Do I really need ORIF Surgery?

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Hello. I fractured my ankle the day after Christmas in Cambodia. Originally, it was a lateral malleolus fibula fracture, non-displaced. I flew to Taiwan (I have family here) right after, and saw a Taiwan doctor. He gave me a short air cast. I had my second followup with him, and now he said that my fracture is now displaced (3 weeks after the incident), and there is a gap from my heel bone and foot bone, and he is recommending ORIF surgery.

I'm terrified of surgery. How could it have gotten worse? I am flying back to the states and seeing a US orthopedic on Tuesday. My ankle looks normal, and it hasn't hurt in the past week. I've been non-weight bearing. I am currently wearing a tall walking boot, and I have my foot bound inside the boot.

Is it necessary to have the ORIF surgery? I've read that there can be a lot of complications from the surgery. On the tradeoff, if I do not get the surgery, I might develop early arthritis. Does ORIF surgery ensure that we won't develop arthritis? Is there any alternatives? 

Thank you. 

 

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  • Posted

    Hi, sorry to hear about your accident!

    If the doctor (and orthopaedic surgeon on Tuesday) recommends ORIF I would go for it. I asked about nonsurgical options for mine in November and he said any 'unstable' fractures would need ORIF, and if it wasn't necessary they wouldn't perform it. I was told before mine that it probably would heal without ORIF (due to me only being 30), but it would be more prone to breaking again, it would mean longer healing times and being non-weight bearing, and just wouldn't be as secure.

    I read a study recently where surgeons are even suggesting that patients can walk on their ankles sooner after ORIF, as in 2 weeks rather than 6-8, as the surgery is so effective.

    I had a trimalleolar fracture, but surgery was complication free and now within 11 weeks I am walking again. Surgery might be scary but the care and follow ups we receive afterwards are brilliant and if you'd feel more comfortable having the plates/screws out after the bones have healed you can do.

    Good luck in your recovery!

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  • Posted

    Christina I am sorry about the break!  It is such a fast and frustrating accident!  I had a spiral fracture on my fibula on November 20 and surgery on the 22nd.  I was really hoping to not have surgery too, I did not understand why a broken bone would not heal in a cast.  My surgeon explained that it might, but because of where the break was, it may not be in perfect alignment and I would very probably get ankle arthritis later. The plate and screws would ensure proper alignment and stabilize the area while the bones did their thing.  I will not lie, it was not fun.  My surgeon was conservative and he said in some countries people will walk in a boot after a couple of weeks, but here is my timeline:

    -Surgery- managed pain for a couple of days with T3's.  Hate them so switched to Ibuprofen for days 3-6 and pretty much was able to stop then.  Had a plate and 6 screws.

    -After 2 weeks plaster cast off and staples out.

    -Boot for 4 weeks with compression sock.  Did not like it much- for the first two weeks it rubbed on my incision and I could feel the plate.  So I would loosen it or take it off once I got where I was going.  I asked my surgeon if I had to sleep in it and he said no- my plate and screws were keeping the ankle aligned, the boot was for protection so if I felt safe (no dog jumping on bed etc). I could ditch the boot at night.

    -4 week x-ray looked great so now one week walking in boot.  Some stiffness and achiness and swellling, but not bad and I could work.  I would go home to elevate.  I started physio so have exercises to loosen and strengthen things again.

    -In week 8 now and pretty much normal again!  I have no boot, I can wear my Skechers and Nikes (no regular boots yet- still a little swollen), but yesterday I took the stairs at work almost normally and got to the bottom and went Wow!  I think I am fixed!!!

    So- it is a long haul and super hard to lie on the couch for 6-12 weeks, depending on your surgery and recovery, but maybe necessary to get fixed.  I used crutches and rented a knee scooter to get around.  The Scooter is fun!  My kids liked it.  You have to accept lots of help.  You can binge watch Netflix and catch up on your reading.  Invite friends for tea.  And amazingly you will be upright again with more empathy than before and be eager and ready to help out others who need it!!!!

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  • Posted

    Hi Nat2908 and erind,

    Thank you both for your kind words and encouragement. It's helpful to hear the recovery timeline! It sounds like the worst part is the first week (in regards to pain management), and it gets progressively easier after the second week. I have been in a walking boot for the past three weeks-more or less used to them. It will be nice not to have to sleep in them though. And it sounds like, if all goes well, the healing will take approx. 2 months. Did you have to buy shower chairs?

    Thank you again!

