the screws and hopfully I will start therapy in 2 weeks after that. I had a trimalleolus fracture & dislocation 9 mths ago. What are some things done in first phases that helped for quicker recovery. You will get better but you have to put a lot of work in it to be close to 100% wich you will never be 100% but close is pretty darn good. That sincere introspection has changed me for good. Traditionally, open reduction and internal fixation of medial malleolus fractures is indicated in trimalleolar ankle fractures.44 Considering the age distribution and peak incidence of trimalleolar ankle fractures, fixation of the medial malleolus may provide an additional stability in these osteoporotic bones.50 But Hoelsbrekken et al showed that non-operative management of minimally displaced medial malleolus fractures after fracture reduction in bi- or trimalleolar ankle fractures results in equivalent outcomes.145 A prospective randomized controlled trial regarding the management of medial malleolus fractures in unstable ankle fractures is awaited, hopefully providing further Level I evidence.146, Operative management includes open and percutaneous techniques with tension-band wiring, plate and/or screw fixation. Open your iPad and chill. What a horrible special fraternity to be a part of, So many kindred spirits telling their stories and reading the encouragement for full recovery is great! 2021 Aug 10;6 (8):692-703. doi: 10.1302/2058-5241.6.200138. No crutches while in cast. They removed it 8 days postop and put me in a boot with no,wt bearing for at least 12 weeks. I had a lot of very localized nerve pain on the inside of the foot at the arch (no break there) after a few weeks. A trimalleolar injury is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the posterior malleolus. The therapist will determine if massage of the scar tissue is necessary so that ankle remodeling occurs properly. By 10 months, my swelling was mostly gone except after a hard workout. 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. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. This page has really helped. To be honest the ankle is still sore and I need to rotate it regularly and stretch to exercise it but it does get better even though it seems an eternity. Screws are the most frequently used implant and are indicated in oblique fractures of the medial malleolus.149 Following the traditional AO technique, two parallel partially threaded cancellous lag screws are inserted preferably into the anterior colliculus.44 This classic approach is challenged by a randomized control trial by Buckley et al, who compared double to single-screw fixation and found comparable results.150 In osteoporotic bone, fully threaded screws or even bicortical fixation can provide more compression and lower rates of radiological loosening.151,152, In cases of distal avulsions (Herscovici type B) or severe comminution, stainless steel tension-band wiring (TBW) constructs are superior in comparison to screws.153 Also, in transverse fractures of the medial malleolus (Herscovici type C), TBW seems to be advantageous.149 The disadvantage of TBW is the frequently observed wire migration in up to one fifth of patients and prominent metalwork causing medial pain and implant removal.154,155 Due to these associated complications, new low-profile knotless systems were developed that still need to prove their reliability.156. I stopped narcotics in the day by wk 2, completely by wk 4. Surgery is frequently delayed days or weeks if there is too much swelling. I want to thank everyone for sharing your experience, strength and hope. We are experimenting with display styles that make it easier to read articles in PMC. 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 . Trimalleolar ankle fractures have a rising incidence in the last decade with up to 40 per 100,000 people per year. Just couldnt move. I am stoutly independent and have refused help my entire life but have found people enjoy helping you out when you need it. It depends. 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. I slipped on day 2 of my holiday. 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. 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. 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. The PA-C says its ok as long as its not around the clock. 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. I am 54 yrs old. Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Unable to process the form. Surgery was done March 2. The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. It does not diminish the pain, inconvenience or lossit just puts this into some perspective. 1D). Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. Vance DD, Swindell HW, Greisberg JK, Vosseller JT. I recently had a trimalleolar fracture in my right ankle. Inter-observer reliability and intra-observer reproducibility of the Weber classification of ankle fractures, Conservative treatment of isolated fractures of the medial malleolus, Medial malleolar fractures: current treatment concepts, Pathoanatomy of posterior malleolar fractures of the ankle. A trimalleolar fracture refers to fractures of all three malleoli of the ankle: lateral malleolus, medial malleolus and the bottom posterior (backside) tibia. Its been miserable. Im a retired rehab therapist, my training helped. 