Question: I fractured my left ankle on February 17 while skiing. My initial orthopedic evaluation was on February 19, when my ortho diagnosed a non-displaced bimalleolar fracture, with the bones in sufficient alignment that surgery was not advised. I was placed in a short leg cast with follow-up scheduled for one week. Notably, the medial malleolus was by far the larger of the two fractures. In fact, although she pointed to something on the fibula, I could not really see the lateral malleolar fracture.

After one week and a new series of x-rays, the short leg cast was removed. The ortho reviewed the films and did a physical exam. She was content with the alignment and felt that she could not do anything surgically that could better position the bones. So I was put back in a short leg cast, non-weight bearing, for follow-up in another three weeks.

I just had that (4 week post-injury) follow up, on March 19. Another series of x-rays were taken (unfortunately, I only have attached photographs of the screen, and not the files themselves). She pointed out that the fracture line on the medial malleolus was fainter compared to the original ER x-rays, but it was still clearly visible. I was given the option of a short leg cast or a boot (still non-weight bearing) for another 2-3 weeks, before next follow-up and evaluation for transition to partial weight bearing. I chose the boot, and am allowed to remove it for showering, but must keep it on for sleep.

My questions are as follows:

1) At this point, around 4.5 weeks after the injury, what kind of bond has likely formed between the fractured bones under the circumstances (e.g., there was no surgical intervention)? Although I am highly compliant with non-weight bearing, I am terrified every time I accidentally bump the boot, or turn in bed. Also, when I shower, I notice that (for either psychological or physiological reasons), the foot and ankle are just frozen in place, and the slightest movement (e.g., when I am gently drying my foot) causes pain.

Would the bones likely have bonded sufficiently to withstand this kind of light "stress"? The x-ray didn't show any obvious callus formation like I see in exemplar x-rays of healing bones. Does this mean that there is no callus? I have a bit of paranoia that every time I look at my ankle the wrong way, I will cause the bones to "re-fracture".

2) Assuming everything proceeds as planned and I transition to PWB on April 9, how long might I expect until I am fully weight bearing and am able to walk?

I have attached the most recent x-rays to this question, but I believe the initial ER x-rays are also uploaded to my account.

Dr. Tayal:

Thank you for the quick and thorough answer. Earlier today I accidentally bore weight on my injured foot when the crutch slipped out from beneath me. There was a sharp pain that subsided, but regardless, I went to urgent care for evaluation.

A new ankle series was performed (attached here, along with the radiologist report). I do notice the healing of the bone more clearly, which you described above.

However, I am confused by something. The radiologist report notes that the tibiotalar space is clear and mortise is well-aligned. This appears to be the case in the view where my ankle was angled inward. However, in the direct view (where my foot was straight), the clear space around the talus seems to be wider around the medial area.

Should I be concerned about injury to the deltoid ligament? Or is the asymmetry of the clear space in that view somehow an illusion?

Thank you again, in advance, for your thoughtful reply to this follow-up.