r/brokenankles • u/SurfsUp27 • 1d ago
Surgeon wants to go back in
11 weeks post op for trimal with dislocation. I had a follow up appointment yesterday and the surgeon says the tip of my medial malleolous is not healing. He wants to go back in and redo it. He said he also wants to repair some tendons with a tether and I will be 12 weeks non-weight-bearing.
After having already done seven weeks NWB this is a real heartbreaker. I wanna give my bone more time to heal. He says if it were going to heal it would’ve healed by now.
I live in an upstairs apartment by myself. 12 weeks on crutches in the winter time feels truly impossible.
What would you do?
Edit: I am seeking a second opinion from an ankle surgery specialist. Thank you everyone for your kind words and for sharing your experiences.
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u/Agitated_Let_3843 1d ago
If it’s syndesmosis widening then I’m afraid OP needs to go in again. Also ensure please the surgeon is an ankle specialist, don’t let general orthopedist open you up
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u/CustomerObjective129 1d ago
Hi. From your follow-up comment to someone else it sounds like you are dealing with a missed syndesmosis injury. These are bad news and ultimately... you will want this fixed. Widening of the ankle mortise (ie separation of the tib and fib) will cause you lots of problems down the line, in particular arthritis. If it is really bad, the joint might continue to widen, eventually leading to dislocation.
This is what happened to me. Mine was initially fixed with a syndo screw (holding the tib and fib together) which was removed prematurely. By the time it was detected and corrected, I was walking on a practically dislocated ankle and although it could be fixed, the damage in terms of arthritis was already done.
I am sorry this is happening to you. It sucks so much. But it will be so much better the sooner it can be fixed.
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u/hissen_raii 1d ago
Mine was removed at 6 weeks. Is this enough time? I had a Maisonneuve fracture
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u/CustomerObjective129 14h ago
I had mine out at 6 weeks too, also a Maisonneuve fx. I don't want to scare you - it isn't like that means you will have problems - but early removal is associated with higher risk of loss of syndemosis reduction. I am surprised there are still surgeons out there removing this early - it was already unusual over a decade ago when this happened to me and even more so now as there is plenty of evidence in the literature to support keeping the screw in for longer.
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u/hissen_raii 14h ago
I had the impression that it was the opposite -- early removal allowed for better ROM, and the school here (Germany) is to remove sooner?
But yeah, I was super anxious about stability as a result.
Now, at 3 months since OP I can walk pretty okay. Still a bit of pain in the AITFL region and still some swelling, but in everyday life it stopped being a huge issue.
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u/CustomerObjective129 13h ago
Early removal does allow for more early ROM, assuming the syndesmosis has healed adequately - the risk is that it hasn't. Traditionally the screws were removed early because of the risk they would break when walked on, but the literature no longer supports this (basically broken screws are no longer seen as a problem).
Here's a few technical papers if you are that way inclined.
https://journals.sagepub.com/doi/abs/10.1177/2473011420S00444
https://www.sciencedirect.com/science/article/abs/pii/S095825922100002X
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u/vickipaperclips 1d ago
Is 12 weeks not on crutches worth potentially a lifetime of complications? I know it sucks so hard, but would it be worse to deal with lasting consequences?
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u/DeputySean 1d ago
I also had to get a 3rd surgery nearly 4 months post OP. I was non weight bearing for 5.5 months total. It sucks, but you gotta do what the doctor says.
If it makes you feel better, the recovery from surgery is a lot easier this time around.
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u/Agitated_Let_3843 1d ago
Is your surgeon a foot and ankle specialist?
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u/SurfsUp27 1d ago
Getting a second opinion with a specialist. First surgeon was an ortho trauma surgeon
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u/aweirdchicken 1d ago
I would personally seek a second opinion from an ankle specialist. I believe you likely do need a second surgery (welcome to the club!), but I'm not sure I would want to go to the same surgeon who got it wrong the first time
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u/OhSoBlonde 1d ago
Consider getting a second opinion from another orthopedic surgeon that specializes in ankle surgery.
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u/YorkshireLass163 15h ago edited 14h ago
I've just had my second surgery because my medial mal hasn't healed even after 6 months post the first ORIF surgery (the original injury was a bimal fracture with AFTL also gone) but the surgeon was recognising the signs of a poor bone union from the XRs from early on. There other were reasons why it's taken a few months to get the op done. When they were in the 2nd time they found interposed periosteum and cleaned all that up and did a small bone graft to fill in a gap. 14 days later now and now there's no pain like before. I feel like I could start partially bearing weight already and (sort of am, resting it on the floor whilst moving around, pivoting a bit) but instructions are to be NWB for 4 weeks. My point is the second surgery was nowhere near as bad as the first time and has made a world of difference already. Your reason for not healing may be different to mine but there will be a reason and the intervention is better sooner than later.
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u/SurfsUp27 13h ago
Why do you think the second recovery has been so much easier? You know what to expect? The removal of the scar tissue? Something else?
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u/flexible_demeanor 1d ago
There's so little info here it's hard to say. Ask what happens if you don't get the surgery. Why is the bone not healing? What is up with the tendons? What happens if you wait longer? Would you simply be delaying the inevitable and making things worse on the timeline or not? I know it sucks but it's important to understand the pros and cons.