11/7- 12 wks post op-final visit with OS.- I am fully healed. Friday i had to fly back to oklahoma. Hi Chris. Thursday i was able to check out of the hospital with 6 screws, one plate and a big ole boot. Inequality should raise suspicion of an unstable ankle injury. Konopitski A, Boniello AJ, Shah M, Katsman A, Cavanaugh G, Harding S. Techniques and considerations for the operative treatment of ankle fractures in the elderly, A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gchter A. Arthroscopic findings in acute fractures of the ankle. Presence of a large ankle effusion on the lateral radiograph may indicate an occult fracture and the need for further evaluation ( 4 ) [C]. No narcotics, but Advil, Tylenol,ice and elevation. My doctor said I should be walking by July which lands three months after my surgery. To be honest you shoud never stop your physical therapy, always find time to do it at home for the next few years if not for the rest of your life. This brought joy to my heart! These are the tibia (shinbone), the fibula (the smaller bone in your leg), and the talus (a bone in your foot). 52 yr. 230 lb. As of today I can walk slowly and carefully in the boot about a half mile with crutches, 50% weight bearing. I was 60 years old. It is the only ligament of the LCL complex that bridges the TC and subtalar joint.14 The PTFL runs almost horizontally from the fibula to the posterior process of the talus. Despite your allergies there are pain killers you can take. I am now almost 6 weeks post-op with no weight beating until June 8th appt. 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. Physical therapy and Occupational therapy. Not being able to do for my self is horrible. 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. Thank you for the heads up about physical therapy and how long it will take to restore some semblance of normalcy. II. I have a very smooth scar that will face over time who I is good cause it is about 10 inches long on the outside of leg. With a bimalleolar fracture, bones on both the inner and outer side of the ankle are injured. Only put it on again when I had to go to an appt. I had surgery next day after injury & had an exterior fixator after the manual reduction didnt work in ER after 2 attempts! I have a cast and use crutches. Still have chronic pain-swelling-Doc said I need to lose the cam boot and try wearing shoes-once I can do this I can drive. driving again!-freedom!! Like many people in this thread I got less than 4 hrs sleep a day for a month. i had surgery the next day. I am thinking of having the plate/screws removed. Its a little disheartening reading some of the other posts and I agree it has been tough having to rely on others for the basics: showering, meals, laundry, grocery shopping but Ive had a awesome support system of family, my dog, friends, boss, etc. Physical Therapy for Bimalleolar and Trimalleolar Fractures Most surgeons wait 2-4 weeks to start a formal physical therapy routine (but it begin immediately). And by the way, this injury really does suck and it is unfair that any of us have to go through this. Havent started PT, thinking i should start my own program for at least the rest of my body. Practically lived on my backside for weeks; tailbone still sore. The ankle joint is a rather complex joint which is actually two joints in one. Have tried to go without the Percocet as I do not want to get dependent on it but barely hanging on by a thread. Hi all, I am 51 and I experieced a trimalleolar fracture Feb 4, had an ORIF on Feb. 6. Combined experimental-surgical and experimental-roentgenologic investigations, Ankle fracture: radiographic approach according to the Lauge-Hansen classification. I did a bi malleolar and spiral fracture of fibula 16 weeks ago when I had a fall in NZ. But I am determined to get back to hiking as soon as I can. Still taking meloxicam. Should start regular PT in a few weeks. I guess it opens and closes the blood vessels around the injured ankle. 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. It was not numb at the time of the break, not after the reduction, and it was not numb pre-surgery. 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. Go back to the surgeon or ER & get it changed. I fell badly in August 2016 and sustained a trimalleolar fracture at age 58. To what extent is up to you. Keep your ankle propped up above your heart this really does help the swelling. Heckman JD, McKee M, McQueen MM, Ricci W, Tornetta P, III. I hope this helps. Court-Brown CM, Biant LC, Clement ND, Bugler KE, Duckworth AD, McQueen MM. The ankle should be stabilized, and the person should be transported to the emergency room. They told me NO IBUPROFEN, but the other pain meds did nothing, so Im taking ibuprofen anyway. I am an active 64 yrs old never broken a bone until I walked off high curb on 8/5/17. A trimalleolar fracture can have long-term impact on your quality of life. 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. Prior to the injury I religiously participated in weight training daily, marathon running, hiking, softball, and kickball. It has really helped. I feel for others going through this. I do squats and lunges and calf raises for my lower body without difficulty. Antibiotic beads were placed in or near infection site. Salai M, Dudkiewicz I, Novikov I, Amit Y, Chechick A. 