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Had Operation For Malleolus Ankle Fracture, Had Screw In Ankle. During Elevation Of Ankle, Foot Tends To Fall Sideways

Posted on Sun, 6 Oct 2013

Question: i am 3 weeks post op from my medial malleolus ankle fracture
had a screw in the ankle

but right from the beginning during th elevation of ankle on pillows my foot tends to fall sideways from my original intended position
so is it ok to elevate or sleep on it sideways

Answered by Dr. K. Naga Ravi Prasad (12 minutes later)

Brief Answer:
Protection in the form of splint is necessary.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

A 3 weeks old post operative medial malleolus fixation with a screw requires some form of external support like a POP Slab or a splint.

Infact, it all depends on the rigidity of fixation of the fracture whether to use any splint or not. If the fracture is rigidly fixed, then no external support is needed.

So,if you have an external support or splint , it doesn't matter in which position the foot is kept.

Hope I have justified your query. I welcome any more clarifications.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (19 hours later)

yes i had a pop slab along with a crepe bandage to tighten the slab right from day one from the surgery

Answered by Dr. K. Naga Ravi Prasad (42 minutes later)

Brief Answer:
With POP slab, nothing to worry.

Detailed Answer:
Hi, It doesn't make any difference in whatever position foot is kept, if the foot is supported by POP slab.

Also, this is just for your information that the movement of external rotation (outward deviation) of the foot will not occur at the level of foot but its actually occuring in the hip joint that makes your foot to rotate inwards or outwards.

Hope this information clears all your doubts.

Have a great day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (29 hours later)

my doctor has not removed my non dissolvable stitch from my ankle its been 3 weeks post surgery is it ok?? or should i go and inform him??
its a medial mallrolus fracture

Answered by Dr. K. Naga Ravi Prasad (33 minutes later)

Brief Answer:
Get it removed.

Detailed Answer:
Hi, its always advisable to remove a non absorbable suture material within 2 weeks after surgery.

You never know how the consequences are going to be, if you leave it unattended.

So, I suggest you to approach your surgeon and get them removed.

Wishing you a quick recovery.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (12 hours later)

sir, you already know that im 3 weeks post operative, how long should i wait to set foot on the ground from today, ive sent my x XXXXXXX showing the fixation

Answered by Dr. K. Naga Ravi Prasad (43 minutes later)

Brief Answer:
Around 4-6 weeks from now.

Detailed Answer:
Hi, Based upon your post op xray film, the fracture may take around 4-6 weeks to unite untill then you are not allowed to bear weight on the limb.

By chance, if you bear weight on the limb before bony union, there is every possibility that the screw may become loose and migrate downwards resulting in loss of fracture fixation.

Hope its clear for you now. Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (16 hours later)

can i place my foot in the following positions as attached in the pics

Answered by Dr. K. Naga Ravi Prasad (48 minutes later)

Brief Answer:
Yes, You can place it.

Detailed Answer:
Hi, Gone through all your pictures.

You can keep your leg in any desired position except bearing weight on the leg as in walking.

Take care. Bye

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (4 days later)

i have a tendency to open my crepe bandage to see my stich area in my medial malleolus fracture area to touch the screw placed in the ankle
is it ok if i do it frequently ??
or should i not do it

Answered by Dr. K. Naga Ravi Prasad (6 hours later)

Brief Answer:
Nothing Happens.

Detailed Answer:
Hi, Nothing happens by simply opening the crepe bandage and having a look at the suture site.

But don't try to meddle the suture area with your nails of the fingers as there is a chance of bleeding and infection.

Wish you a quick recovery. Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (39 hours later)

also i have a tendency of rubbing the screw and suture area over the crepe bandage
is it ok if i do this
will there be a chance of screw moving or a malunion or non union

Answered by Dr. K. Naga Ravi Prasad (6 minutes later)

Brief Answer:
Avoid meddling the area too much.

Detailed Answer:
Hi, Too much of rubbing over the suture site or over the screw heads is not advisable as it may evoke an inflammatory response inside. So avoid it. If you are having itching over the area, use some simple antihistamine preparations.

A rigidly fixed screw is not supposed to move with simple rubbing over it, so the question of malunion or nonunion will not arise in case of good fixation.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (47 hours later)

almost 5 weeks pot op medial malleolus screw fixation surgery
now i start to xperience from today small acute pain like or tingling like non- continuous sensation on the fracture site
is this beacuse i move my ankle too much??

Answered by Dr. K. Naga Ravi Prasad (12 minutes later)

Brief Answer:
May be a vague non-specific symptom.

Detailed Answer:
Hi, it could be a nonspecific symptom not related to the fracture fixation. As your limb is immobilized in a POP slab, you cannot expect any movement to occur at the level of the fracture.

As your symptoms of tingling & minor ache are occuring infrequently, they do not carry much significance.

Hope I have justified your query.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (3 days later)

yes
the tingling pain occurs after i get up from my sleep only
the pain occurs exactly at the screw head
at 5 weeka post-op is it still necessary for active toe movement
thanku for answering my questions patiently

Answered by Dr. K. Naga Ravi Prasad (17 hours later)

Brief Answer:
All are normal phenomenon.

Detailed Answer:
Hi, Tingling pain occurs after getting up from sleep just because of the pressure exerted by the cast in one position over the cutaneous nerves, which is again normal.

Because the screw head is positioned just below the skin, it will be tender to touch.

I personally dont think that active movements are necessary after 5 weeks.

Good luck. Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (9 days later)

its been 7 weeks post op and my doctor removed my plaster cast and checked the ankle and he said that i start walking with partial weight bearing only on toes and two exercises ie., foreward and backward ankle movement, i asked my doc for x XXXXXXX he said its not necessary why??
and why should i walk partial weight bearing

Answered by Dr. K. Naga Ravi Prasad (33 minutes later)

Brief Answer:
Its individual surgeon's preference

Detailed Answer:
Hi, some surgeons take a check xray of the fractured area to see that it has united or not. Some will not prefer it, so its the surgeons personal preference.

After anyform of XXXXXXX fixation for a fracture, we generally advice partial weight bearing initially followed by full weight bearing as tolerated. So, its a routine protocol followed by orthopedic surgeons.

Good day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (3 hours later)

my doctor said i have to tie a crepe bandage to ankle while partial weight bearing and should do the ankle foreward and backward movement but not side movement for 2 weeks then come for a visit

apart from these are there any other things for me to follow and any other precautions to be taken care of??

Answered by Dr. K. Naga Ravi Prasad (41 minutes later)

Brief Answer:
Nothing in particular

Detailed Answer:
Hi, Be careful while walking on uneven surfaces as your ankle joint may move sidewards (inversion or eversion) causing more strain on the fracture fixation.

Other than this, there is no other particular precaution to be followed. Just follow the instructions given by your treating doctor.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (3 days later)

i fell on my surgically fixated ankle(medial malleolus screw) as u seen in my past pictures
i fell on it while walking on crutches during partial weight bearing exerise on toes
now while walking on it i get a small acute tiny pain like sensation near my surgical site while tring to bear weight
what should i do
the doctor wont be avalaible till next week

Answered by Dr. K. Naga Ravi Prasad (7 hours later)

Brief Answer:
You need an xray of the ankle joint

Detailed Answer:
Hi, any amount of pain occuring at the site of operated site is not a good sign.

Go and get an xray of the ankle joint to see for the implant position and the fracture status.

As you are not having unbearable pain, you can wait till your treating doctor arrives.

To be on the safe side don't put any weight on the leg till you consult your doctor.

Keep your limb elevated and use an analgesic medicine as needed.

Regards

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar