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Dr. Andrew Rynne

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Suggest treatment for chronic pain after fracture

Answered by
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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 11255 Questions

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Posted on Mon, 1 Sep 2014 in Bones, Muscles and Joints
Question: Trimalleolar fx w dislocation incl 2 post fragments 3yrs ago. HW removed. Pain never went away. Chronic pain. Still 6-7/10. Is this normal for this break?
doctor
Answered by Dr. Praveen Tayal 14 days later
No i do not think that your fracture was treated correctly. I want to see your current x ray to advise you further management. Meanwhile apply compression bandage and hot water fomentation.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 4 days later
Trimalleolar fx with severe dislocation 3.5 yr ago. Pain never went away. 6-7/10 pain with swelling that has gotten worse in past few months. (Not just stiffness and occasional pain, but cont chronic pain). The most recent xray i have is 2 yrs old. Taken approx 6 weeks after hardware removal which was 1.5 yrs after fracture. Had tightrope instead of synd screw. Complete disruption of distal tibiofibular ligaments. Tore syndesmosis. Two posterior fragments. One large. Appreciate your advice. 1.5 years between tje two films. Thank you for your advice. Would like your opinion as to whether i have had successful healing or if anything can br done for the pain andswelling.
doctor
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
The bones have almost healed

Detailed Answer:
Hello,
Thanks for posting your query.
The bones have almost healed but I think that you have developed osteoarthritis in the joint that is causing the pain and stiffness. Calcium and Vitamin D3 supplements with regular physiotherapy and hot fomentation will help in restoring the joint movements.
A lateral view of the joint will help in a better evaluation.
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.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Praveen Tayal 14 hours later
Will see if i can get a lateral view. I just expected to be better 3.5 yrs after break. I am a pharmacist and I work 10hr days. My entire leg is hurting by the time i go to bed worse up to knee. It actually keeps me awake. It still hurts in the morning but is better. Again this is not just soreness and stiffness. It has hurt for 3 yrs. my surgeon said it could be ligaments because they can calcify as they heal since they are left to heal on their own. But wouldnt the ligaments be repaired as well as bones? Can that not be taken care of during orif?
doctor
Answered by Dr. Praveen Tayal 4 hours later
Brief Answer:
Give more rest to your feet

Detailed Answer:
Hello.
Thanks for writing again.
The ligaments are not repaired during ORIF. Since the ligaments are a blood less structure the healing is slow and may remain incomplete after years of getting injured. You are also putting too much stress on your feet. It is better to cut down your working hours and give more rest to your feet.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 3 days later
So is this level of pain simoly "normsl" for what my dr called a "severe trimalleolat fracture dislocation"? Ive talked to others with similar injuries and they say the just have stiffness or sorrness. As stated i still have daily pain. Could the fact thst i had a 2 posterior fragments and one large posterior fragment make it worse? Also why does my leg hurt up to the knee? Could the syndesmosis injury cause the pain? And to end would therebe any benefit to a follow up MRI? Thanks for your help.
doctor
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
MRI scan will help.

Detailed Answer:
Hello.
The pain varies from person to person and with the level of fibrosis and the extent of ligament injury. The pain till the knee is also within normal limits. The multiple fragments make it even worse. Syndesmosis is also a cause of constant pain.
A follow -up MRI scan and lateral view X-ray will help in detecting the extent of fibrosis and ligament healing.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 23 hours later
Thank you. I am attaching a lateral view but it is 2 years old. Please let me know your thoughts. Also can anything be done to help other than anti inflammatories? I am using compression stockings at work and they do help but if i dont wear them they look like the picture below. I guess I will follow up with my surgeon. I just dont want to go for him just to say it is a normal expectation for my injury and there is nothing he can do. Thanks again for your advice and assistance .
doctor
Answered by Dr. Praveen Tayal 29 minutes later
Brief Answer:
No lateral view X-ray attached.

Detailed Answer:
Hello.
There is no lateral view X-ray attached. The swelling in the foot is obvious but manageable with anti inflammatories and compression stockings.
Keeping the foot elevated on two pillows while resting will also help.
Regards.

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