Broken ankle not healing

by Carrie
(Springfield MO)

I fell at the beginning of December 2015 as I was getting out of a booth with a step down I didn't see. I heard the pop and crack and was in immediate pain. Very minor bruising, but lots of swelling and pain radiating up my leg. X-ray showed the ankle fracture so I was put in an aircast and have kept my aircast on except to take a bath. Fast forward for now March 2016 still in pain, still have minor swelling, and still have this aircast. I'm due for an MRI to check everything out but the doctor says it just isn't healing. He's already thrown out the idea its possible for me to be in this for two more months. What am I doing wrong? Is this normal? Why am I not healing? Should I get a second opinion? I'm an avid runner, swimmer, and workout junkie. I've gained weight and I'm generally starting to feel depressed. Is there anything else that I should be doing?

RESPONSE

Hi Carrie,

The two things I would be curious to know is 1. how bad is the fracture and 2. how old are you?

Because you are so athletic I am going to go out on a limb and suppose that you are under 50 years of age. Age, particularly in a women is of importance when it comes to fractures simply because the issue of osteoporosis (demineralization of bone) comes into play in regards to your healing capabilities. If a bone is demineralized it will not heal in a normal time line.

Because you are so active, I will also assume you are not a smoker as that too will affect healing time.

Lastly, it comes down to the degree of fracture, in other words, how big is the "crack". Many ankle fractures are surgically repaired immediately, while some, if in the opinion of your doctor, are not that severe, can heal via immobilization. When I think of Aircast, I think of essentially an ankle brace. I am hoping when you refer to Aircast you mean a boot encompassing your foot and lower leg.

Additionally, you do not mention if you have been weightbearing or not during this period of time.

So, right now you are roughly three months post trauma and under ideal conditions you should have been healed and of course you are not as verified by your doctor.

It now becomes a question of whether there is any healing going on, or your fracture essentially looks the same today as it did three months ago on x-ray.

If the recent x-ray does show signs of healing but not quite "done" then you should probably stay the course, assuming your ankle is being properly immobilized.

The only suggestion I would make is to consider the use of a bone stimulator. This is an ultrasound device that you wear and use for a limited time during the day to "stimulate" the fracture to heal.

Bone stimulators can be very effective in moving along slow healing bone. This is something you should speak to your doctor about.

If the bone has shown absolutely no sign of repair then there is more cause for concern. Although a bone stimulator could also be tried in this scenario, the chances of success become diminished and your concern then should be of what we call a non-union, where the fracture site never actually heals.

Since I am answering your question from the other side of the internet and do not have the luxury of seeing your x-rays, if you have any concerns about your doctor's ability to treat this problem going forward, then a second opinion from a local doctor, would certainly be a good idea.

Marc Mitnick DPM
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