Avulsion Fracture Lateral Malleolus

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I rolled my right ankle at work in the woods April 20, 2016. Stepped over a log on a steep slope onto a loose boulder. I was working on a remote area and was dropped off/picked up by helicopter. I ended up walking on my foot for another 4-5km that day hobbling along thinking I had severely sprained it. Finally made it home and proceeded with the RICE method. By morning swelling was worse and decided to get it checked. Here is a summary of my results/treatment so far:

1. April 20 rolled ankle

2. April 21 – Visit ER. Dr. has x-ray completed. Tells me it is a small undisplaced fracture of lateral malleolus. Go get aircast, use crutches (NWB) and follow up with family Dr in 2 weeks. He said I would be “good to go” in 4-6 weeks.

3. 2 weeks later follow up with family Dr. She tells me to have to x-rayed again in 2 weeks (4 weeks post-injury)

4. 4 weeks post-injury x-ray shows no signs of healing. Family Dr. says continue NWB for 4 more weeks

5. 8 weeks post-injury x-ray again shows no signs of healing and according to the radiologist report “doesn’t look like it will ever heal”. Family Dr. doesn’t know what to tell me and says I need to see a specialist (which could take months to get into). I feel like she knows nothing at this point as she told me to go home for another 4 weeks and

"we'll have it x-rayed" again. While waiting to hear about when my appointment with the orthopedic surgeon would be I called my cousin would is an OS and he said without see my xrays that it was a common injury and that although no signs of healing that slowing introducing weight to my ankle would help with healing (wean off crutches wearing aircast over 2 week period). Got call for appointment with specialist.

6. 11 weeks post-injury meet with specialist. He has x-ray completed again (which I was never shown) and says that it is an avulsion fracture and there is a bone flake at the very distal tip of my fibula. He checked my ankle and I had no pain or swelling. Says that it will remain like this held in place by “filaments” and soft tissue likely for the rest of my life. He expects a full recovery and has given me a Rx for physio and wants to see me in 6 weeks to make sure I have full ROM again. He says this type of injury is treated as a sever ankle sprain. 

I have been doing a lot of research and haven’t been able to find a similar case to mine where it was “okay” to leave this bone chip/flake floating around in my foot. I just don't understand how this would be acceptable to leave in there. I live a very active personal liefestyle (hiking, hunting, fishing, etc.) and also depend on my feet for my career as a forester working/walking in the worst possible terrain there is to walk on. I am worried that maybe I needed/need surgery or that this may cause me huge problems later in life. Since I haven’t been able to find anything online I am wondering if this is not as “common” as he says it is. It was not an ankle specialist I went to just a general OS (not sure if that matters). Anyway, any advice or encouragement or otherwise would be greatly appreciated.

Thanks for your time.

Ashley

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7 Replies

  • Posted

    Hmm. I'd get another opinion. I had a straight snapped Fibula, didn't heal =bone graft and plates. I know of someone who was in a motorcycle accident and smashed his ankle. 18 months later, day I had my survey, they opened him up to vacuum up ( not right words) , shards of random slithers etc of bone.

    Surgery may be possible. Insist on getting your x-rays. You may have to pay. Its your leg!

    Sounds painful.

    Good Luck

    @(*+*)@

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  • Posted

    If u have no pain or swelling I would listen to the specialist and begin PT.  My X-rays also did not show healing.  Was told by 2 different dr that X-rays don't always show the healing that is going on.  PT essential to get mobility back.  

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  • Posted

    sometimes bones can take a very long time. i broke my ankle and was told "it's ok you just have to wait". if there is nothing wrong they usually say to wait 6 months before a bone graft.

    in the x-rays isn't easy to see the precise status, maybe you should ask for a scan.

    yes weight bearing can stimulate the bone but only if it doesn't hurt

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  • Posted

    Do you have any update to your ankle condition? I was diagnosed with a similar injury and I'm weighing my options. Did you have surgery to remove the bone, or is it still in your ankle?

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  • Posted

    Rest assured that the chip of bone is NOT 'floating' around in your foot. It is well attached to the ligaments that holds your ankle bones together. As it is so small, surgery is not feasible to replace the chip to its original position. Most of the time, the chip will move back to its original position and knit back together. Sometimes this doesn't happen, and and it stays knitted to the ligaments. Again, sometimes this may cause problems. At this stage, physiology might be beneficial.

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  • Posted

    They can leave the fragment in but you shouldn't!! I am 36 now with arthritis is five different spots in my ankle I have a hard time walking and when I do walk there is just consistent pain I haven't been able to run in 10 years I haven't surfed in almost 3 years. My original injury happened when I was 24 in the USMC we were training had a pack that weight between 130-140 lbs twisted my ankle thought nothing of it figured just a sprain year goes by still not getting better then I see an ortho doctor I end up getting brostrum(ligament ) surgery . 6 months later still not getting better saw a different doctor he said that my surgery I just had brought my bones closer together and now there rubbing. I got a medical separation in 2007 my ankle still not healed. Go to veteran affairs for 8 years nothing still don't know why my ankle is sore and now my ankle locks up literally locks I can't move it I have to twist and turn it to unlock it. In 2015 I requested to see a different doctor outside the VA  got an MRI done and he said I have OCD my ankle is deteriorating and I asked him why my ankle locks up he said I have a 10mm broken bone fragment moving around lodging between my other bones creating a wedge. So if they (your doctors) know you have loose bone tell them take it out before It causes more damage!!! Request an MRI to get a better picture of what's going on in your ankle and lastly if your doctors tell your it looks normal but you know it isn't find a new doctor every doctor I see has there own opinion find the doctor that you think can help I'm still looking 

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