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Dr. Andrew Rynne

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Does an un-displaced medial malleolar fracture require surgery?

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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 11561 Questions

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Posted on Wed, 5 Dec 2018 in Back Pain
Question: I was diagnosed with a medial malleolar fracture of my left tibia following a skiing accident. Based on the ED evaluation, the fracture was non-displaced at the time and "likely would not require surgery". There are two views, one more oblique than the other, the latter of which shows a slightly more displaced fracture. I am 5 days out from the injury and am in a short leg cast. I am in discomfort, am completely non weight bearing, and have generally babied the ankle, keeping it elevated while staying in bed, but have had the occasional unavoidable knock into a door frame, etc, while navigating with crutches to and from the bathroom or my desk.

I was hoping to have a look at the x-ray (mindful of the fact that I will be returning in less than a week for more imaging to determine the need for surgery, which the PA-C suggested would not be likely if everything stayed in place). What are thoughts on surgery for this type of fracture? I am a 32 year old male who leads an active lifestyle. I want to be able to return to my fitness routine (and skiing), but also need to be able to return to weight bearing as soon as safely possible for my job. Given the imaging where displacement is apparently minimal, is surgery indicated? (I recognize that this could change).

Assuming nothing moves, and the bone stays as pictured, what are general thoughts on the appropriateness of surgical reduction anyway? Any effect on recovery time, and ability to return to full strength and activity in the future? I've read about impaction and indentation. Based on these films, is this a factor herein?

Kind regards.
doctor
Answered by Dr. Praveen Tayal 29 minutes later
Brief Answer:
Details below.

Detailed Answer:

Hello,

There is an undisplaced medial malleolar fracture, we need surgery if there is displaced fracture or when fracture fragments are not stable. In your case, the fracture is minimum or undisplaced, therefore, surgery is not required. You will be able to return to weight bearing after applying fiber or air boot cast.

Surgery in your case will have no extra benefit over cast except soft tissue trauma and implant in situ.

Recovery time will be 6-8 weeks in cast and 10-15 days of physiotherapy. After recovery, you will have the ability to return to full strength and activity in the future.

I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

Regards,
Dr. Praveen Tayal
Orthopedic Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 2 days later
Thanks very much Dr. Tayal.

My follow-up question concerns DVT. Obviously, I am immobilized and am non weight bearing, so my ability to do any physical movement of the affected ankle is restricted. How concerned should I be about developing DVT? I am a 32 year old male, non-smoker, healthy BMI.

Nobody mentioned anything about a blood clot until today, a week after the injury, when my ortho advised to start taking Aspirin 2x daily, and to look out for calf pain. However, my entire lower leg is sore. I can't tell which pain is associated with possible DVT, and which is from the injury itself. Should I be taking blood thinners?
doctor
Answered by Dr. Praveen Tayal 9 hours later
Brief Answer:
Blood thinners not needed now.

Detailed Answer:

Hello,

A mild pain in the calf is normal after such an injury and immobilization. In case there is visible swelling on the calf and the pain is gradually increasing then DVT can be suspected. The confirmation can be done only after a color doppler scan. Blood thinners are not needed till the diagnosis is confirmed. You can continue with Aspirin to decrease your chances of developing DVT.

Hope my answer is helpful.

Regards,
Dr. Praveen Tayal
Orthopedic Surgeon
Above answer was peer-reviewed by : Dr. Raju A.T
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