I’m not asking for medical advice, but I was thinking of asking my doctor a silly question on Thursday, and am hoping those with some medical knowledge here can tell me just how silly it is.
I broke my fibula in mid-October, while running. Not being smart enough to tell the difference between a broken bone and a minor sprain, I hoofed it with a barely noticeable limp and a small amount of pain for exactly a month.
By the time I made it to the orthopedist, I had managed to damage a couple of tendons, weakening my ankle significantly. The doc got me into surgery the following day. Before the surgery, he told me I’d be in a cast for six weeks, then a removable, walkable “air cast” for a while.
After the surgery, which involved metal plates and screws to bring some bones together and allow the tendons to heal (they’ll be removed in 5 months or so), he told me that my broken bone was already healing well on its own; the tendons and bone spread were more the issue at that point.
Next Thursday I’m scheduled to get my cast off. My question for him will be, since my bone was already healing by the time I got the cast, will the air cast really be necessary? After all, the part that still needs to heal is being held together with lots of metal; is there any need to continue to immobilize from the outside?
I mean, whatever, I’ll be thrilled to be off the crutches, but these things look kind of expensive, and I have kind of a high deductible (and I don’t even know how much the surgery cost yet).
You damaged your tendons. The aircast is not only for the bone, but also is intended to support the tendons while they continue healing. There’s a lot more going on in your leg than just the bone propping you up like a stick puppet, and all that complex machinery of bone, tendons, ligaments, muscles, and cartilage is going to require time to put itself back together. Ankles can be extremely tricky joints to deal with, when they start having issues. And while your leg is busy repairing and strengthening itself, it needs to be sheltered from undue stress and strain.
Also, “aircast” can mean different things. It doesn’t necessarily have to be the 2001: A Space Odyssey gizmo. I had an “aircast” when I had a severely sprained ankle in which I chipped a bit off a foot bone, and it was just one of these. I found it extremely comfortable–comforting, even–and I used to wear it sometimes even after my ankle was pretty much healed, like whenever it felt tired.
So before you panic at the cost, and ignore doctor’s orders, and wind up crippling yourself for life, why not find out exactly what’s entailed.
ETA: Also, the aircast has the effect of reminding you that you need to slow down, especially since we already know that you’re the type to run on a broken leg.
I busted up my ankle terribly some time back. After a splint, then a cast, then a walking cast, I had a cast similar to that shown in the first link. I think it was $40- not aircast brand, though. It was no trouble, except I had to wear wider legged pants for a while.
My husband had an aircast just like the one in the second link - it was $60 or $80 IIRC.
That extra support was vital. It was nice to throw on even after the prescribe time when I was tired (like moving day) and didn’t want to concentrate on every single time I put down my foot.
Bones are easy, tendons are the thing to protect. Tendons will take longer to heal because they have much fewer blood vessels soaking them then bone. They also have fewer nerves, so they complain less and sometimes stop hurting when only partially healed. This is not a good thing, since athletes may interpret it being all healed and don’t understand why health professionals are trying to restrict them.
It’s more likely that your ligaments have suffered rather than your tendons in a typical ankle injury, but that’s a nitpick.
It’s a perfectly reasonable question and you should ask it; there are too many variables for anyone but the surgeon to give you good advice. Internal fixation may or may not be sufficiently stabilizing for the ligamental injury, depending on what was done. The ankle is a mortise and tenon joint, with the distal fibula and tibia forming the mortise. You want the whole thing nice and stable so that the talus (the tenon) doesn’t flop around or drive up like a wedge and splay out the distal fibula and tibia.
There are expensive and fancy splints, and there are usually less expensive alternatives, so you’ll want to mention that cost is an issue.
If your deductible is yearly, and you’ve already met it (hard to believe you have not, given what has been done so far), this may be the time to pull out all the stops and treat yourself to the Cadillac contraption. Whatever you do, if your maximum deductible is yearly, push everything you can into the same year.
You say you had a metal plate put in. I broke my fibula in the ankle area nearly three years. I would up in the hospital and the X-rays showed broken bone and damaged ligaments. This was on a Tuesday. I was told that I had to wait a few days for the swelling to go down else they couldn’t close the incision properly. Thursday evening a surgeon came by and said he would operate the next morning “unless the ORs were filled with emergency cases”. He went on to say that I would be in a cast and have to use crutches for 6 weeks, although they might be able to put on a walking cast after three. He added that I would then have to undergo considerable physical therapy since the ankle would have been immobile for six weeks. At 9PM on Friday, they finally told me that the operation had definitely been postponed till the next day (at least). At 8AM on Saturday, they wheeled me down to the operating room and a different surgeon appeared to greet me. He explained that he was going to put a metal plate in but no cast and that I should start walking on it as soon as it felt like I could. I asked him why the other surgeon had given different advice. He got a bit emphatic as he said, “I’ve been trying to tell those guys for 25 years that once the bone is stabilized by the metal plate, casts and crutches are unnecessary.” He said I would want to use a cane for a couple weeks, but I should walk as much as I felt comfortable with. At a followup appointment two weeks later, he suggested I lose the cane and said that most likely physical therapy would not be necessary since the ankle had not been immobile.
And so it proved. I walked around the house for a couple weeks (too icy to think of going outside) and after two weeks drove a mile to an indoor shopping center and walked around there a few times. Within three months, I was walking four miles to my office. And no PT.
Incidentally, it was a young surgeon whom I spoke to first and the one who actually operated was in his sixties, I would estimate.
Obviously every case is different, but I really wonder if, at age 68, I ever would have achieved full mobility had I been treated by the first surgeon.
There are many varieties of fibular fracture at the ankle. The OP’s reference to “bone spread” and a screw fixation for an bony injury already a month old suggests to me that the principle concern was disruption of the syndesmosis between the distal fibula and tibia. This is quite a different problem from the typical fibular fracture…while early ambulation is generally good, this may be one of those cases where it is not, and the fixation in question may have been for the purpose of making sure the syndesmotic disruption was supported until it has a chance to completely heal. In such a situation, the ortho may be concerned that early ambulation and weight-bearing without proper support may drive the tibia and fibula apart from the wedge action of the talus.
Whether you take it off or wait for the doc to take it off, you can still take it home and throw rocks at it. You can only do that if you are without sin, though.
