When is the ideal time to do surgery of a broken outer ankle bone?
Patient's Query
Hello doctor,
I broke my outer ankle bone. The first X-ray was taken when I first had the accident, and the second X-ray was taken eight days after casting. I consulted three bone and joint specialized hospitals, but two doctors advised surgery, and the other one said that it could be preserved.
I want to know if I should get myself re-examined and take an MRI to see if the ankle ligaments are torn or not. Should I continue waiting until the cast is removed and check again later? If I have to continue with the cast but if my ankle is still too loose, can I have surgery later or have I passed the golden period for surgery? Can a grade 3 ligament tear heal on its own? Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I have seen both of your X-rays. The first one shows clear-cut subluxation of the ankle joint with fracture. The second one shows a good reduction. Now there are two points:
- Since there is subluxation, it goes without saying that the ligaments are torn.
- The reduction is good but, I do not know if it is stable or not. This can only be assessed during reduction. Therefore, the doctor who has reduced might be the best to comment on the stability. If it is unstable, then it has to be operated without any doubt.
In my opinion, you can keep the cast for six to eight weeks, remove it, and then check for stability. You may require ligament reconstruction later on.
I hope this helps.
Do revert in case of any further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have shared the images of my ankle after eight days of plaster cast (I changed to a fiberglass cast). Can you diagnose the level of the torn ligament?Will there be any difference if I get surgery sooner or later in case it is not stable? Kindly let me know.
Hi,
Welcome back to icliniq.com.
The actual condition of the ligament can only be assessed with the help of an MRI (magnetic resonance imaging). However, in such cases, the ligaments to get torn are the deltoid and talofibular ligaments. If your ankle is unstable, then early surgery has a better prognosis.
I hope this helps.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I have a final question to make a decision. Should I take an MRI test now to decide how damaged the ligament is to get surgery or continue to wait for a few more weeks with the conservative therapy and then make a decision? Which is better? Kindly suggest.
Hello,
Welcome back to icliniq.com.
Glad to have you back.
As I have suggested to you earlier, you should continue with the cast. In my practice, I have seen patients not requiring surgery later on as sometimes ligaments heal with time. You should decide to get an MRI if there are signs of instability after eight weeks of having the cast.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Do you have any tips that can aid in healing like food or exercise? Can you please suggest any exercises to practice after cast removal?
Hello,
Welcome back to icliniq.com.
I think active plantar flexion and dorsiflexion are the only exercises that you can do after removing the cast. You will have a lot of stiffness after cast removal. Right now, there is no exercise as you need strict immobilization of the ankle.
I wish you good health.
Do revert in case of any further queries.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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