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. 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. Anna, do not weight-bear before your doctor says it is ok. This type of fracture is usually sustained after high-impact injuries, including falls, car accidents, or sports injuries. Minihane KP, Lee C, Ahn C, Zhang L-Q, Merk BR. Exercising the rest of your body will help immensely, good idea to start at home, progress to a gym/pool when youre more mobile. Im wondering g about why some have non weight bearing for 12 weeks. Hi. I have a feeling Im not quite half way to weight bearing walking by the way some of the comments Im reading here. 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. Ankle was shaking violently out of cast but now OK. 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. This review considers current scientific findings regarding all three malleoli to understand the complexity of trimalleolar ankle injuries and provide the reader with an overview of treatment strategies and research, as well as future perspectives. This helps a lot. 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. They will also help set realistic goals to keep a person moving forward in their recovery. I am advised that the swelling may last several months. If two of these are involved in a fractured ankle, then it is labeled a bimalleolar fracture and if all three are involved then the diagnosis becomes a trimalleolar fracture. Nov 11 yet another surgery,infection in bones,cleaned out infection and removed 2 screws that were also infected. Cast was removed before I went home on Aug 24. De Vries JS, Wijgman AJ, Sierevelt IN, Schaap GR. Hartford JM, Gorczyca JT, McNamara JL, Mayor MB. Computed tomography is essential for classification and operative planning. In any case, the ankle is good, not as much flexibility as Id like, but Im walking. Your email address will not be published. I have too much arthritis in my back, knees, hands to use crutches because that is 10 times as painful as the ankle. Im fully aware I am along way from recovered but there is a very dim light at the end of the tunnel , so for those who have sustained this injury recently please prepare yourself and your family for the long journey ahead. Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial. Breederveld RS, van Straaten J, Patka P, van Mourik JC. Trimalleolar fractures are unstable fractures often associated with significant ligamentous injury and almost always require internal fixation. I have lost between 20 & 30% range of motion in that ankle which is now starting to cause issues in my knees and hips. 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. Without the aides to living life over the past few weeks would have been difficult. 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. Lamontagne J, Blachut PA, Broekhuyse HM, OBrien PJ, Meek RN. Suffered a trimalleolar on feb 17 , going to see Md tomorrow for X-rays and see about upgrading weightbearing . This portion of the tibia is sometimes referred to as the posterior malleolus. I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces. These stabilise the two bones above the ligament whilst the ligament heals. Slip and fall on tile floors. The current literature strongly advocates the operative treatment of ankle fractures involving the posterior malleolus. That was unbearable. I am a very active 28 year old petite female. 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. Required fields are marked *. But will wait and see about that.Go to Dr weds will see when I can walk again. Like the previous poster said its good to know what Im up against. My ortho MD okd swimming with very soft kick as long as I was safe getting in/out. Immunoglobulins to aid the immune system of the patients and to immunized them from Clostridium tetani products which is usually from the fixation devices. By wk 3 I started driving with left foot plus cruise control. For a while everytime you would push to new limits of exercise the ankle would rebel. The therapist can educate the patient on ways to transition from non-weight bearing to full weight bearing and answer any questions about the different sensations that will occur when the foot is placed on the ground for the first time following surgery. Ferries JS, DeCoster TA, Firoozbakhsh KK, Garcia JF, Miller RA. off pain meds 3 days after sugery nurses were impressed i was off of them so fast. Each one seemed to improve my ROM. Was able to remove boot for sleep and if sitting.-huge relief! I am going on 10 weeks since my trimalleolar fracture and dislocation. This is an area that acts as an anchoring location for the ligaments that are the static stabilizing structures of the ankle/foot complex. 