     

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  • Posted

    Shower chairs and a knee scooter are helpful, I tended to struggle on sticking my leg out of the shower which was awkward! I would buy the cast cover and a waterproof chair if it happened again.

    The pain is bad for the first few weeks, in particular when sleeping (my bad leg used to jerk out when falling asleep and cause so much pain!) and the burning sensation when standing up, but now I think it's just the stiffness of the foot that hurts and not the actual fractures.

    Today is my first day at work that I've left my crutches at home, and although I've brought the boot with me I haven't needed it yet. It's been less than 3 months and I'm amazed at the human body's ability to heal itself, especially with my 3 breaks and surgery! At times you just think that you'll never walk again and you get so depressed, but there really is light at the end of the tunnel.

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  • Posted

    Yes. I think I'm feeling a lot of...anger, or what ifs. sad I thought I was healing so well for three weeks, and I may have to go through the entire process again. I am feeling a little discouraged and disappointed in my body and my progress (or lack thereof). I was doing really well and feeling a lot better until my most recent doctor's appointment. Now it does sort of feel like it'll take a while to heal. Hopefully, I can heal and walk by 2 months post surgery if required. Thank you!

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    • Posted

      The reason there are so many ORIF surgeries is probably exactly because of your kind of break so do not "what if!"  You helped me because I would love to have avoided a surgery and my "what if" is would it have healed fine in just a cast.  Your experience and others that I have heard tell me that the surgeons do know what is best and I guess some breaks simply need the extra help.  So don't blame your body!  How did you break your ankle?  I am curious.  It was bad enough for me in my own town, I can just imagine the extra hassle if I was travelling!!!

      I did not get a shower chair.  I bathed a lot and had my foot up on the edge of the tub in a plastic bag.  When I showered, I sat on a sturdy stool that I had anyway.  It did make me nervous- I moved super slowly and put towels down everywhere to avoid even a hint of slipping!!!!  In hindsight I think a shower chair is a great idea.

      I highly recommend a scooter!  I returned my crutches and scooter yesterday.  In week 9 now and so happy to be upright.  Still have quite a thick ankle, I am elevating it now after working all day, but it really is doing well.  The only pain I feel is along my incision- where the screws are is tender and I cannot wear my normal boots yet.  I hope that improves, it seems like a long time for it to still hurt.  My surgeon does not like to remove the hardware unless it is really uncomfortable and if that is the case, he does it after one year.  I am not sure- I may need to go that route.

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    • Posted

      Hi erind,

      Thanks for your note! I broke my ankle on a family vacation in Cambodia. We were bike riding in Angkor Wat, and I biked over a hidden tree root, fell, and caught my ankle in the bike. 

      Yes-I think surgery might be the best option. I hope four weeks later wouldn't add any new complications.

      Thanks for your note!

      Christina

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    • Posted

      Thanks Christina,

      Yes I could see how a bike riding fall could happen.  Yikes.  One more thing to fear!  I have become weirdly interested in people's stories!  It seems falls are the most common- on ice, curbs and stairs.  I was running late for an appointment and had to cross a train track and slipped on a wet wood board.   Now I move slowly and am nervous to do anything that could cause another break, such as skiing!  Hopefully my fears go away as I heal and feel stronger!

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  • Posted

    Hello Christina,

    I understand your consternation about the prospects of surgery.

    Yes, surgery is sometimes required, but it always involves risks as you are well aware. There is always the chance a surgery will be bungled, or that infection or nerve damage may follow. And then, if there is excruciating pain post-surgery any powerful pain killers prescribed may bring their own miserable side effects.

    Naturally, surgical procedures are an additional trauma in themselves, and can be expected to delay full recovery from ankle injury as compared to non-surgical cases. Tissue scarring can contribute to slower recoveries as well.

    Finally, their is a risk, however small, that surgery will not lead to a happy long-term successful recovery.

    In my personal case (a medial bimalleolar fracture of right ankle), my orthopedist declared the break was displaced slightly more than their tolerances. He suggested that without surgery future ankle arthritis was possible. However, he was willing to work with me on a 'wait and see' approach- deferring surgery and waiting to see how the displacement healed (meanwhile I was non-weight bearing and in a CAM boot).

    X-rays by week 4 or 5 showed that fracture had healed amazingly well and displacement was no longer noticeable. Of course I was fortunate to dodge surgery but behind the scenes I really did everything I could to help things along, including a diet enriched for bone healing, and use of a PEMF device useful for orthopedic injuries.

    Remember, if you have any doubts whatsoever about need for surgery you are entitled to get a second opinion, preferably by an orthopedist who would not be your personal surgeon.

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