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. . This term trimalleolar fracture is broadly used to include the three structures, which get affected in the trauma or impact, which causes ankle fracture. I was amazed that the hot water in my shower registered 115 degrees, the cold water 57 degrees. Hate it. Tell the doctor to prescribe them. Its been almost 5 months with 8 weeks of PT and I am still not walking without limping and swelling. For those struggling, I hope your healing goes well. Then no more pain until after surgery. He said it should prevent me from having more problems & pain in the future. Is this normal? I am very discouraged that the pain is just as bad now as it was 2 months ago. It did takes several years to be completely pain free. 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. On the distal end of the Tibia and Fibula a lump of bone develops into a malleolus or malleoli (singular). Place a towel around your affected foot just under the toes. You are at a tough stage. Le Fort-Wagstaffe tubercle). Plate with 7 screws. Yea!!! The epidemic of ankle fractures in the elderly: is surgical treatment warranted? 1758, The treatment of unstable fractures of the ankle using the Acumed fibular nail. Im hoping this is only temporary until the surgery settles in my ankle. Maybe that will help a little. Update- post- trimalleolar injury- 6 months: I know that immediately after my injury I wanted some sort of a timeline so here I am at 6 months and I would say that I am 85% back to normal. Open fractures in the elderly: the importance of skin ageing. Learn more about us on Yelp, Avvo or Google. I just didnt think it was a good idea to stretch the blood vessels in my foot and ankle for any period of time. 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. van den Bekerom MP, Haverkamp D, Kloen P. Biomechanical and clinical evaluation of posterior malleolar fractures: a systematic review of the literature, Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature, Posterior malleolus fractures: worth fixing. Triathlete and RN. Thanks for the encouragement! ; Ankle Injury Management (AIM) Trial Collaborators. It was actually the ooze from the incisions into the combines that had dried as hard as a brick. A talar shift of 1 mm results in a 42 percent . My arm was splinted for 3 wks and then removed. Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. ), and just got released to walk carefully outsidein the sun!! The treatment for a bi or trimalleolar fracture begins immediately. Bartonek J, Rammelt S, Tuek M, Naka O. Posterior malleolar fractures of the ankle. I am using a walker and wheelchair. 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 am 75 years old and on April 12 suffered a Trimalleolar fracture in dislocation of my left ankle. I keep my ankle raised above my heart and ice pack it. Thank God I was out with something that caused amnesia! I am a healthy and active walker/hiker, 66 yo who slid down two steps at the end of January 2018. I was in a plaster cast for 2 weeks and have been in an air cast ever since. Walking uneven terrain was still uncomfortable. Inmans joints of the ankle. At 9 weeks my doctor released me to full weight-bearing but the physical therapist suggested that I make a gradual transition. I just experienced a trimal about two weeks ago.. Fracture blisters lready present and alli have fallen a half dozen times in he spint already. 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 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. That doesnt help you at all but at least you will know that is normal. Ambulance to hospital, x-ray showed a trimalleolar displaced fracture. Plus, Ive only been able to visit my horse 3 times since the accident and I am missing her, and riding her, like CRAZY!! Good luck if you are facing this injury .no easy or fast cure unfortunately painfully slow and very difficult and long recovery. . And, for those like me still on the road to recovery, hang in there. 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. Think of this as an extended vacation. According to www.uptodate.com: Over five million ankle injuries occur each year in the United States alone. I have never appreciated my hubby so much in our 27 years! The initial treatment is geared towards reducing swelling and pain and restoring the passive motion of any body part that is not in a cast. Narcotics/Analgesic since there is severe pain noted on the patient, this type of medications relieves the pain. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Feng K, Trimalleolar fracture. In boot. Cant do one legged toe raises yet. 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. I started doing ROM approximately 1 week post surgery. Arthroscopically assisted versus standard open reduction and internal fixation techniques for the acute ankle fracture. Trimalleolar fracture with a dislocation here! Upon once the bone is opened the area of the fracture will be placed with screws, pins or any fixation device to make sure that the bones re properly aligned and back to its normal positions. Hi, I had Trimalleolar fracture on April 16th. Im afraid to say that I still get swelling on a daily basis and it niggles and aches often. To everyone else out there with a similar injury, just keep fighting, it will get better and finally heal. Hoefnagels EM, Waites MD, Wing ID, Belkoff SM, Swierstra BA. This article does a great job explaining the general recovery from bi- and trimalleolar fractures. My the force be with you!! Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. My doctor has not even offered that as an option. Very stiff every morning and it takes me a while to get going. Single fibres can reinforce the intermalleolar ligament. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. 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 started doing range of motion exercises 4 times per day as soon as the Dr. gave me the go-ahead. Im still about 10lbs off on my repaired left leg, my right is still stronger. I was apprehensive of this additional surgery but Fab has put my mind at ease. The arm was a dislocated elbow with an ulna fx, no surgery was needed. I am devesrated to say the least but everyone keeps getting on me for being so depressed, saying that I have to be positive. Anyone else experience this intense burning pain? While high impact sports accidents can cause ankle fractures, so can simple falls. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. I had surgery 2 weeks later & have 2 plates with 14 screws. Other posts are giving me hope. Best for ROM was sitting in a hot bath several times a day and forming the letters of the alphabet using your big toe as the pen tip. Dr says fwb, pain feels like major sprain when i apply pressure, and swelling is instant, going back on jan 30 to see dr,hoping infection is gone and I can finally give up antibiotics. Rder BW, Figved W, Madsen JE, Frihagen F, Jacobsen SB, Andersen MR. The authors would like to thank Fritz Seidl, M.A. I am an adventurous 58 yo and fit the category perfectly! God bless. 4010 West 65th Street, Edina, MN 55435 Phone: 952-944-2519 Fax: 952-944-0460 www.mosmi.org Ankle Fracture Post-op Rehabilitation Protocol 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. Gosh, I sound like the Tortoise in The Tortoise and the Hare LOL.. I had a rotation of therapists and always dreaded when the ex gymnast was up. This is an injury that you will never fully recover from. Most of the time, if the medial malleolus and lateral malleolus fractures are repaired, the posterior fragment will go back into place on its own. Im following my doctors orders, but Im also one of those that wants to speed things up and looks for reasons to do so. I have discovered a help network amongst my friends and family that I never realised I had. but i am hoping for a quick recovery as my wedding is the beginning of seotember, and I am not limping nor wearing a boot down that aisle. Vidovi D, Elabjer E, Mukardin IVA, Milosevic M, Bekic M, Bakota B. Posterior fragment in ankle fractures: anteroposterior vs posteroanterior fixation. The doctor said removal is unwise because the bones now have holes from the screws and increases the risks for just another break. Three bones make up the ankle joint. Im glad I found this site as it gives me an idea of the tough uphill battle ahead of me to get back to some semblance of normalcy. My PA suggested I stop my ROM exercises for 3 or 4 days to see if it alleviates the pain, but Im nervous I will lose my range of motion that Ive worked so hard to have. They had to reduce the fractures 4 times (and by the 4th time it was a little painful). The trimalleolar fracture of the ankle is the least common type of fracture among ankle fractures. 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. Exercise your healthy parts daily, set realistic goals & celebrate achievements. I also have trimalleolar fracture & dislocation as a result of a body surfing accident whilst on holiday in Puerto Vallarta Mexico 27/3/17. Parker L, Garlick N, McCarthy I, Grechenig S, Grechenig W, Smitham P. Screw fixation of medial malleolar fractures: a cadaveric biomechanical study challenging the current AO philosophy, Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws, Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures, Modified tension band wiring of medial malleolar ankle fractures, Tension band fixation of medial malleolus fractures. 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 . 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. Once in a while, the patient has to undergone series of x-rays to check if the bones are properly aligned. Is this pain normal? My ankle stayed splinted two wks after surgery and then I got switched to a cast with suture removal. Karbassi JA, Braziel A, Garas PK, Patel AR. Im now 5 months post op from a trimalleolar fracture. The plaster they put on after the surgery was put on incorrectly, according to the PA-C as it was wrapped completely around my leg. My ankle was shattered & my life turned upside down but do what the doctors say, follow phyios instructions & do your exercises. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus. I broke down and joined a gym at 41 years old knowing that I would never be the same if I didnt. People think you should be up and running after six weeks. Ebraheim NA, Ludwig T, Weston JT, Carroll T, Liu J. On the one side, there is a growing number of elderly patients with osteoporotic fractures and relevant concomitant conditions in which internal fixation to restore anatomical ankle joint congruity poses a particular challenge. So glad to find all this info.first website that came up when I googled.healing from trimalleolar fracture..I also dislocated my ankle on May 29th. Stability of the syndesmosis after posterior malleolar fracture fixation. And then have courage to start putting weight on now healed bones ..walker for 80 days. I stopped wearing the boot and just started limping around. My hardware is exactly as in the picture shown in this article. ER tried to relocate the tibia, but only managed 2/3 repositioning. Usually the patient will have to wear a short-leg cast or a removable fracture boots to make sure that the legs fixation devices will be in place. I was not prepared. 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 . The prescribed physical therapy after a trimalleolar fracture may initially help the patient properly use any prescribed assistive walking devices. I am able to do stairs one foot at a time. 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. 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. Biomechanical comparison of intramedullary fibular nail versus plate and screw fixation. I am almost 12 weeks post surgery and anticipate that at the next visit I will become fully weight bearing. have split and spend most days resting leg splint is terrible seems like it rubbing stitches and dont sleep very well. Thera bands were great too. Orthopedists must be specific when documenting fracture repair because CPT's index breaks down the ankle fracture codes into six types: lateral, medial, bimalleolar, trimalleolar, pilon/planfond or 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. Evidence-based treatment of open ankle fractures, Predictors of postoperative wound necrosis following primary wound closure of open ankle fractures. 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 . I am going on 6mos.since injury, no cast,no splint,and no boot. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. It is tough not being able to go out by yourself, drive yourself. It spans from the period of a few hours up to several days of delay in order to minimize soft tissue swelling.63 A retrospective cohort study in Norway with 1011 patients showed no difference regarding postoperative length of stay, complications, and functional outcomes in patients with closed ankle fractures treated with ORIF during the first 8h, 8h to 6 days and > 6 days.64 Other studies are in line with these findings, reporting no difference regarding postoperative wound infections between early and delayed surgery groups.6567 In contrast, a case series of Schepers et al found a significant difference regarding wound complications between patients treated within one day and with delay.68 They also performed a literature review including six studies showing a significant increase of wound complications when surgery was delayed.63,66,68-73 Considering the published studies, their heterogeneity and partially low quality, there is no definite recommendation for the optimal timing of the operative treatment of closed ankle fractures (Table 1). Cant wait until this is all behind me. Glad to find other stories and experiences. [Figure 2], Medial Malleolus Fracture since this a fracture that involves an impact or indent on the ankle joint, bone grafting is necessary. Yes, as you all know, but for a new people reading thisthis is a complicated fracture, that may well impair our ability in some degree or fashionbut look around.it can be so much worse. 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. you will get there too! Ive got plates and about 10 screws. 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. Leardini A, OConnor JJ, Catani F, Giannini S. A geometric model of the human ankle joint, Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion. -albeit some at a slower pace. My problem is now (my good ankle) and calf is in a lot of pain and my ankle is starting to swell. This seems odd to me considering Im 51. 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. I have a knee scooter and can drive. Initially I had no pain besides at the moment of break. read dozens of these posts But it is very hard to be when I have to depend on my fianc for everything. Flexion is taking a lot longer to rebound.. 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. However, an important factor, the configuration of the posterior malleolus fragment, is not represented in the AO/OTA classification. Anyone have icky ugly scars? For the most part I try and just ignore the pain and maintain a normal daily life. If it is only nausea you get when taking some pain killers, take them with food &/or anti-nausea medication. Following surgery the patient will be completely non-weight bearing for a period of 2-3 months. The ankle swells when my leg is vertical and it gets quite painful, but the swelling goes away after elevating my leg. 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. I wanted to share my story to give hope to anyone going thru this experience. There is widening of the tibiofibular syndesmosis. 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. Contemporary demographics and complications of patients treated for open ankle fractures. Am 54 and had enough of the pain anyone else like me. i do have my knee cart that helps allot. Fortunately, this injury will usually clear spontaneously. I was not walking without any aid until post op 5 months ! Thank you for a very informative site. 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